COVID-19 inpatients with psychiatric disorders: Real-world clinical recommendations from an expert team in consultation-liaison psychiatry.
J Affect Disord
; 274: 1062-1067, 2020 09 01.
Article
in En
| MEDLINE
| ID: mdl-32663933
ABSTRACT
BACKGROUND:
The management of coronavirus disease 2019 (COVID-19) in patients with comorbid psychiatric disorders poses several challenges, especially regarding drug interactions.METHODS:
We report three representative case-scenarios on patients with psychiatric disorders and COVID-19 to provide a practical approach based on the existing literature and the clinical experience of an expert team in consultation-liaison psychiatry. CASE-CENTEREDRECOMMENDATIONS:
Psychopharmacological ongoing treatments should be prioritized and most doses should be reduced 25-50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion, and methadone. If the psychopharmacological usual doses are in the low-to-median range levels, a dose change during COVID-19 drugs co-administration is not recommended, but only ECG and clinical monitoring of adverse effects and drug levels if required. Furthermore, when introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present. (A) In agitated delirium, olanzapine is recommended as first-line antipsychotic and quetiapine should be avoided. (B) In severe mental illness (SMI), essential treatments should be maintained. (C) In non-SMI with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated.LIMITATIONS:
Most recommendations on pharmacological interactions provide only a limited qualitative approach and quantitative recommendations are lacking.CONCLUSIONS:
Patients with psychiatric disorders and COVID-19 should be managed on a personalized basis considering several clinical criteria and, should not be excluded from receiving COVID-19 treatments. Risks of pharmacological interaction are not absolute and should be contextualized, and most psychopharmacological treatments should include an ECG with special attention to QTc interval.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Referral and Consultation
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Coronavirus Infections
/
Betacoronavirus
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Inpatients
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Mental Disorders
Type of study:
Diagnostic_studies
/
Guideline
/
Prognostic_studies
/
Qualitative_research
Limits:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
J Affect Disord
Year:
2020
Document type:
Article