title: [The risk for myocarditis of clozapine and other atypical antipsychotics: case report and study of the literature].
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 enzymes (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 was increasing 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 psycho-pharmacotherapeutic 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.
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Universität Leipzig. michael.adamaszek@sachsenklinik.de
authors.forename: Michael
authors.initials: M
authors.lastname: Adamaszek
authors.forename: Sebastian
authors.initials: S
authors.lastname: Olbrich
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.forename: Peter
authors.initials: P
authors.lastname: Schönknecht
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use / Q000633:toxicity*; D003024:Clozapine / Q000627:therapeutic use / Q000633:toxicity*; D003419:Crisis Intervention; D003617:Dangerous Behavior; D003702:Delusions / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000139:chemically induced* / Q000175:diagnosis; D010343:Patient Admission; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine