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.

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 M202. SEX-RELATED DIFFERENCES IN CLOZAPINE SIDE EFFECTS IN PATIENTS WITH TREATMENT-RESISTANT SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S213-S213
Author(s):  
Francesca Martini ◽  
Marta Bosia ◽  
Mariachiara Buonocore ◽  
Marco Spangaro ◽  
Margherita Bechi ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Sex Differences ◽  
Weight Gain ◽  
Postural Hypotension ◽  
Central Obesity ◽  
Treatment Resistant ◽  
Chi Square ◽  
Clozapine Treatment ◽  
Chi Square Analysis

Abstract Background Treatment resistant schizophrenia (TRS) affects up to 30% of patients with psychosis and is a major cause of disability. Although clozapine is the only indicated drug for TRS, it is largely underused, partially due to its life-threatening adverse effects (AEs) as agranulocytosis and myocarditis. However, clozapine treatment is also burdened by other AEs as constipation, hypersalivation, postural hypotension, tachycardia, metabolic abnormalities and weight gain. In recent years many efforts have been made to outline clinical and neurobiological characteristics of TRS. Although sex is one of the most relevant factors accountable for the clinical variability of schizophrenia, literature on sex differences in clozapine’s tolerability is still limited. Studies showed that women experience more often than men weight gain, hyperglycemia and constipation. Conversely, hypertension and dyslipidemia seem more frequent in men. Based on these premises, our study aimed to investigate sex differences in prevalence of clozapine’s chronic AEs in TRS patients. Methods We performed an observational cross-sectional study with TRS on 147 patients, 93 males and 54 females with at least two-year clozapine treatment. We assessed metabolic status and AEs by interviews, collection of clinical data (BMI, waist circumference, blood pressure and heart rate) and blood tests including lipid profile, fasting glucose and HbA1c. Chi-square analysis was used to investigate the association between sex and clozapine AEs (tachycardia, postural hypotension, constipation, hypersalivation and metabolic syndrome). Multiple logistic regression analyses were performed to further analyze the relationship between sex and AEs considering the role of possible confounding factors as plasmatic concentration, oral dosage, number of daily administration, age and duration of therapy. Results We found a higher prevalence of tachycardia in males (p=0.034, χ2=4.49) and of orthostatic hypotension (p=0.01, χ2=6.70) and constipation (p=0.01, χ2=6.45) in females. Logistic regressions showed that male sex was the only significant predictor of tachycardia (p=0.01), while female sex predicted hypotension (p=0.04) and constipation (p=0.03). Although no differences emerged for hypersalivation and metabolic syndrome (MetS), Chi-square showed significant differences in prevalence for two MetS criteria: hypertriglyceridemia (56.94% in men, 29.79% in women, p=0.003, χ2=8.43) and central obesity (83.33% in men, 97.44% in women, p=0.03, χ2=4.69). Discussion Consistent with previous literature, our study showed sex differences in prevalence of chronic clozapine’s AEs. Although perceived as minor AEs, hypotension, constipation and tachycardia could affect patient’s quality of life, cause treatment discontinuation or increase mortality. In particular, postural hypotension and tachycardia have been associated with an increased risk of all-cause death and cardiovascular events in the general population. Clozapine-related constipation can develop into full-blown ileus in up to 2.1% of cases, a higher, more durable and more dangerous risk than agranulocytosis. Finally, hypertriglyceridemia and central obesity are well known cardiovascular risk factors. Our study suggests clinicians should carefully monitor for clozapine’s AEs also considering sex, in order to early detect them, promptly treat them and prevent severe complications. Literature suggest some of the sex differences reported in schizophrenia may be due to the protective role of estrogens. Further studies, with a particular attention to hormonal status, could contribute to better understand the pathophysiology of sex differences in TRS and define a personalized therapeutic approach.

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.

THE CONTRIBUTION OF E. M. MELETINSKY TO THE CAUCASIAN EPOS STUDIES. ON THE 100TH ANNIVERSARY OF THE BIRTH OF THE SCHOLAR

2020 ◽  
Vol 3 (4) ◽  
pp. 76-89
Author(s):  
Zurab D. Dzhapua ◽  
Keyword(s):  
Early Stage ◽  
100Th Anniversary ◽  
North Caucasus ◽  
The North ◽  
The People ◽  
History Of ◽  
High Level ◽  
Very High ◽  
Cultural Hero

