¿Mantenimiento o retirada? Pericarditis en un paciente en tratamiento con clozapina: a propósito de un caso / To persist or to withdraw? Pericarditis in a patient undergoing treatment with clozapine: report of a clinical case

Introducción: La pericarditis inducida por clozapina es un cuadro raro, pero potencialmente grave para cuya resolución se recomienda la discontinuación del tratamiento con clozapina. Presentación del caso Se trata de un varón de 17 años en tratamiento con clozapina por el fracaso de 3 líneas antipsicóticas previas, con una buena respuesta terapéutica, que 2 meses después del inicio del fármaco desarrolla un cuadro de pericarditis. En la evaluación multidisciplinar, se decide conjuntamente con la familia el tratamiento de la pericarditis, manteniendo clozapina en dosis menores, con la resolución de la misma y conservando la estabilidad psicopatológica. Discusión La miocarditis y pericarditis inducidas por clozapina son efectos adversos graves que aparecen en su mayoría en el primer mes de tratamiento. La actitud generalizada frente a la pericarditis inducida por clozapina es su retirada. Esta retirada puede plantear un dilema ético y debe ser valorada cuidadosamente, ya que el riesgo de descompensación psiquiátrica y pérdida de la calidad de vida debe ser tenido en cuenta. Conclusión Este caso resalta la importancia de realizar un balance riesgo/beneficio en cada caso complejo, reflejando la encrucijada ética del manejo de los efectos adversos de clozapina, puesto que su retirada puede comprometer negativamente la estabilidad psicopatológica y la calidad de vida del paciente. (AU)

Introduction: Clozapine-induced pericarditis is a rare but potentially serious condition for which discontinuation of clozapine treatment is recommended for resolution. Presentation of the case A 17-year-old male under treatment with clozapine due to failure of three previous antipsychotic lines, with good therapeutic response, who two months after starting the drug developed pericarditis. Discussion Clozapine-induced myocarditis and pericarditis are serious adverse effects that appear mostly in the first month of treatment. The generalized attitude towards clozapine-induced pericarditis is its withdrawal. This withdrawal may pose an ethical dilemma and should be carefully assessed, as the risk of psychiatric decompensation and loss of quality of life should be taken into account. Conclusion This case highlights the importance of performing a risk/benefit balance in each complex case, reflecting the ethical conflict of the management of clozapine adverse effects, since its withdrawal may negatively compromise the patient's psychopathological stability and quality of life. (AU)

[Does the COVID-19 pandemic condition the delusional content of patients with psychosis? An observational study]. / ¿La pandemia de COVID-19 condiciona el contenido delirante de los pacientes con psicosis? Un estudio observacional.

Introduction: The primary objective is to analyse the impact of the COVID-19 pandemic on the triggers of psychopathology and on the delusional content of patients with psychotic symptoms treated during the first three months of the pandemic in a tertiary hospital in Madrid.Methods: We conducted a cross-sectional, observational and retrospective study of all patients attending the psychiatric emergency room (ER) between 11th March and 11th June 2020. Sociodemographic and clinical variables were included. The chi-squared test or Fisher's exact test were performed to compare categorical variables. The level of statistical significance was set at p<0.05.Results: In the first month of the pandemic, COVID-19 conditioned the delirious content of 38.5% of the admitted patients and acted as a direct trigger for 46.2% of consultations. In the second week it affected 100.0% of the patients in both cases. Subsequently, a progressive and significant decrease was observed, with COVID-19 being the triggering factor for 17.6% and 11.5% of consultations in the second and third months of the pandemic respectively. Similarly, it was the main determinant of the delusional content in 13.7% and 3.8% of cases respectively.Conclusions: The current pandemic affects delirium's pathoplasty. The delusional content of patients admitted with psychotic symptoms is quickly conditioned, which may be related to the radical change in their life, without transition or prior preparation. The patient's environmental context and events have a huge impact on the dynamics and characteristics of mental disorders.

