Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, Florida, USA.
Curr Drug Saf. 2022;17(4):382-386. doi: 10.2174/1574886316666211130142624.
The emergence of coronavirus SARS-CoV-2, and the subsequent global epidemic of COVID-19, brought with it innumerable new clinical experiences across all medical specialties, and psychiatry is no exception. Individuals with serious mental illness, in particular schizophrenia and related disorders, may be especially susceptible to coronavirus infection given the overlapping risk factors of vulnerable sociodemographic status, increased challenges with quarantining requirements, and limited compliance with "respiratory etiquette." The case presented here describes a patient with schizophrenia who was being managed on clozapine and who developed symptomatic COVID-19 infection. Special care was taken to ensure that potential interactions between clozapine and the associated COVID-19 treatments were safe for the patient's mental and physical wellbeing.
A 71-year-old schizophrenic Caucasian male is being managed with clozapine. While hospitalized, the patient was screened positive for COVID-19 and was admitted to the ICU due to his declining respiratory status. He was treated with both remdesivir and prednisone. He was able to fully recover from his COVID-19 infection.
The authors review the clinical characteristics of the case, highlighting both the overlapping synergistic effects and antagonistic influences of clozapine therapy in combination with COVID-19 and its associated treatments. A review of the literature offers an opportunity to examine various frameworks for individualized clinical decision-making while making the case for greater epidemiologic research into the optimal management of individuals with a psychotic disorder who are diagnosed with COVID-19 infection.
冠状病毒 SARS-CoV-2 的出现以及随后 COVID-19 的全球大流行，给所有医学专业带来了无数新的临床经验，精神病学也不例外。患有严重精神疾病的个体，特别是精神分裂症和相关障碍患者，由于脆弱的社会人口地位、隔离要求增加的挑战以及“呼吸礼仪”遵守情况有限等重叠的风险因素，可能特别容易感染冠状病毒。这里介绍的病例描述了一名正在接受氯氮平治疗的精神分裂症患者，他出现了有症状的 COVID-19 感染。特别注意确保氯氮平和相关 COVID-19 治疗之间的潜在相互作用对患者的身心健康都是安全的。
一名 71 岁的白人精神分裂症男性患者正在接受氯氮平治疗。住院期间，该患者 COVID-19 检测呈阳性，并因呼吸状况恶化而被收入 ICU。他接受了瑞德西韦和泼尼松治疗。他从 COVID-19 感染中完全康复。
作者回顾了该病例的临床特征，强调了氯氮平治疗与 COVID-19 及其相关治疗联合治疗时的协同作用和拮抗作用的重叠。文献复习提供了一个机会，可以检查个体化临床决策的各种框架，同时为患有精神障碍并被诊断为 COVID-19 感染的个体的最佳管理进行更多的流行病学研究。
