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Initiation of Clozapine Therapy in a Patient with Preexisting Leukopenia: A Discussion of the Rationale of Current Treatment Options

Initiation of Clozapine Therapy in a Patient with Preexisting Leukopenia: A Discussion of the... Clozapine remains the most effective agent for diminishing or eliminating psychotic symptoms in treatment-resistant patients. However, among such patients, a small percentage (<3.0%) develops clozapine-induced granulocytopenia (CIG). In spite of the fact that lithium and granulocyte colony stimulating factor (G-CSF) have been shown to reverse CIG, many such patients are consigned to treatment with antipsychotic agents that have failed in the past. Apparently, their physicians are not aware that these patients can be salvaged for ongoing clozapine treatment. We report the effectiveness of lithium in reversing CIG in a young man with preexisting mild granulocytopenia. The rapidity of onset of leukocyte depletion is discussed in light of previously hypothesized autoimmune mechanisms of CIG. This case dramatizes the importance of lithium (or G-CSF) augmentation in those patients to maintain clozapine treatment so that their neutropenia can be reversed, and they can continue to benefit from the unique antipsychotic qualities of clozapine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Clinical Psychiatry Springer Journals

Initiation of Clozapine Therapy in a Patient with Preexisting Leukopenia: A Discussion of the Rationale of Current Treatment Options

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Publisher
Springer Journals
Copyright
Copyright © 2001 by American Academy of Clinical Psychiatrists
Subject
Medicine & Public Health; Neurology; Psychiatry; Psychopharmacology
ISSN
1040-1237
eISSN
1573-3238
DOI
10.1023/A:1014681418969
Publisher site
See Article on Publisher Site

Abstract

Clozapine remains the most effective agent for diminishing or eliminating psychotic symptoms in treatment-resistant patients. However, among such patients, a small percentage (<3.0%) develops clozapine-induced granulocytopenia (CIG). In spite of the fact that lithium and granulocyte colony stimulating factor (G-CSF) have been shown to reverse CIG, many such patients are consigned to treatment with antipsychotic agents that have failed in the past. Apparently, their physicians are not aware that these patients can be salvaged for ongoing clozapine treatment. We report the effectiveness of lithium in reversing CIG in a young man with preexisting mild granulocytopenia. The rapidity of onset of leukocyte depletion is discussed in light of previously hypothesized autoimmune mechanisms of CIG. This case dramatizes the importance of lithium (or G-CSF) augmentation in those patients to maintain clozapine treatment so that their neutropenia can be reversed, and they can continue to benefit from the unique antipsychotic qualities of clozapine.

Journal

Annals of Clinical PsychiatrySpringer Journals

Published: Oct 19, 2004

References