Análisis de la demanda asistencial en la urgencia y unidad de hospitalización psiquiátrica en el contexto de pandemia por COVID-19 / Analysis of the demand for care in a psychiatric emergency room and an acute inpatient unit in the context of the COVID-19 pandemic

INTRODUCCIÓN: El objetivo consiste en analizar el impacto del COVID-19 en la demanda asistencial de las urgencias y en los ingresos psiquiátricos durante el primer mes de la pandemia. MÉTODOS: Realizamos un estudio transversal observacional retrospectivo en pacientes que acuden a urgencias psiquiátricas entre el 11 de marzo y el 11 de abril de 2019 y 2020 respectivamente. Se incluyeron variables sociodemográficas y clínicas en el estudio. Se realizaron las pruebas de Chi Cuadrado o Test exacto de Fisher para el contraste de hipótesis de variables categóricas y la prueba U Mann-Whitney para el contraste de variables cuantitativas. El nivel de significación estadística se estableció en p<0.05. Los análisis se realizaron con IBM SPSS Statistics. RESULTADOS: Se observa un descenso significativo de la media de pacientes atendidos al día en urgencias entre ambos periodos, siendo esta de 5,91 (±2,53) en 2019 y de 2,41 (±1,81) en 2020 (p<0.001). Se ha visto una disminución significativa de la ocupación media de camas en la UHB, ocupándose un 91,84% (±7,72) de camas en 2019 y un 58,85% (±13,81) en 2020 (p<0,001). En cuanto a la proporción de ingresos de los pacientes que acuden a urgencias, se ha visto un aumento significativo en el año 2020 respecto al año anterior. CONCLUSIONES: La demanda en la urgencia de pacientes psiquiátricos y la ocupación media de camas se ha reducido durante el primer mes tras la declaración de la pandemia. El miedo al contagio puede actuar como modulador de la demanda psiquiátrica.

INTRODUCTION: The aim is to analyze the impact of COVID-19 on the demand for emergency care and psychiatric admissions during the first month of the pandemic. METHODS: We conducted a retrospective, observational and cross-sectional study. We reviewed the clinical records of all patients attending the psychiatric emergency room (ER) between March 11th and April 11th, of both 2019 and 2020. Sociodemographic and clinical variables were included in the study. Chi-square test or Fisher's exact test were performed to compare categorical variables, while U Mann-Whitney U test was used for quantitative variables. The level of statistical significance was set at p<0.05. Analysis were conducted using IBM SPSS Statistics. RESULTS: The was a significant decrease in the number of patients attended in the ER. An average of 5.91 (±2.53) patients were treated per day in 2019 compared to 2.41 (±1.81) in 2020 (p<0.001). There was also a significant decrease in the occupancy rate at the inpatient psychiatric unit, with a 91.84% (±7.72) of beds occupied in 2019 and only 58.85% (±13.81) in 2020 (p<0.001). Regarding the percentage of patients admitted after assessment in the ER, there was a significant increase in 2020 compared to the previous year. CONCLUSIONS: The demand for care in the psychiatric emergency room and the average bed occupancy have decreased during the first month after the declaration of the pandemic. Fear of contagion may act as a modulator of psychiatric demand.

Eosinofilia y hepatitis en el tratamiento con clozapina: a propósito de un caso / Eosinophilia and hepatitis in a patient on clozapina treatment: A case report

Introducción: Además de agranulocitosis, el tratamiento con clozapina se asocia con eosinofilia. Aunque es un efecto secundario poco conocido, tiene una incidencia similar a la primera y además es potencialmente grave, ya que puede afectar a órganos diana como el hígado. Presentación del caso: Varón con sintomatología psicótica que tras varias semanas de ingreso comienza tratamiento con clozapina por la falta de respuesta farmacológica. Coincidiendo con el inicio de la misma presenta eosinofilia junto con un aumento de las enzimas hepáticas que alcanzan niveles tóxicos, por lo que se procede a su retirada. Discusión: La eosinofilia inducida por la clozapina puede ser periférica y benigna o puede infiltrar órganos diana como el hígado, desencadenando una hepatitis potencialmente mortal. Conclusiones: A pesar de que la hepatitis secundaria al tratamiento con clozapina puede ser fulminante, los controles seriados de las enzimas hepáticas no se incluyen en el protocolo de seguimiento de dicho tratamiento

Introduction: In addition to agranulocytosis, treatment with clozapine is associated with eosinophilia. Although it is a little-known side effect, it has an incidence similar to the former, and is also potentially serious, since it can affect target organs, such as the liver. Presentation of the case: A male with psychotic symptoms, on whom, after several weeks in hospital, it was decided to start clozapine due to the lack of pharmacological response. Coinciding with starting the drug, he presented with eosinophilia, as well as increased liver enzymes that reached toxic levels. The drug was then withdrawn. Discussion: Eosinophilia induced by clozapine may be peripheral and benign, or it may infiltrate target organs such as the liver, triggering potentially life-threatening hepatitis. Conclusions: Although hepatitis secondary to treatment with clozapine may be fulminant, serial liver enzyme tests are not included in the follow-up protocol for this treatment