Bupropion With Clozapine: Case Reports of Seizure After Coadministration.

BACKGROUND: Clozapine is more effective than other atypical antipsychotics for treatment resistant schizophrenia, but has serious side effects. Clozapine has an estimated cumulative seizure risk of 10% in patients treated for 3.8 years. Bupropion can also induce seizures and its estimated risk is 0.4% at recommended doses. While some risk factors for seizures are known, much remains unknown about predicting seizure risk. Cases: We present 2 cases of seizures in patients treated with clozapine and bupropion without a seizure history. In the first case, a patient with schizoaffective disorder treated with dual antipsychotic therapy had a witnessed generalized tonic-clonic seizure. With the exception of bupropion/naltrexone which was started 2.5 months prior for weight loss, she had not had any recent medication changes. In the second case, a patient with schizoaffective disorder was treated with clozapine and was prescribed bupropion SR for smoking cessation for an extended duration. He had cut back on cigarette use in the 2 months prior to reporting "spells." The neurologist's assessment was probable epileptic seizures which resolved after the bupropion was stopped and divalproex was started for seizure prophylaxis. CONCLUSION: Clozapine and bupropion are known to lower the seizure threshold, but little information is available regarding the risk when used in combination. It is unclear whether these agents, when used in combination, have additive seizure risk or possible synergistic effects. Bupropion should be used cautiously in patients treated with clozapine. Safer agents that do not lower the seizure threshold should be utilized whenever possible.

Cardiometabolic management in severe mental illness requiring an atypical antipsychotic.

INTRODUCTION: Cardiometabolic management was evaluated in patients with diabetes and a severe mental illness that require treatment with an atypical antipsychotic. METHODS: Seventy-four patients with diabetes and a severe mental illness treated with an atypical antipsychotic from the Fargo Veterans' Affairs Health Care System were included in this retrospective study. Primary end points analyzed the change in hemoglobin A1c (Hgb A1c), blood pressure, and low-density lipoprotein (LDL) cholesterol 12 months prior to and 12 months following the initiation of an atypical antipsychotic. Secondary end points evaluated changes specific to clozapine and olanzapine. Additional secondary end points evaluated the medication management for cardiometabolic disease prior to and following atypical antipsychotic initiation. RESULTS: In the 12 months following atypical antipsychotic initiation, there were no statistically significant changes in metabolic parameters. Mean Hgb A1c increased from 6.9% to 7.2% (P = .47), mean systolic blood pressure decreased slightly from 132 to 127.8 mm Hg (P = .97), mean diastolic blood pressure decreased slightly from 79.6 to 76.6 mm Hg (P = .19), and mean LDL remained unchanged at 104.4 mg/dL (P = .92). Medications to control cardiometabolic disease increased substantially following atypical antipsychotic initiation; 35.1%, 39.2%, and 39.2% of patients were started on one or more new antihyperglycemics, antihypertensives, and statins, respectively. DISCUSSION: Patients had a significant increase in prescriptions to manage cardiometabolic disease in the 12 months following initiation of an atypical antipsychotic. Although medications to manage cardiometabolic disease increased, the actual metabolic parameters did not significantly change during the same time period.

Benzodiazepine use, misuse, and abuse: A review.

Benzodiazepine (BZD) abuse has reached epidemic levels and results in poor outcomes, particularly when combined with concomitant central nervous system depressants. BZDs are abused most commonly in combination with opioids and alcohol. Emergency department visits and related deaths have soared in recent years. In the absence of other medications or illicit substances, BZDs are rarely the sole cause of death. Prescription drug abuse has received more attention in recent years, yet much remains unknown about BZD abuse. BZDs have low abuse potential in most of the general population. A subset is at elevated risk of abuse, especially those with a history of a substance use disorder. Education, prevention, and identification are vital in reducing BZD abuse.

Changing the conversation about hunger: the process of developing Freshplace.

BACKGROUND: Despite public and private food assistance programs, food insecurity and hunger are persistent public health problems. Freshplace is an innovative food pantry collaborative whose goal is to build long-term food security and self-sufficiency among residents of the North End of Hartford, Connecticut. Freshplace was founded by Foodshare (FS), the Chrysalis Center (CC), Inc., and the Junior League of Hartford (JLH), Inc., who then partnered with the University of Connecticut to design and evaluate the program. OBJECTIVES: This article describes the community-based participatory research process involved with developing and evaluating Freshplace. METHODS: We are conducting a randomized, controlled study to compare 100 Freshplace members with 100 people who receive food from traditional food pantries. Main outcome measures include food security, self-sufficiency, and diet quality. Change scores are compared from baseline to 3 months using independent t tests. RESULTS: Freshplace opened in July 2010. We have recruited 233 people to participate in the study. Over 3 months, Freshplace members had larger change scores than the comparison group in food security scores (1.6 vs. 0.7 points; p < .01), and fruit and vegetable intake (1.9 vs. -1.4 points; p < .01). CONCLUSIONS: Freshplace is a successful, community- university partnership bringing together three community agencies and a state university. This is the first food pantry intervention to be evaluated, and preliminary results are promising.