Myocarditis in patients on long-term antipsychotics –mechanism, management and recent updates

Daniel, Patterson; Rajaree, Katta Maanya; Luna, Rudy; Jafor, Sadeque; Prasad, Sakshi; Avanthika, Chaithanya; Jhaveri, Sharan

doi:10.1016/j.heliyon.2023.e13930

Cited by 11 publications

(13 citation statements)

References 115 publications

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“…Numerous studies have established significant associations between microdeletion and conditions such as schizophrenia and related psychoses. 1 , 3 , 9 , 13 – 17 This is supported by the observation that people with learning disabilities and schizophrenia had a higher prevalence of the 15q11.2 deletion than the general population. 13 In schizophrenia patients, the prevalence of the 15q11.2 BP1-BP2 deletion ranges from 0.14% to 0.65%.…”

Section: Discussionmentioning

confidence: 73%

“… 9 However, the presence of a particular copy number variant (CNV) alone is not sufficient evidence for it to be a causative factor 9 owing to its low penetrance (2% for schizophrenia), which supports the hypothesis that a combination of genetic and environmental factors are responsible for psychoses and schizophrenia. 7 , 11 , 15 Furthermore, it has been reported that individuals diagnosed with schizophrenia and pathogenic CNVs have an increased likelihood of resistance to treatment. 3 …”

Section: Discussionmentioning

confidence: 99%

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Late onset psychosis in a case of 15q11.2 BP1-BP2 microdeletion (Burnside–Butler) syndrome: A case report and literature review

Das,

Shet,

Palakodeti

et al. 2024

SAGE Open Medical Case Reports

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Burnside–Butler syndrome is an inheritable genetic condition characterized by the partial deletion of specific genetic material located on chromosome 15q11. Individuals diagnosed with this particular medical condition display a variety of neuropsychiatric disorders, including psychosis, aggression, mood disorders, anxiety disorders, developmental disorders involving learning difficulties, language delays, autism spectrum disorders, and attention-deficit/hyperactivity disorder. The authors discuss the case of a 51-year-old Caucasian female diagnosed with Burnside–Butler syndrome at 8 years. The article highlights the importance of raising awareness regarding the complex nature and delayed onset of neuropsychiatric symptoms associated with this syndrome. It also emphasizes the need for comprehensive evaluation and multidisciplinary care for individuals affected by this uncommon condition.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Late onset psychosis in a case of 15q11.2 BP1-BP2 microdeletion (Burnside–Butler) syndrome: A case report and literature review

Das,

Shet,

Palakodeti

et al. 2024

SAGE Open Medical Case Reports

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“…Side effects of clozapine can be dependent on doses of clozapine and the duration for which it has been given [3 ]. Clozapine is nearly completely absorbed from the gut, highly protein bound and has high first-pass metabolism in the liver [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clozapine can induce various hematological changes, including neutropenia, eosinophilia, and thrombocytopenia, which may make the patient more susceptible to both local and systemic infections [ 2 , 3 ]. Additionally, it is important to note that infections can affect serum clozapine levels by influencing its metabolism [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

A Case Report of a Patient with Soaring Clozapine Levels after Developing a Urinary Tract Infection

Kumar Agrawal,

Das,

Abednego B. Adre

et al. 2024

Case Reports in Psychiatry

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Clozapine is an antipsychotic medicine used to treat mental illnesses that is resistant to therapy. It can induce dose-dependent adverse effects such as increased susceptibility to infections and hematological irregularities. In this case report, we present a 37-year-old woman with schizoaffective disorder who experienced clozapine side effects following a moderate urinary tract infection (UTI). Her serum clozapine levels and side effects were increased throughout her UTI but resolved once the UTI was managed conservatively. We reviewed clozapine’s pharmacokinetic properties to understand why serum levels rose during infection. While we could not definitely explain the mechanism of elevation, we emphasize the importance of monitoring serum clozapine levels and keeping watchful for adverse effects, as well as heightened scrutiny, evaluation for recent infections, and regular monitoring of patients.

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“…3 clozapine is not indicated as a first-line drug because its use has been associated with a number of side effects such as agranulocytosis, myocarditis, metabolic syndrome, seizures, sialorrhea, etc. 4 Rarely, clozapine is associated with the side effect of eosinophilia. Eosinophilia, a non-dose-dependent side effect, has been reported as a rare adverse effect of clozapine.…”

Section: Discussionmentioning

confidence: 99%

Clozapine-induced eosinophilia: A case report

Das,

Itrat,

Hernandez

et al. 2023

SAGE Open Medical Case Reports

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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.

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Myocarditis in patients on long-term antipsychotics –mechanism, management and recent updates

Cited by 11 publications

References 115 publications

Late onset psychosis in a case of 15q11.2 BP1-BP2 microdeletion (Burnside–Butler) syndrome: A case report and literature review

Late onset psychosis in a case of 15q11.2 BP1-BP2 microdeletion (Burnside–Butler) syndrome: A case report and literature review

A Case Report of a Patient with Soaring Clozapine Levels after Developing a Urinary Tract Infection

Clozapine-induced eosinophilia: A case report

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