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Successful rechallenge after clozapine-associated myocarditis.

BMJ Case Rep

May 2022

Psychiatry, NHS Ayrshire and Arran Woodland View, Irvine, UK.

Clozapine is a highly effective medication used in management of treatment-resistant schizophrenia. Clozapine-associated myocarditis (CAM) is a rare but increasingly recognised complication of clozapine titration. Following an episode of CAM, clinicians can face a challenging dilemma of balancing the risks of recurrent myocarditis against the harms of ongoing psychosis.

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Article Synopsis
  • The study focuses on a 73-year-old woman with bipolar disorder who developed Pisa syndrome (PS) after starting clozapine, a medication often used for severe psychiatric conditions.
  • Pisa syndrome is a rare type of dystonia that can arise from neuroleptic medications, linked with clozapine though it has a lower risk compared to other antipsychotics.
  • Effective management of clozapine-induced PS involves reducing or stopping the medication, and reporting such cases can help in better understanding the risks and characteristics of this syndrome.
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Clozapine has been widely used as an antipsychotic drug for the treatment of refractory schizophrenia. Unfortunately, a wide range of blood dyscrasias have been reported as adverse effects of this drug. Agranulocytosis has gotten the most clinical vigilance; however, there are substantial reports of other blood dyscrasias associated with Clozapine some more serious than others.

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Clozapine-associated neutropenia following augmentation with sodium valproate.

SAGE Open Med Case Rep

May 2021

Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Clozapine is gold standard for the management of treatment-resistant schizophrenia. It can offer life-changing symptom reduction where other antipsychotics have failed, and for these patients, treatment with clozapine should be maintained, if in any possible way. However, treatment with clozapine comes with a risk of developing potentially fatal adverse reactions, for example, severe neutropenia or agranulocytosis, in which case, treatment must be discontinued.

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