Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Psychiatry Res. 2019 Sep;279:90-97. doi: 10.1016/j.psychres.2019.07.008. Epub 2019 Jul 6.
The aim of this study was to investigate and compare the incidence of suspected or definite cases of clozapine induced myocarditis (SDM) and clinical factors which could influence its onset in two different time periods, defined by pre- and post-cardiac monitoring at an inpatient setting, during the initiation phase of clozapine treatment. Hospital records of patients started on clozapine in the inpatient unit between 2011 and 2018 were investigated. Eight in 38 patients (11.3%) were classified as SDM after the initiation of the monitoring protocol, whereas only 1 in 33 patients (1.4%) was classified as SDM, before. Monitored and non-monitored patient groups were similar with regard to demographic and clinical variables. Diagnosis of schizoaffective disorder and use of concominant lithium, valproic acid and atypical antipsychotics were higher in patients with SDM, while clozapine dose titration was similar compared to the rest of the patients. Cardiac monitoring seems to be the main factor leading to the increase in the detection of clozapine induced myocarditis (CIM). If not monitored, the outcome of CIM can be fatal without any warning signs and symptoms. Concominant use of mood stabilizers including valproic acid and lithium, are important risk factors for the development of CIM.
本研究旨在调查和比较氯氮平诱导性心肌炎（SDM）疑似或确诊病例的发生率，以及在氯氮平治疗起始阶段，在住院环境下心电监测前后两个不同时期影响其发病的临床因素。研究调查了 2011 年至 2018 年期间在住院部开始氯氮平治疗的患者的住院记录。在开始监测方案后，38 名患者中有 8 名（11.3%）被归类为 SDM，而在监测方案之前，33 名患者中只有 1 名（1.4%）被归类为 SDM。监测和非监测患者组在人口统计学和临床变量方面相似。SDM 患者的精神分裂情感障碍诊断和同时使用锂、丙戊酸和非典型抗精神病药物的比例较高，而与其他患者相比，氯氮平剂量滴定相似。心脏监测似乎是导致氯氮平诱导性心肌炎（CIM）检测增加的主要因素。如果不进行监测，CIM 的后果可能是致命的，没有任何警告症状。包括丙戊酸和锂在内的情绪稳定剂的同时使用是 CIM 发展的重要危险因素。
