Das Myokarditisrisiko einer Clozapin-Therapie und bei anderen atypischen Antipsychotika

 

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Zusammenfassung

Anliegen Mit der vorliegenden Kasuistik möchten wir das kardiale Nebenwirkungsrisiko von Clozapin thematisieren. Methode und Ergebnisse Wir stellen den klinischen Behandlungsverlauf einer schizomanischen Episode hinsichtlich Therapieerfolg und Komplikation einer Myokarditis vor. Schlussfolgerungen Der vorliegende Fall repräsentiert ein häufiges klinisches Dilemma, über das jeweils nur unter gewissenhafter Risikobewertung im Einzelfall zu entscheiden ist. Trotz der Schwere der psychiatrischen Erkrankung, musste aufgrund des unmittelbar lebensbedrohlichen Charakters der Myokarditis eine fortbestehende produktiv-psychotische Symptomatik in Kauf genommen werden.

Abstract

Objective Clozapine is considered as a strong psychopharmaceutic agent in symptom control of psychotic disturbances. However, possible side effects to hematologic, metabolic and cardiologic systems are still entailing a defensive application in psychiatric praxis. Methods A patient suffering from schizoaffective disorder clinically developed symptoms of cardial disturbances under the psychopharmacotherapy of Clozapine. Specific laboratory analysis and technical procedures were applied, clarifying the background of this serious event. Results ECG and specific myocardial encymes (CK, Troponine-I) requesting an acute myocardial infarction were negative. Specific laboratory analysis revealed positive inflammation markers with elevated C-reactive protein and interleukin-6. Additionally, there were increasings of TNF-alpha and C3 as well as an eosinophilia at differential blood cell count. Echocardiography found an unspecific dyskinesia of the left ventricle, but contrast-enhanced cardial MRI showed structural intramyocardial inhomogeneities suggesting a myocarditis. Conclusions In spite of the striking psychopharmacotherapeutic benefit, Clozapine may be associated with serious cardial events. We discuss these cardiological problems in association to a Clozapine therapy in regard to its clinical relevance in treatment of psychotic disturbances.

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Michael Adamaszek, MD

Neurologisches Rehabilitationszentrum
Universität Leipzig

Muldentalweg 1

04828 Leipzig-Bennewitz

Email: michael.adamaszek@sachsenklinik.de