Memduha Aydın

Continuing clozapine treatment with lithium in schizophrenic patients with neutropenia or leukopenia: brief review of literature with case reports

Objective: Clozapine is a second-generation antipsychotic used for treatment-resistant schizophrenia. Despite its effectiveness, clozapine is largely underused due to serious side effects such as leukopenia or neutropenia. We aimed to review whether to continue, discontinue or rechallenge clozapine treatment after such haematological side effects. Methods: We reviewed and summarized the literature on the use of clozapine, how to deal with its side effects, and suitable options in case of any haematological problems. Then, we described several cases successfully treated with clozapine and lithium after development of neutropenia or leukopenia Results: We present three patients with treatment-resistant schizophrenia. While they had demonstrated poor response to multiple antipsychotic trials, clozapine was started. Clozapine induced neutropenia; or leukopenia developed in some cases that was successfully reversed after lithium onset. Increased serious side effects related with coprescription of lithium and clozapine were not observed. Conclusion: Lithium increases neutrophil and total white blood cell count as a side effect that may be useful in patients who develop neutropenia or leukopenia while being treated with clozapine.

Evaluation of retinal nerve fiber layer, macular, and choroidal thickness in schizophrenia: spectral optic coherence tomography findings

ABSTRACT OBJECTIVES: The study was performed to evaluate the retinal nerve fiber layer (RNFL), macular, and subfoveal choroidal thickness (SFCT) in patients with schizophrenia and healthy controls using spectral domain optical coherence tomography (SD-OCT). METHODS: Fifty-nine schizophrenic patients and 36 age- and sex-matched healthy volunteers were enrolled in this cross-sectional clinical study. The RNFL, macular, and SFCT thickness measurements obtained by SD-OCT were compared between the groups. RESULTS: The mean age of 59 patients included in this study was 34.64 years and the mean age of 36 healthy controls was 32.08 years, mean illness duration was 10.33 years, mean total Positive and Negative Symptom Scale (PANSS) score was 75.18, and mean CGI-S score was 3.88. Macular thickness in the superior inner (350.97 ± 16.51 vs. 341.81 ± 16.35), nasal inner (348.97 ± 17.53 vs. 340.25 ± 17.55), inferior inner (345.5 ± 17.59 vs. 335.47 ± 16.92), temporal inner (333.28 ± 17.96 vs. 321.97 ± 19.96), and temporal outer (289.14 ± 14.10 vs. 281.29 ± 15.31) segments were significantly decreased in schizophrenic patients. However; RNFL thickness and choroidal thickness (CT) measurements between the two groups were similar. No significant correlation was found between illness duration, PANSS score, CGI-S score and RNFL thickness and macular thickness measurements. There was a weak negative correlation between disease duration and CT. CONCLUSIONS: The findings from this study suggest that macular thickness measurements are reduced in schizophrenic patients but do not indicate any significant change in RNFL or choroids. Further studies are needed to determine the potential application of optical coherence tomography as a tool for the diagnosis and monitoring the progression of this disease.

Medroxyprogesterone acetate-induced mania in a patient with bipolar affective disorder

Medroxyprogesterone acetate (MPA) is a steroidal progestin which is used as a contraceptive, in hormone replacement therapy, dysmenorrhea and amenorrhea. A 19-year-old female with bipolar affective disorder who was started on MPA for the treatment of secondary amenorrhea developed manic episodes while taking MPA pills. She was in remission for three years when MPA was commenced. As manic symptoms emerged following the onset of MPA treatment, risperidone and valproic acid was administered, which was then switched to aripiprazole and lithium treatment because of side effects. The manic episode resolved three weeks after hospital admission. This case report highlights the risk of commencing hormone pills in patients with personal history of affective disorders because of the possibility of MPA-induced manic episode.

İlk atak psikoz hastalarında nötrofil lenfosit oranının değerlendirilmesi

Giris: Inflamasyonun sizofreni patofizyolojisinde rol oynayabilecegi ile ilgili literaturde giderek artan bir fikir birligi vardir. Kan notrofil lenfosit orani basit, ucuz ve inflamasyonun guvenilir bir gostergesidir. Bu calismanin amaci; ilk atak psikoz ile notrofil lenfosit orani arasindaki iliskiyi incelemek ve eger bir iliski varsa bunun hastalik siddeti ile iliskisini arastirmaktir. Yontem: Bu retrospektif calismada Ocak 2011 ile Haziran 2014 tarihleri arasinda hastanemizde tedavi edilmis 58 ilk atak psikoz hastalarinin hastane kayitlari analiz edildi. Hastane kayitlarindan hematolojik parametreler, Kisa Psikiyatrik Degerlendirme Olcegi (KPDO) puanlari ve demografik veriler elde edildi. Ilk atak psikoz tanili 58 hastanin hematolojik parametreleri ve notrofil lenfosit oranlari 37 kisilik saglikli kontrol grubunun degerleri ile karsilastirildi. KPDO puanlari ile notrofil lenfosit oranlari arasindaki korelasyon degerlendirildi. Bulgular: Ortalama notrofil lenfosit orani hastalarda kontrol grubuna gore anlamli derecede yuksek cikti (2,22 ± 1,25 vs. 1,63 ± 0,38, p = 0,041). Notrofil sayisinda hastalar ve sagliklilar arasinda fark yoktu (4,03 ± 0,70 vs. 4,20 ± 1,48, p = 0,525), ama lenfosit sayisi hastalarda anlamli derecede dusuktu (2,56 ± 0,55 vs. 2,19 ± 0,77, p = 0,013). Ilk atak psikozlarda notrofil lenfosit orani ile hastalik siddeti (KPDO puani) arasinda anlamli korelasyon yoktu (n = 58; r = 0,060, p = 0,655). Sonuc: Calismamizda; fiziksel olarak saglikli, daha once hic antipsikotik kullanmamis ilk atak psikoz hastalarinda notrofil lenfosit orani fiziksel ve ruhsal olarak saglikli katilimcilara gore yuksek cikmistir.