The article analyses the contribution of Meletinsky to Caucasian epic studies. The role of Caucasian epic traditions in the study of the problem of the origins and the early forms of the epos is considered. A significant number of the comparative-typological studies of Meletinsky are based on the materials of mythoepic cultures of Caucasus mountain people. The scholar singled out the Caucasian epics, along with some other traditions, as the special early stage in the history of the epic. Meletinsky was one of the pioneers in the fundamental studies of the Caucasian Nart epics. Based on the analysis of materials available to him at that time, Meletinsky comes to the fundamental conclusions on the genre nature, national versions, images, subjects and motifs of the Nart epic. The scholar considered Sataney and Sasrykua to be the earliest characters in the epic, whose images clearly reflected the features of a cultural hero, especially in the close Abkhaz and Adyg versions. Furthermore, according to Meletinsky, the Transcaucasian legends about the chained heroes – Abkhaz Abryskil, Armenian Mger and Georgian Amiran – represent a kind of interweaving of mythological epic and heroic tales, in which the motives of cultural exploits are largely supplanted by episodes of the heroic struggle with Giants. In the studies of Meletinsky, the epic traditions of the people of the North Caucasus and Transcaucasia are subjected to the deepest analysis at a very high level of comparative studies.

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.

SELF-GOVERNMENT BODIES ARE A KEY LINK IN THE SOCIAL PROTECTION SYSTEM

2021 ◽  
Vol 6 (4) ◽  
pp. 5-16
Author(s):  
Bekjon Ismoilov ◽  
Keyword(s):  
Low Income ◽  
Social Protection ◽  
Legal Framework ◽  
Executive Branch ◽  
Point Of View ◽  
Public Confidence ◽  
History Of ◽  
Low Income Families ◽  
High Level

The article directly analyzes the powers and activities of local self-government bodies in the field of social protection. The role of mahallas, one of the most important branches of the executive branch,in the way of life of the population has been studied using the existing legal framework. When we evaluate the activities of the communities from the socio-legal point of view, we believe that this system really plays an important role in improving the lives of the population and solving the problems that concern them. At the neighborhood level, people in need of social protection, people with special needs and low-income families are constantly under the care and attention of our state. The role of local self-government bodies in the targeted and targeted use of benefits, financial assistance and other types of social assistance providedby our government to needy families is unique. That is, they are the ones who are most responsible for providing pensions and benefits. In this process, the fulfillment of their duties in full compliance with the principle of socialjustice is a strong guarantee of a high level of public confidence in public policy. The article also provides a comparative analysis of the history of the origin of the concept of neighborhood and the scientific and theoretical views expressed about thissocial structure. In addition, the role of local self-government bodies in public life and public administration has been discussed in detail

Explaining “How... Politics Actually Work”: The German Historian Wolfgang Reinhard, the Theory of Verflechtungen and Micropolitics

2021 ◽  
pp. 118-123
Author(s):  
Alice Plate ◽  
Keyword(s):  
Early Modern ◽  
Social History ◽  
State Institutions ◽  
Relationship Types ◽  
History Of ◽  
High Level ◽  
Informal Relations ◽  
Client Relations ◽  
Theoretical Foundations

The conceptualization of the role of informal relationships, including patron-client relations, in the development of Early Modern state institutions in modern European historiography is usually associated with the names of R. Munier, S. Kettering and A. Maczak, whose works have long since become classics. Less well known in this context is the Verflechtungstheorie (lit. theory of entanglement), developed in the 1970s by the Freiburg historian W. Reinhard. The aim of this article is to examine the Verflechtungstheorie in historical perspective and its theoretical foundations, as well as the history of its reception in the context of the development of social history in Germany. In doing so, the author explains the reasons why Reinhard's approach occurred less influential in comparison with the works of the historians mentioned above. The article is based on a detailed study of Reinhard's works dedicated to the Verflechtungstheorie (since the 1990s micropolitics), starting from his 1979 monograph Freunde und Kreaturen (“Friends and Creatures”) and ending with the most recent publications in the 2010s. The beginning of the article is devoted to the formation of the conceptual apparatus of Reinhard's theory. He understands the term Verflechtungen as the result and foundation of social interaction based on four relationship types - kinship, compatriot, friendship and patronage, playing, according to Reinhard, a key role in premodern times. The theoretical basis of Reinhard's explanatory model is formed by the sociometry of the American sociologist J. L. Moreno, and Reinhard viewed his concept of elite relations as a kind of network analysis. Further on the article moves on analyzing the reception problem of the presented theory. According to Reinhard, the Verflechtungstheorie experienced reception difficulties within historical scholarship mostly for being technically ahead of its time. However, as the article shows, the main reason was that the concept failed to meet the zeitgeist prevailing in postwar German historiography. While social history developing under the influence of the Bielefeld school focused on the study of microhistorical subjects, Reinhards's approach was mainly a political one. Abandoning the term Verflechtungen in the mid-1990s and replacing it with the term micropolitics, Reinhard did not solve the problem. This change was a merely linguistic one, and Reinhard continued to argue that informal relations mark a negotiable stage, which is characteristic for societies with a high level of mobility and an underdeveloped statehood. In conclusion, the article shows that the results of Reinhard's scholarly work should not be considered a failure. The main merit is its continuity: some of Reinhard's former students proved that informal relationships are by no means a parasitic atavism associated solely with corruption.

