Benzos and COVID-19?

Benzos don't cause respiratory depression in therapeutic doses or overdose, unless taken w/ CNS depressants

Data on benzos on people w/ comorbid respiratory conditions like pneumonia, COPD are conflicting

#psychiatryofpandemics

Acute use of benzos, unlikely to cause respi depression

Chronic use - increased risk of pneumonia (sedation --> aspiration pneumonia, etc.). Not big risk but understandable concern

Pragmatic: Avoid benzos if possible, choose short-acting , lowest dose, shortest time

Vitamin D and COVID-19!

Treating vit D deficiency to decrease respiratory disease: NNT = 3, drops to NNT = 8 in severe deficiency.

High levels of vitamin D associated to lowest severity of respiratory infection, now including COVID-19 (Indonesian study). #psychiatryofpandemics

Recommendation: give vitamin D supplementation to all patients with psychosis

#psychiatryofpandemics

Lithium!

Exclusively renal secretion. In AKI sudden increase in Li levels. CKD assoc. with poorer outcomes in COVID-19

Those with COVID - 2 risks: AKI leads to acute Li toxicity, and chronic lithium use can increase risk of CKD (poorer COVID-19 outcomes)

#psychiatryofpandemics

Do ***NOT*** stop lithium suddenly!!! Educate people taking lithium about signs of toxicity #psychiatryofpandemics

Don't use medications in delirium

Save for last line for targetted symptoms (if really needed, antipsychotics preferred)
#psychiatryofpandemics

Clozapine and COVID-19

Key message: Make every effort to keep them on clozapine. It is a uniquely effective drug, and stopping is likely to lead to relapse.

#psychiatryofpandemics

Clozapine itself doesn't put you at risk of COVID-19

It's the person's cardiovascular comorbidities and metabolic syndrome from the drug that puts them at risk

+risk of superimposed pneumonia from clozapine #psychiatryofpandemics

Clozapine and COVID-19:

Treat comorbidities and side effects as much as possible
Hypersalivation
Pneumococcal, flu shots
Address Vitamin D deficiency

#psychiatryofpandemics

Clozapine and COVID-19

ANC monitoring (ah hello, old friend). Focus on NOT total WBC, but neutropenia.

>80% of aranulocytosis occurs in 1st 18 weeks, After that, risks comparable to other antipsychotics

#psychiatryofpandemics

People with respiratory illness on Clozapine: plasma levels can rise due to reduced CYP1A2 induction
-unable to inhale cigarette smoke/stop smoking
-changes in CYP1A2 levels

#psychiatryofpandemics

Continue Clozapine
Pay attention to neutrophils
Check plasma levels
Monitor other side effects

#psychiatryofpandemics

Depot medication (long-acting injectables) and COVID-19

To reduce no. of depot admins without reducing efficacy of regimen, remmeber basic depot kinetics

Longer dosing interval can be compensated by ensuring overall dose is same. BUT don't stop reviewing #psychiatryofpandemics

What does the psych- in psychopharmacology mean?

Soul. The pharmacology of the soul. You are a soul chemist (if you believe the soul resides in the brain)

I LOVE THIS #psychiatryofpandemics