Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation.

Autor:	Qurashi I; High Secure Services, Ashworth High Secure Hospital, UK., Stephenson P; High Secure Services, Ashworth High Secure Hospital, UK., Nagaraj C; Low Secure Servies Hollins Park Hospital, UK., Chu S; Department of Psychology, University of Central Lancashire, UK., Drake R; Division of Psychology and Mental Health, University of Manchester, UK., Couchman L; Therapeutic Drug Monitoring, Analytical Services International, UK., Flanagan R; Toxicology, King's College Hospital NHS Foundation Trust, UK.
Jazyk:	angličtina
Zdroj:	BJPsych bulletin [BJPsych Bull] 2019 Dec; Vol. 43 (6), pp. 271-274.
DOI:	10.1192/bjb.2019.50
Abstrakt:	Aims and Method: To investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013. Results: Thirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers. Clinical Implications: Approximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking after transfer. Monitoring of clozapine serum levels and assessment of mental state in the immediate period after a change in smoking status is indicated.
Databáze:	MEDLINE
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