DiPaula Bethany A, Thomas Michele D
Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA.
Pharmacotherapy. 2009 Jul;29(7):852-7. doi: 10.1592/phco.29.7.852.
Varenicline is a novel treatment for smoking cessation; however, the agent has not been well studied in a population with severe mental illness. Varenicline can reportedly cause neuropsychiatric adverse effects, some resulting in hospitalizations and/or suicides. We describe a case of clinician-observed, worsening psychotic symptoms in a patient with chronic mental illness who was receiving varenicline. A 45-year-old woman with bipolar disorder, mixed type with psychotic features, was admitted to a psychiatric hospital due to acute decompensation after she discontinued her drug therapy. Because of the facility's smoke-free policy, the patient was not permitted to smoke cigarettes during her hospitalization. Over the next several weeks, her condition was stabilized with psychotropic drugs. Her symptoms improved, and plans were made for her discharge. Varenicline was prescribed to manage her nicotine cravings. After 2 days of treatment, staff members noted worsening of the patient's psychotic symptoms and agitation. Varenicline was discontinued, the patient's mental status returned to baseline, and she was subsequently discharged. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 7) between the patient's worsening psychosis and her varenicline therapy. This case report provides valuable support of previously published cases that demonstrate the risk of exacerbation of psychotic symptoms with varenicline use in patients with severe mental illness. With proper assessment and management of varenicline-induced neuropsychiatric effects, health care professionals can provide an important role in helping to prevent and manage worsening psychiatric symptoms.
伐尼克兰是一种用于戒烟的新型治疗药物；然而，该药物在患有严重精神疾病的人群中尚未得到充分研究。据报道，伐尼克兰可引起神经精神方面的不良反应，有些不良反应会导致住院和/或自杀。我们描述了一例在接受伐尼克兰治疗的慢性精神疾病患者中，临床医生观察到的精神病症状恶化的病例。一名45岁患有双相情感障碍、混合型伴精神病性特征的女性，在停止药物治疗后因急性失代偿入住精神病院。由于该机构的无烟政策，患者在住院期间不允许吸烟。在接下来的几周里，她的病情通过精神药物得以稳定。她的症状有所改善，并制定了出院计划。开了伐尼克兰来控制她对尼古丁的渴望。治疗2天后，工作人员注意到患者的精神病症状和激越加重。停用伐尼克兰后，患者的精神状态恢复到基线水平，随后出院。使用纳伦霍药物不良反应概率量表表明，患者精神病症状恶化与她使用伐尼克兰治疗之间可能存在关联（评分为7分）。本病例报告为先前发表的病例提供了有价值的支持，这些病例表明在严重精神疾病患者中使用伐尼克兰会有使精神病症状加重的风险。通过对伐尼克兰引起的神经精神效应进行适当评估和管理，医疗保健专业人员在帮助预防和管理精神病症状恶化方面可发挥重要作用。
