Das Soumitra, Itrat Annie, Hernandez Mary Elizabeth Trejo, Subedi Rasish, Jogarajah Thusanth, Vashist Sreshatha, Daggala Nikitha
Emergency Mental Health, Sunshine Hospital, Melbourne, VIC, Australia.
Broadmeadows Inpatient Unit, Northern Health, Broadmeadows, VIC, Australia.
SAGE Open Med Case Rep. 2023 Aug 31;11:2050313X231195961. doi: 10.1177/2050313X231195961. eCollection 2023.
Schizophrenia is a chronic neuropsychiatric illness defined by the appearance of positive, and negative symptoms and/or cognitive impairment. Antipsychotic drugs are predominantly used in the treatment of psychotic disorders, but not all patients with schizophrenia respond to every antipsychotic medication. Clozapine is one of the best atypical antipsychotics and is highly effective in treating treatment-resistant schizophrenia. Evidence suggests that clozapine appears to be effective in lowering the risk of suicide, extrapyramidal side effects, and relapse in patients with schizophrenia. Per contra, clozapine is not the first-line treatment due to its unalterable aftereffects such as agranulocytosis, metabolic syndrome, seizures, and rarely, eosinophilia. Eosinophilia can be life-threatening. Eosinophils infiltrate different tissues and cause inflammation in multiple organs causing end-organ damage. The current study aimed to report the incidence of eosinophilia associated with clozapine use in patients with schizophrenia. Literature on clozapine-induced eosinophilia is relatively scarce. Understanding the progression and management of clozapine-induced eosinophilia and its end-organ effects is imperative. While there is insufficient data about the guidelines in the management of clozapine-induced eosinophilia, this study contributes to understanding the patterns of the disease progression with clozapine dosage. A case study was done on a patient with schizophrenia and autistic spectrum disorder who was on clozapine. Data on how eosinophil levels varied with clozapine dosing was analyzed and documented. The evidence of clozapine dosage affecting eosinophil and C-reactive protein levels in this patient was summarized in a table and a narrative review.
精神分裂症是一种慢性神经精神疾病,其特征为出现阳性症状、阴性症状和/或认知障碍。抗精神病药物主要用于治疗精神障碍,但并非所有精神分裂症患者都对每种抗精神病药物有反应。氯氮平是最好的非典型抗精神病药物之一,对治疗难治性精神分裂症非常有效。有证据表明,氯氮平似乎能有效降低精神分裂症患者的自杀风险、锥体外系副作用和复发风险。然而,由于氯氮平存在诸如粒细胞缺乏症、代谢综合征、癫痫发作等不可改变的后遗症,且罕见地会导致嗜酸性粒细胞增多症,所以它并非一线治疗药物。嗜酸性粒细胞增多症可能危及生命。嗜酸性粒细胞会浸润不同组织,在多个器官引发炎症,导致终末器官损伤。本研究旨在报告精神分裂症患者使用氯氮平后发生嗜酸性粒细胞增多症的发生率。关于氯氮平诱发嗜酸性粒细胞增多症的文献相对较少。了解氯氮平诱发嗜酸性粒细胞增多症的进展、管理及其对终末器官的影响至关重要。虽然关于氯氮平诱发嗜酸性粒细胞增多症管理指南的数据不足,但本研究有助于了解该疾病随氯氮平剂量的进展模式。对一名正在服用氯氮平的精神分裂症和自闭症谱系障碍患者进行了病例研究。分析并记录了嗜酸性粒细胞水平随氯氮平剂量变化的数据。该患者中氯氮平剂量影响嗜酸性粒细胞和C反应蛋白水平的证据汇总在一张表格中,并进行了叙述性综述。