Neutropenia is an adverse effect of various pharmacological therapies, including antipsychotics. Among the second-generation antipsychotic (SGA) medications, clozapine is most notable for neutropenic adverse effect. Risperidone, another SGA drug, is linked mainly with metabolic adverse effects, but rarely, blood dyscrasia adverse reactions have been reported. Hence, we report the case of a 56-year-old African American woman who developed severe neutropenia following two weeks of oral risperidone treatment. Her neutrophil levels returned to normal limits following discontinuation of risperidone and switching to haloperidol.

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Background: This study was designed to assess the determinants of utilization of Traditional Birth Attendants (TBAs) services by pregnant women in different communities in Ogbomoso, Nigeria.Methods: This was a community- based cross-sectional study. Fisher's formula was used to calculate the sample size and a total of 270 eligible pregnant women were enrolled for the study using multistage sampling technique. Data was collected using pretested structured interviewer-administered questionnaire. Data analysis was done using SPSS version 20 and results were presented in frequencies and percentages.Results: Factors found to have a significant influence on the utilization of TBA services in this study include: low educational status (p <0.001), lower socioeconomic status (p <0.001), and compassionate care given by the TBAs (p=0.004). Other factors include service proximity and lower cost of TBA services.Conclusions: The impact of TBAs and their services cannot be overemphasized in the present state of maternal and child health in Nigeria.  Lower educational status among others has been found to be a strong predictor of utilization of TBA services. There is, therefore, the need to improve the educational and socioeconomic status of women in order to allow them to access quality health care services that will safeguard their well-being. Inculcating compassionate care into orthodox healthcare delivery will go a long way to improve patronage and discourage TBA utilization.

Tachycardia emergent from clozapine treatment is usually transient, often missed, unreported, and therefore frequently goes untreated resulting in possible premature discontinuation of an otherwise effective treatment. Clozapine-induced tachycardia results from direct effects on the sympathetic nervous system including the blockade of cardiac muscarinic M2 receptors, presynaptic α2 adrenoceptors, and indirect activation of the β adrenoceptors. Unfortunately, there are no clear guidelines for monitoring or treating tachycardia induced by clozapine. We present a case of a 55-year-old man with treatment-resistant schizophrenia initiated on clozapine who developed persistent tachycardia and right bundle branch block in the course of treatment. Tachycardia persisted despite treatment with metoprolol and necessitated a transfer to the intensive care unit. A reduction in clozapine dose with the addition of adjunctive antipsychotic(lurasidone) stabilized the patient’s heart rate. This case highlights the need for consistent physical examination and a multidisciplinary-based treatment approach for patients on clozapine. The case also suggests that clozapine dose reduction and combination antipsychotic treatments may preclude the need to discontinue clozapine in patients with persistent tachycardia.

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