Safety of a Clozapine Trial Following Quetiapine-Induced Leukopenia: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Asma H. Almaghrebi
Keyword(s):  
Treatment Options ◽  
Young Female ◽  
Similar Reaction ◽  
Careful Monitoring ◽  
Treatment Resistant ◽  
Blood Cell Count ◽  
Antipsychotic Medications ◽  
Case Presentation ◽  
Clozapine Treatment ◽  
History Of

Background: The clozapine-derivative quetiapine has been shown in some cases to cause leukopenia and neutropenia. Case Presentation: We reported on a case of a young female diagnosed with treatment-resistant schizophrenia. After failed trials of three antipsychotic medications and despite a history of quetiapineinduced leukopenia, clozapine treatment was introduced due to the severity of the patient’s symptoms, the limited effective treatment options, and a lack of guidelines on this issue. Result: Over a ten-week period of clozapine treatment at 700 mg per day, the patient developed agranulocytosis. Her white blood cell count sharply dropped to 1.6 &#215; 10<sup>9</sup> L, and her neutrophils decreased to 0.1 &#215; 10<sup>9</sup> L. There had been no similar reaction to her previous medications (carbamazepine, risperidone, and haloperidol). Conclusion: The safety of clozapine in a patient who has previously experienced leukopenia and neutropenia with quetiapine requires further investigation. Increased attention should be paid to such cases. Careful monitoring and slow titration are advisable.

scholarly journals Protocol for Clozapine Rechallenge in a Case of Clozapine-Induced Myocarditis

2019 ◽  
Vol 65 (7) ◽  
pp. 448-453 ◽  
Author(s):  
G. Shivakumar ◽  
N. Thomas ◽  
M. Sollychin ◽  
A. Takács ◽  
S. Kolamunna ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Female Patient ◽  
Young Female ◽  
Careful Monitoring ◽  
Treatment Resistant ◽  
Titration Phase ◽  
Subsequent Response ◽  
History Of

Objective: Protocol for clozapine rechallenge in patients with a history of clozapine-induced myocarditis. Method: Clozapine-related cardiovascular adverse effects including myocarditis and cardiomyopathy have limited its widespread use in treatment-resistant schizophrenia. Here, we present a case of clozapine-induced myocarditis and successful cautious rechallenge. Ms. AA, a young female patient with severe psychosis developed myocarditis during her initial clozapine titration phase, which was thus discontinued. Subsequent response to other medications was poor, and she remained significantly disabled. We reviewed blood-based biomarkers identified during the emergence of her index episode of myocarditis and developed a successful clozapine rechallenge protocol, based on careful monitoring of changes in these indices and a very slow clozapine re-titration. Results and Conclusions: This protocol may have utility in the management of patients with a history of clozapine-induced myocarditis.

scholarly journals A case of sigmoid volvulus in an unexpected demographic

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohammad Saba ◽  
Joshua Rosenberg ◽  
Gregory Wu ◽  
Gudata Hinika
Keyword(s):  
Abdominal Pain ◽  
Severe Pain ◽  
Rare Case ◽  
Young Female ◽  
Sigmoid Volvulus ◽  
Case Presentation ◽  
Operative Complications ◽  
History Of ◽  
Male Sex ◽  
Emergent Laparotomy

Abstract Background A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female. Case presentation A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications. Conclusion This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

Clozapine: A Case Vignette

1996 ◽  
Vol 4 (6) ◽  
pp. 336-337
Author(s):  
Ilana Nayman
Keyword(s):  
Young Woman ◽  
Psychiatric Practice ◽  
Case Vignette ◽  
Treatment Resistant ◽  
Symptom Resolution ◽  
Clozapine Treatment ◽  
Level Of Functioning ◽  
History Of ◽  
High Level

This paper describes successful clozapine treatment in a young woman with a five year history of treatment-resistant schizophrenia. After various treatment-resistant strategies had been given, clozapine was commenced. Symptom resolution within 4 months and sustained high level of functioning within 7 months was achieved. The role of clozapine in general psychiatric practice is evident. Clozapine should be considered earlier in the illness course than was formerly the case.

scholarly journals A Case Report on Treatment Outcomes of 50 Years Old Hypertensive Female with Intracranial Haemorrhage

2021 ◽  
pp. 61-65
Author(s):  
Seema Yelne ◽  
Roshan Umate
Keyword(s):  
Therapeutic Intervention ◽  
Intracranial Haemorrhage ◽  
Treatment Options ◽  
Brain Cells ◽  
Early Management ◽  
Case Presentation ◽  
History Of ◽  
Ct Brain ◽  
Surrounding Areas ◽  
The Brain

