ABSTRACT
Clozapine has a unique efficacy in treatment-resistant schizophrenia. Its use is, however, associated with potential adverse events. Among those, clozapine induced rhabdomyolysis can compromise clozapine treatment. Recommendations surrounding the management of this rare adverse event are limited. We present a case of clozapine-induced rhabdomyolysis. A 20-year-old Caucasian male diagnosed with resistant schizophrenia developed, after a 5-month total exposition and a significant response to treatment, a marked creatine kinase (CK) elevation and important myalgia in the weeks following an increment from 175 to 200 mg of the daily dose of clozapine. This event also coincided with weight training as reported by the patient. The patient was hospitalized, and the clozapine was stopped following the diagnosis of rhabdomyolysis (CK 45,564 U/L). The cause of rhabdomyolysis was thoroughly investigated, and clozapine was held accountable for most. Clozapine cessation led to a severe psychotic relapse. Clozapine rechallenge while strictly monitoring CK was then performed allowing a significant clinical response. Clozapine was pursued despite two other episodes of mild CK elevations observed following weight training. Rhabdomyolysis comes as a rare adverse event of clozapine and its mechanism is poorly understood. Evidence on clozapine rechallenge following this adverse event is lacking and the innocuity of such practice is unknown. The unique aspect of our case report is that a shared decision with the medical team, patient and family led to a proactive clozapine rechallenge. More research is needed to provide robust guidelines and evidenced based approaches for clinicians in such a clinical dilemma.
ABSTRACT
BackgroundThe COVID-19 pandemic and the isolation measures taken to control it has caused important disruptions in economies and labour markets, changed the way we work and socialize, forced schools to close and healthcare and social services to reorganize in order to redirect resources on the pandemic response. This unprecedented crisis forces individuals to make considerable efforts to adapt and can have serious psychological and social consequences that are likely to persist once the pandemic has been contained and restrictive measures lifted. These impacts will be significant for vulnerable individuals and will most likely exacerbate existing social and gender health and social inequalities. This crisis also puts a toll on the capacity of our healthcare and social services structures to provide timely and adequate care. In order to minimize these consequences, there is an urgent need for high-quality, real-time information on the psychosocial impacts of the pandemic. The MAVIPAN (Ma vie et la pandemie/My life with the pandemic) study aims to document how individuals, families, healthcare workers, and health organisations that provide services are affected by the pandemic and how they adapt. MethodsThe MAVIPAN study is a 5-year longitudinal prospective cohort study that was launched on April 29th, 2020 in the province of Quebec which, at that time, was the epicenter of the pandemic in Canada. Quantitative data is collected through online questionnaires approximately 5 times a year depending on the pandemic evolution. Questionnaires include measures of health, social, behavioral and individual determinants as well as psychosocial impacts. Qualitative data will be collected with individual and group interviews that seek to deepen our understanding of coping strategies. DiscussionThe MAVIPAN study will support the healthcare and social services system response by providing the evidence base needed to identify those who are most affected by the pandemic and by guiding public health authorities decision making regarding intervention and resource allocation to mitigate these impacts. It is also a unique opportunity to advance our knowledge on coping mechanisms and adjustment strategies. Trial registrationNCT04575571 (retrospectively registered)