scholarly journals Revealing the evolutionary history of a reticulate polyploid complex in the genus Isoëtes

2020 ◽  
Author(s):  
Jacob S. Suissa ◽  
Sylvia P. Kinosian ◽  
Peter W. Schafran ◽  
Jay F. Bolin ◽  
W. Carl Taylor ◽  
...  
Keyword(s):  
North American ◽  
Evolutionary History ◽  
Restriction Site ◽  
Reticulate Evolution ◽  
List Type ◽  
Reproductive Barriers ◽  
Nuclear Markers ◽  
History Of ◽  
High Level

SummaryPolyploidy and hybridization are important processes in the evolution of spore-dispersed plants. Few studies, however, focus these dynamics in heterosporous lycophytes, such as Isoëtes, where polyploid hybrids are common and thought to be important in the generation of their extant diversity. We investigate reticulate evolution in a complex of western North American quillworts (Isoëtes) and provide insights into the evolutionary history of hybrids, and the role of polyploidy in maintaining novel diversity.We utilize low copy nuclear markers, whole plastomes, restriction site-associated DNA sequencing, cytology, and reproductive status (fertile or sterile) to investigate the reticulate evolutionary history of western North American Isoëtes.We reconstruct the reticulate evolutionary history and directionality of hybridization events in this complex. The presence of high level polyploids, plus frequent homoploid and interploid hybridization suggests that there are low prezygotic reproductive barriers in this complex, hybridization is common and bidirectional between similar—but not divergent—cytotypes, and that allopolyploidization is important to restore fertility in some hybrid taxa.Our data provide five lines of evidence suggesting that hybridization and polyploidy can occur with frequency in the genus, and these evolutionary processes may be important in shaping extant Isoëtes diversity.

scholarly journals Ukrainian font: origins, stages of formation, stylistic features

2021 ◽  
Author(s):  
Antonina Dubrivna ◽  
Sofiia Doronina
Keyword(s):  
Visual Communication ◽  
Native Speakers ◽  
Special Role ◽  
Knowledge Based ◽  
Folk Traditions ◽  
History Of ◽  
Definition Of ◽  
High Level ◽  
National Style

The purpose of the article is to highlight the peculiarities of the establishment of the Ukrainian font and analysis of the interaction of formative and figurative features in the retrieval system of national style. The methodology is built according to the general principles of art history of scientific knowledge based on system-analytical, complex-historical, formal approaches, and generalization. The scientific novelty lies in the revelation of visual and communicative aspects and artistic and stylistic features of the Ukrainian font within the context of a comprehensive definition of the factors of its formation and development. Conclusion. The perspective of the development of the modern Ukrainian font is outlined, which lies in the assertion of the national component based on the stable foundation of the past, the contradictions of evolution, and the formation of its new forms and models. The special role of the Ukrainian font as a means of visual communication with a high level of perception by native speakers of the Ukrainian language is determined. The positive effect of using accidental fonts in order to embody Ukrainian authentic folk traditions has been revealed. Keywords: Ukrainian font, national style, writing, font graphics, visual communication, perception.

Elaborating the role of reflection and individual differences in the study of folk-economic beliefs

2018 ◽  
Vol 41 ◽  
Author(s):  
Kevin Arceneaux
Keyword(s):  
Decision Making ◽  
Individual Differences ◽  
Cognitive Processes ◽  
Evolutionary History ◽  
Behavioral Responses ◽  
History Of ◽  
Economic Beliefs

AbstractIntuitions guide decision-making, and looking to the evolutionary history of humans illuminates why some behavioral responses are more intuitive than others. Yet a place remains for cognitive processes to second-guess intuitive responses – that is, to be reflective – and individual differences abound in automatic, intuitive processing as well.

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