Introduction: The burden of stroke is strongly affected by ageing. Intracerebral haemorrhage (ICH) has catastrophic effects, and treatment options are limited.  ICH has long been considered to be the stroke specific type with the worst diagnosis. Hypertensive Intracranial Haemorrhage is a form of stroke that occurs when an artery in the brain bursts and the blood spreads to surrounding areas. Due to this bleeding, permanent damage occurs to brain cells.  Swelling of brain tissues occurs from annoyance due to trauma. This condition is known as cerebral oedema. The collection of blood is called a hematoma.  Due to hematoma, the pressure on nearby tissues increases and decreases crucial blood flow and persistently destroys brain cells. Case Presentation: This is a case of 50 year old hypertensive female with intracranial Haemorrhage.  Her diagnostic CT Brain (plain) was done. Complete blood investigations were done. She had history of Hypertension since 24 years and vomiting for 2-3 times. Therapeutic Intervention and Outcomes: In the present case received Inj. Cefrizone 1 gm IV, bd, Inj. Pan 40mg iv od, Inj. Emset 4mg iv tds, Inj. Limsol 100 ml tds and tab Telmakind 40 mg BD and all other investigation done.  No challenges were reported in therapeutic intervention. Patients blood pressure was managed and controlled and further progression of hematoma was prevented. Conclusion: Reduction of hypertension can be done through awareness, screening and early management of chronic diseases.

scholarly journals Chronic Serotonergic Overstimulation Mimicking Panic Attacks in a Patient with Parkinson’s Disease Receiving Additional Antidepressant Treatment with Moclobemide

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Marc Praetner ◽  
Timo Schiele ◽  
Lukas Werle ◽  
Janina Kuffer ◽  
Sandra Nischwitz ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Case Report ◽  
Depressive Symptoms ◽  
Antidepressant Treatment ◽  
Treatment Options ◽  
Panic Attacks ◽  
Case Presentation ◽  
History Of ◽  
Serotonin Toxicity

Background. The pharmacological treatment options of Parkinson’s disease (PD) have considerably evolved during the last decades. However, therapeutic regimes are complicated due to individual differences in disease progression as well as the occurrence of complex nonmotor impairments such as mood and anxiety disorders. Antidepressants in particular are commonly prescribed for the treatment of depressive symptoms and anxiety in PD. Case Presentation. In this case report, we describe a case of a 62-year-old female patient with PD and history of depressive symptoms for which she had been treated with moclobemide concurrent with anti-Parkinson medications pramipexole, rasagiline, and L-DOPA+benserazide retard. An increase in the dosage of moclobemide 12 months prior to admission progressively led to serotonergic overstimulation and psychovegetative exacerbations mimicking the clinical picture of an anxiety spectrum disorder. After moclobemide and rasagiline were discontinued based on the hypothesis of serotonergic overstimulation, the patient’s psychovegetative symptoms subsided. Conclusions. The specific pharmacological regime in this case probably caused drug-drug interactions resulting in a plethora of psychovegetative symptoms. Likely due to the delayed onset of adverse effects, physicians had difficulties in determining the pharmacologically induced serotonin toxicity. This case report emphasizes the complexity of pharmacological treatments and the importance of drug-drug interaction awareness in the treatment of PD patients with complicating nonmotor dysfunctions such as depression.

Continuing clozapine treatment after a diagnosis of cardiomyopathy

2018 ◽  
pp. 1-5 ◽  
Author(s):  
F. Williams ◽  
F. Lenihan ◽  
A. Rowe
Keyword(s):  
Mental Illness ◽  
Treatment Resistant ◽  
Psychiatric Unit ◽  
Clozapine Treatment ◽  
History Of ◽  
Secure Unit

A patient in a medium secure psychiatric unit with a 19-year history of treatment-resistant schizophrenia and violence whose mental illness only responded to clozapine, was noted to have a sustained tachycardia. Echocardiography revealed mild biventricular cardiomyopathy. The patient was not significantly affected by this. Initial recommendation from Cardiology was to consider discontinuation of clozapine. It was decided, however, that the risk of worsening psychosis and resultant violence outweighed the risk of the patient’s relatively mild cardiomyopathy. The patient was commenced on ramipril, and later bisoprolol. The patient no longer requires treatment in a medium secure unit and has remained on clozapine with follow-up from cardiology.

scholarly journals 177 Management of Treatment-Resistant Schizophrenia With Clozapine Augmentation

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 102-102
Author(s):  
Pwint Phyu ◽  
Emelina Arocha ◽  
Juan D. Oms ◽  
Luxhman Gunaseelan ◽  
Golbon Foroughi ◽  
...  
Keyword(s):  
Physical Examination ◽  
Laboratory Tests ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Panic Attacks ◽  
Pharmacologic Therapy ◽  
Comorbid Conditions ◽  
Treatment Resistant ◽  
History Of ◽  
Funding Acknowledgements

AbstractA 44-year-old woman with a history of chronic schizoaffective disorder, epilepsy, social phobia, anxiety, and panic attacks presented with concern for “feeling anxious.” After a history, physical examination, and laboratory tests, the woman received a diagnosis of treatment-resistant schizophrenia. While clozapine is the standard therapy for schizophrenia, certain patients such as the woman in this case do not respond well to clozapine monotherapy, requiring clozapine to be augmented with other antipsychotics or antidepressants. This case outlines the unique challenges of managing patients with treatment-resistant schizophrenia, especially when they present with comorbid conditions such as epilepsy that can limit treatment options. A multipronged approach, including pharmacologic therapy as well as cognitive behavioral therapy, should also be considered.Funding AcknowledgementsNo funding.

