Wednesday, 5 October 2016

Kathlyn Ronaldson on reducing the burden of adverse effects from antipsychotics

SPHPM Adjunct Senior Research Fellow Dr Kathlyn Ronaldson recently co-authored a book that will serve as a valuable resource for psychiatrists and help promote the safe use of antipsychotic medication.

As well as teaching commitments in undergraduate pharmacology and therapeutics and disease prevention, Kathlyn is an experienced pharmaco-epidemiologist who recently completed a case-control study of clozapine and myocarditis. She gladly accepted the invitation to contribute a chapter to the book entitled, Life-threatening effects of antipsychotic drugs.

“I thought the book was an excellent idea, as the intention was to include the latest information on incidence, risk factors, mechanism, differential diagnosis, treatment and prevention. The book was designed to assist psychiatrists to diagnose these life-threatening effects early, treat them effectively and, if possible, prevent them occurring,” Kathlyn said.

In one chapter she discussed how myocarditis (inflammation of the myocardium, the middle layer of the heart wall) can occur in response to clozapine, but can be difficult to distinguish from other more common conditions. In the chapter, she developed a useful flow chart tool for differentiation of myocarditis from pneumonia, pulmonary embolism, coronary artery disease and neuroleptic malignant syndrome.

After submitting her chapter on myocarditis and cardiomyopathy, Kathlyn was invited to be a co-editor and to write two more chapters on other adverse effects including heat stroke, rhabdomyolysis, interstitial lung disease and interstitial nephritis; as well as contributing to chapters on pancreatitis and gastrointestinal effects.

The authors hope that the book will help promote safer use of antipsychotic medication by those who need it. Clozapine, an antipsychotic medication used to treat schizophrenia which has failed to respond to other medication carries a number of life-threatening effects including intestinal obstruction, agranulocytosis and myocarditis. Despite these effects, mortality is reduced in psychiatric patients taking clozapine. A chapter in the book emphases this fact.

“While review articles can be helpful, having a single volume to put on the shelf with advice on a wide range of life-threatening effects will be a valuable resource for psychiatrists. The book will also be useful to pathologists faced with diagnosing a cause of death in a psychiatric patient, who dies suddenly without predetermined life-threatening condition,” Kathlyn said.

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