RESUMO
Nonadherence to medications is common and associated with poor or limited clinical outcomes in the treatment of bipolar disorder. A review of the literature discloses that adverse effects are one of the commonly reported reasons for nonadherence to mood stabilizers by patients with bipolar disorder. Nevertheless, other than such broad summaries, relatively little attention has been given to the role of adverse effects in relation to nonadherence. This review article is the first to consolidate the available data on this topic. Weight gain, perceived cognitive impairment, tremors, and sedation are the adverse effects most likely to lead to nonadherence. Further research is needed to anticipate, identify, manage, and potentially minimize the impact of adverse effects.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Adesão à Medicação , Psicotrópicos/efeitos adversos , Transtorno Bipolar/psicologia , Transtornos Cognitivos/induzido quimicamente , Humanos , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Tremor/induzido quimicamente , Vigília/efeitos dos fármacos , Aumento de Peso/efeitos dos fármacosRESUMO
BACKGROUND: Clozapine is reserved for overcoming treatment resistance in schizophrenia. Malignancy is common in schizophrenia; however, there is limited evidence available on continuing clozapine with chemotherapy, with both having hematological adverse effects. OBJECTIVE: To report a case on the use of granulocyte colony-stimulating factor (G-CSF) in conjunction with clozapine and chemotherapy. METHODS: We searched PubMed for any available information on the use of granulocyte G-CSF with clozapine and chemotherapy. We report the case of a patient with schizophrenia who developed B-cell lymphoma and was treated with chemotherapy consisting of CHOP regimen, rituximab, and methotrexate. He was continued on clozapine and G-CSF. RESULTS: We did not find any reports on G-CSF use in conjunction with clozapine and chemotherapy. We found case reports and a case series on the use of G-CSF in clozapine rechallenge with clozapine-induced agranulocytosis with mixed results. In our patient on clozapine, the white blood cell counts reduced by chemotherapy, were successfully replenished with the use of filgrastim, a G-CSF. CONCLUSIONS: With risks of psychosis relapse and exacerbation with discontinuing clozapine, the addition of G-CSF could be a useful aid in replenishing white cell counts lost to chemotherapy whilst continuing clozapine. However, further study is needed on this combination.