scholarly journals Unusual Paraneoplastic Presentation of Cholangiocarcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Aman Opneja ◽  
Sonia Mahajan ◽  
Sargam Kapoor ◽  
Shanthi Marur ◽  
Steve Hoseong Yang ◽  
...  
Keyword(s):  
Recurrent Disease ◽  
Stage Iv ◽  
Ct Scanning ◽  
Paraneoplastic Syndromes ◽  
Treatment Resistant ◽  
Case Presentation ◽  
Pruritic Rash ◽  
Pet Ct ◽  
Oral Steroids ◽  
History Of

Introduction.Cutaneous paraneoplastic syndromes are a heterogeneous group of skin manifestations that occur in relation to many known malignancies. Paraneoplastic occurrence of SCLE has been noted but is not commonly reported. SCLE association with cholangiocarcinoma is rare.Case Presentation.A 72-year-old man with a history of extrahepatic stage IV cholangiocarcinoma presented with a pruritic rash. Cholangiocarcinoma had been diagnosed three years earlier and was treated. Five months after interruption of his chemotherapy due to a semiurgent surgery, he presented with explosive onset of a new pruritic rash, arthralgias, and lower extremity edema. Physical exam revealed a scaly erythematous rash on his arms, hands, face, neck, legs, and trunk. It was thick and scaly on sun exposed areas. Skin biopsy revealed vacuolar interface dermatitis. Immunofluorescence revealed IgM positive cytoid bodies scattered along the epidermal basement membrane zone. PET-CT scanning revealed metabolically active recurrent disease in peripancreatic and periportal region with hypermetabolic lymph nodes. Oral steroids and new regimen of chemotherapy were started. Rash improved and steroids were tapered off.Discussion.Paraneoplastic syndromes demonstrate the complex interaction between the immune system and cancer. Treatment resistant SCLE should raise a suspicion for paraneoplastic etiology.

scholarly journals Clozapine Treatment in Patients with Prior Substance Abuse

2003 ◽  
Vol 48 (2) ◽  
pp. 111-114 ◽  
Author(s):  
Deanna L Kelly ◽  
Elizabeth A Gale ◽  
Robert R Conley
Keyword(s):  
Substance Abuse ◽  
Rating Scale ◽  
Therapeutic Option ◽  
Research Unit ◽  
Treatment Resistant ◽  
Clozapine Treatment ◽  
History Of ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
One Year

Objective: This study examined outcomes following discharge on clozapine for treatment-resistant schizophrenia patients with and without diagnosed substance abuse histories. Methods: Those discharged on clozapine from a research unit between April 1991 and March 1996 were followed with respect to hospitalization status. Of the treatment-resistant patients with schizophrenia, 19 were diagnosed as individuals with substance abuse, while 26 patients had no history of abuse. Patients were openly treated with clozapine and were included in the study if they were stabilized and discharged on the medication. Results: Patients who had histories of abuse exhibited a better treatment response and a lower total Brief Psychiatric Rating Scale (BPRS) score at discharge, compared with the non–substance abuse group. One-year readmission rates were 21% and 23% in patients with and without prior substance abuse histories, respectively ( P = ns). Conclusions: Clozapine may be a therapeutic option for the dually diagnosed population and may offer benefits to patients with schizophrenia who have a history of substance abuse.

scholarly journals A Case Report on Pelvic Floor Dysfunction

2021 ◽  
pp. 556-561
Author(s):  
Dipali D. Zade ◽  
Pooja Kasatwar ◽  
Rupali Thorat
Keyword(s):  
Pelvic Floor ◽  
Myofascial Pain ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Treatment Options ◽  
Case Presentation ◽  
Strengthening Exercises ◽  
History Of ◽  
Definition Of ◽  
The Relationship

Background: Pelvic floor dysfunction and pelvic myofascial pain are treatable and common musculoskeletal conditions. Understanding the relationship between pelvic girdle and pelvic floor muscles (PFM), hips and spine will help the practitioner to diagnose and treat these conditions. Pelvic floor dysfunction and pelvic pain are treated with clinical examination and complete medical history of PFMs. Treatment is a in cooperatives approach, which consists of medications, pelvic floor physical therapy, injection and other treatment options. Case Presentation: We are presenting case of 40 female with complaints of pain in abdomen and discomfort during micturition. On evaluation she was diagnosed with the pelvic floor muscle dysfunction. For the management of same she was referred to physiotherapy department. Treatment: For the management of pelvic floor dysfunction, various levels of physiotherapeutic interventions were given to the patient, which includes strengthening exercises, endurance exercises to improve the overall functional capacity of the patient. Conclusion: This examines the physical and anatomical examination of the pelvic floor, discusses the epidemiology and definition of pelvic floor dysfunction and explains the physiotherapy approach to treating these common conditions.

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