The Effects of Co-prescription of Pantoprazole on the Clozapine Metabolism.

BACKGROUND: Polypharmacy including somatic medications such as proton pump inhibitors is a common phenomenon in psychiatric care. The aim of this study was to evaluate the pantoprazole effects on clozapine metabolism. METHODS: A large therapeutic drug-monitoring database containing plasma concentrations of CLZ was analyzed. The results were stratified into four groups: a non-smoking (n=250) and a smoking group (n=326), and two groups co-medicated with pantoprazole: non-smokers (n=26) and smokers (n=29). The analysis was based on the non-parametrical Mann-Whitney U test (M-W-U) with a significance level of 0.05. RESULTS: Differences reached statistical significance for pharmacokinetic parameters between CLZ monotherapy and co-medication with pantoprazole neither in smokers nor in non-smokers (p>0.05 for M-W-U in pairwise comparisons). In patients with clozapine monotherapy, smokers had a higher daily dosage of CLZ compared to non-smokers (mean dosage 363±181 vs. 291±145 mg/day, p<0.001 for M-W-U). CONCLUSIONS: Adding pantoprazole to an ongoing treatment with clozapine does not alter the metabolism of clozapine to a significant extent.

Cannabis use among a sample of 16 to 18 year-old students in Switzerland.

BACKGROUND: The aim of this study was to estimate the prevalence of cannabis use among Swiss students and to assess their attitudes regarding health and safety issues associated with drug use. SUBJECTS AND METHODS: After a workshop, 173 students (23.1% male, 75.7% female; 44.4% age 16, 43.8% age 17 and 11.8% age 18) from a Swiss school were surveyed by questionnaire. RESULTS: 59.3% (n=103) of all participants had tried cannabis, and 30.1% of those who reported cannabis use had consumed more than 100 joints. Of those 103 students with cannabis experience, 6.8% rated the risk of cannabis-related psychic effects as low, and 9.8% were not concerned about driving under the influence of cannabis. In cases of heavy cannabis use, the chance of increased tobacco, alcohol or other drug use is higher than for those with less or no cannabis use at all (odds ratios of 4.33-10.86). CONCLUSIONS: This paper deals primarily with cannabis prevalence data in adolescents from previous studies and sources, and shows that our findings deviate significantly - and surprisingly - from past research. Our data from a school survey indicates higher cannabis use than data from official drug policy studies. Additionally, our data shows that the students' self-reported attitudes towards health and safety issues were mostly realistic. The examination of methodological issues that might impact prevalence estimates should be added to the cannabis literature.

Psychosocial situation of living donors: moods, complaints, and self-image before and after liver transplantation.

BACKGROUND: Living donor liver transplantation (LDLT) has developed into an established therapy for terminal liver diseases. There is, however, little knowledge of the psychosocial situation of living donors. The aim of this study was to investigate the course of donors' moods, physical complaints, and self-image in the preoperative decision process and six months after surgery. MATERIAL/METHODS: Fifty-two potential donors were evaluated at the Charité Berlin. On the basis of the clinical interview, seven (13%) potential donors were not recommended for LDLT for psychosocial reasons. Twenty-six donors underwent liver resection and were re-evaluated six months after surgery. Donors' moods were investigated with the Berlin Mood Questionnaire (BMQ) and their physical complaints were assessed by the Giessen Complaint Questionnaire (GCQ). The Narcissism Inventory (NI-90) was used to assess their self-image. RESULTS: Potential donors who were not recommended for surgery showed significantly higher values for negative moods, physical complaints, and 'narcissistic rage". After surgery, donors' self-images were generally stabilized. Nevertheless, five donors (19%) showed high values for "threatened self" before and after transplantation, as well as high values for negative moods and complaints after LDLT. CONCLUSIONS: The resection of the right hepatic lobe holds promise of a good psychosocial outcome, with stable self-image and self-esteem for most donors. A minority of donors exhibited enhanced perception of distress and low self-esteem before and after surgery, which can easily be overlooked in the preoperative evaluation. A psychometric assessment of self-image before transplantation should be added to the clinical interview evaluation of potential living donors.