ABSTRACT Background Chloroquine and hydroxychloroquine are among several experimental treatments being investigated in the urgent response to the COVID-19. With increased use of these medications, physicians need to become knowledgeable of these drugs’ neuropsychiatric side effects and interactions with psychiatric medications. Methods Literature review was performed in PubMed from 1950-2020 regarding psychiatric topics and targeted pharmacological properties of chloroquine and hydroxychloroquine. Review First, chloroquine and hydroxychloroquine may mildly inhibit CYP2D6 metabolism of psychiatric medications, and psychiatric medications that interfere with CYP2D6 or CYP3A4 activity could alter chloroquine and hydroxychloroquine levels. Second, they may prolong the QT interval, warranting caution with concomitant prescription of other QT prolonging agents. Finally, neuropsychiatric side effects are very uncommon but possible, and include a potentially prolonged phenomenon of “psychosis following chloroquine.” Hydroxychloroquine has less information available about its neuropsychiatric side effects than chloroquine, with psychosis literature limited to several case reports. It is not clear whether patients with psychiatric illness are more vulnerable to neuropsychiatric sequela of these medications, however, overdose on these medications by suicidal patients has high risk of mortality. Conclusion The risk of neuropsychiatric side effects of chloroquine and hydroxychloroquine when used for COVID-19 treatment is not known. Best practice may include suicide risk assessment for patients treated with hydroxychloroquine. However, delirium is expected to be a more likely etiology of neuropsychiatric symptoms in critically ill patients treated for COVID-19, and adjustment disorder is a much more likely etiology of anxiety and depression symptoms than the side effects of chloroquine or hydroxychloroquine.

中文翻译：

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COVID-19 后氯喹和羟氯喹治疗的精神病学方面：精神药理学相互作用和神经精神后遗症

摘要背景氯喹和羟氯喹是在对 COVID-19 的紧急反应中正在研究的几种实验性治疗方法。随着这些药物使用的增加，医生需要了解这些药物的神经精神副作用以及与精神药物的相互作用。方法 对 1950 年至 2020 年 PubMed 中有关氯喹和羟氯喹的精神病学主题和靶向药理特性的文献进行回顾。综述 首先，氯喹和羟氯喹可能会轻度抑制精神科药物的 CYP2D6 代谢，干扰 CYP2D6 或 CYP3A4 活性的精神科药物可能会改变氯喹和羟氯喹的水平。其次，它们可能会延长 QT 间期，与其他 QT 延长剂的伴随处方需要谨慎。最后，神经精神方面的副作用非常少见，但也是可能发生的，包括可能长期存在的“服用氯喹后出现精神病”的现象。与氯喹相比，羟氯喹关于其神经精神副作用的可用信息较少，精神病文献仅限于几个病例报告。目前尚不清楚患有精神疾病的患者是否更容易受到这些药物的神经精神后遗症的影响，但是，自杀患者过量服用这些药物具有很高的死亡风险。结论 氯喹和羟氯喹用于 COVID-19 治疗时神经精神副作用的风险尚不清楚。最佳实践可能包括对接受羟氯喹治疗的患者进行自杀风险评估。