The majority of research on reactions to smoking bans in psychiatric facilities focuses on staff feedback in acute inpatient settings. The purpose of this pilot study was to assess inpatient attitudes about a complete smoking ban in an intermediate to long-term psychiatric facility. One hundred inpatients were surveyed via questionnaire. Inpatients reported changes in smoking and improvements in health as a result of the ban, despite evidence of non-compliant smoking at the facility. There was evidence that inpatients perceived others' attitudes about the ban to be worse than reality. The findings from this pilot study suggest that consequences of smoking bans in psychiatric facilities are not as negative as some perceive. Smoking bans in intermediate to long-term settings may result in improvements in health among both smoking and non-smoking patients.
Analysis demonstrated no change in psychiatric symptomatology or cardiometabolic factors 1 year post-smoking cessation in individuals with schizophrenia taking clozapine, olanzapine, or both. Further investigation is needed before concluding that smoking cessation has no impact on symptoms or on cardiometabolic risk factors. Despite a slight but statistically significant worsening in GAF scores, the health benefits of smoking cessation should continue to form the basis of encouraging smoking cessation in persons with SMI while longer term and methodologically more rigorous assessments on psychiatric and general health status are undertaken.
Autonomic agents, anti-infective agents, and proton pump inhibitors and other gastrointestinal agents were all associated with hematological ADRs when co-prescribed with clozapine. Medications from these classes should be initiated cautiously in patients being treated with clozapine to avoid precipitous drops in ANC or WBC that may increase the risk of agranulocytosis.
The authors describe a rare case of "concealed" congenital Long QT Syndrome (LQTS) Type 3 in a patient with treatment resistant schizophrenia and no known personal or family history of cardiac disease. The patient in this Case Report had a hidden genetic condition revealed only following the essential administration of antipsychotics. As a result, this patient experienced an aborted cardiac arrest and a total of five episodes of ventricular tachycardia (VT) requiring cardioversion. Successful control of the VT occurred with an Automatic Internal Defibrillator (AID), judicious use of antipsychotic medications, and anti-arrhythmic medications. Risk factors for this rare anomaly include history of syncopy, unexplained ventricular arrhythmias, history of sudden cardiac death in a young family member, unusual reaction to initial dosages of medication known to prolong QTc which includes antipsychotics (particularly in combination). The work-up for those with risk factors would be a thorough family history of sudden cardiac death, baseline ECG, electrolytes, cardiology and electrophysiological consultation, and when indicated a genetic analysis for the Long QT Syndrome (LQTS). Monitoring includes ongoing patient assessment for symptoms, ECGs and electrolytes when indicated such as when medication and dosages are adjusted, AID interviewing, and cardiac and electrophysiological follow-up.
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