RESUMO
BACKGROUND: Eosinophilia associated with clozapine treatment has been reported in some studies and limited case reports. Because little is known regarding incidence, course, and relevance of this finding, clozapine therapy has been terminated prematurely in some patients with elevated eosinophil counts. METHOD: Records were reviewed on 118 consecutively hospitalized, acutely psychotic patients treated over a 1-year period with clozapine for at least 3 weeks. Demographic data were obtained on those patients, and white blood cell counts were analyzed. We reviewed the data for predisposing factors, associated medical findings, or clinical sequelae, and performed a two-sided Fisher's exact test to determine if sex or diagnosis was associated with a higher risk of developing eosinophilia. The literature pertaining to this blood dyscrasia and its relationship to clozapine was reviewed. RESULTS: In our population, the cumulative incidence of eosinophilia among women was 23% (13/57), a statistically significant higher risk (p < .01) than that in men (7% [4/61]). In all cases, the eosinophilia was noted between Weeks 3 and 5 of treatment and resolved without medical or psychiatric complications. CONCLUSION: Eosinophilia should be added to the list of commonly observed side effects of clozapine treatment. Women appear to be at significant risk. Eosinophilia usually occurs early in therapy, spontaneously resolves, and is not associated with any known complications. An otherwise healthy person with this blood dyscrasia may continue with treatment but should be monitored closely. Further investigation into this finding may provide insight into the mechanism of neutropenia and other adverse reactions to clozapine.
Assuntos
Clozapina/efeitos adversos , Eosinofilia/induzido quimicamente , Transtornos Psicóticos/tratamento farmacológico , Doença Aguda , Adulto , Transtorno Depressivo/tratamento farmacológico , Eosinofilia/sangue , Eosinofilia/epidemiologia , Feminino , Hospitalização , Humanos , Incidência , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Esquizofrenia/tratamento farmacológico , Fatores SexuaisRESUMO
BACKGROUND: Clozapine has been increasingly shown to be effective in the acute and maintenance treatment of bipolar disorders. For this reason, we studied whether clozapine alone is effective as a mood stabilizer in patients with refractory bipolar disorders. METHOD: Subjects were part of a long-term follow-up study cohort of 193 patients with refractory mood disorders who were treated with clozapine at McLean Hospital prior to July 1, 1992. Patients included in this study were those older than 16 years with bipolar disorder (manic or mixed) and schizoaffective disorder, bipolar type, discharged taking clozapine alone (N = 17). Hospital records on all patients were reviewed by trained raters blind to "best-estimate" diagnoses. Response to clozapine was determined by the Clinical Global Impressions-Improvement (CGI-I) scale. Patients were contacted at least 6 months after clozapine initiation for semistructured follow-up interviews by raters blind to diagnosis and baseline information. RESULTS: Seventeen subjects were contacted 16.1 +/- 5.6 months after clozapine initiation. Most of the 17 patients had previously failed trials of lithium, valproate, carbamazepine, neuroleptics, combinations of these, and electroconvulsive therapy; or had tardive dyskinesia. Of these patients, 65% (11/17) continued to be on clozapine therapy alone at follow-up and had no subsequent rehospitalization or affective episode. At follow-up, there was a significant decrease in the rehospitalization rate (p = .025) than before starting clozapine and a significant improvement in CGI-I scores (p = .02). CONCLUSION: Clozapine monotherapy is an effective mood stabilizer, reducing both the number of affective episodes and rehospitalizations in patients with severe refractory bipolar illness.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Clozapina/uso terapêutico , Adulto , Transtorno Bipolar/prevenção & controle , Transtorno Bipolar/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/prevenção & controle , Transtornos Psicóticos/psicologia , Recidiva , Estudos Retrospectivos , Esquizofrenia/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: To determine the efficacy and tolerance of long-term clozapine therapy in refractory affective illness. METHOD: Hospital records were reviewed for 193 treatment-resistant patients with a discharge diagnosis of bipolar disorder (N = 52), schizoaffective disorder (N = 81), unipolar depression (N = 14), schizophrenia (N = 40), or other disorders (N = 6) started on clozapine therapy as inpatients at McLean Hospital. An independent "best-estimate" diagnosis, based on DSM-III-R criteria, was established for each patient. Patients were contacted at least 6 months after clozapine initiation for structured follow-up interviews by raters blind to diagnosis. Patients were stratified by diagnosis, and a variety of patient characteristics and outcome measures were compared. RESULTS: Subjects were followed up a mean of 18.7 months after clozapine initiation. Bipolar manic and schizoaffective bipolar subjects had significantly better outcomes than unipolar, bipolar, and schizoaffective depressed patients on a variety of measures. One or more episodes of depression prior to clozapine predicted clozapine discontinuation (p = .01). Affective and schizoaffective subjects had baseline measures of social functioning similar to that of the schizophrenics but had significantly greater improvement in scores at follow-up. CONCLUSION: Clozapine is an efficacious and well-tolerated therapy for refractory affective illness. Manic symptomatology predicts a more favorable response than depression.
Assuntos
Transtornos Psicóticos Afetivos/tratamento farmacológico , Clozapina/uso terapêutico , Adulto , Transtornos Psicóticos Afetivos/psicologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Feminino , Seguimentos , Humanos , Masculino , Probabilidade , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Ajustamento Social , Resultado do TratamentoAssuntos
Fluvoxamina/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Disfunções Sexuais Psicogênicas/induzido quimicamente , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Fluvoxamina/administração & dosagem , Fluvoxamina/efeitos adversos , Humanos , Incidência , Masculino , Transtornos Mentais/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Disfunções Sexuais Psicogênicas/epidemiologiaRESUMO
The systematic study of delusional misidentification syndromes has been hampered by the often confusing and imprecise eponymic nomenclature currently in use. We present a case report that demonstrates the inadequacies of the current system. We then propose a new classification system designed to improve research and understanding in this important area.
Assuntos
Delusões/diagnóstico , Terminologia como Assunto , Idoso , Encéfalo/fisiopatologia , Síndrome de Capgras/diagnóstico , Delusões/fisiopatologia , Delusões/psicologia , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Humanos , Transtornos da Memória/diagnóstico , Transtornos da Memória/fisiopatologia , Testes NeuropsicológicosRESUMO
The purpose of this study was to test the hypothesis that minor EEG abnormalities predict a favorable response to clozapine. Eighty-six psychotic clozapine-treated psychiatric inpatients with EEG records before starting clozapine were included in the study. When all diagnostic groups were combined, there were no significant differences in clinical outcome between patients with abnormal EEGs and patients with normal EEGs. However, female patients with abnormal EEGs had a significantly greater improvement in Global Assessment of Functioning (GAF) scores compared to female patients with normal EEGs. In addition, patients with major depressive episodes (bipolar, schizoaffective, unipolar) and abnormal EEGs had a significantly greater improvement in GAF scores compared to the same subgroup of patients with normal EEGs. The results suggest that EEG abnormalities before clozapine treatment many predict a favorable clinical response in specific groups of patients.