RESUMO
Two percent of acute pancreatitis are drug induced. In the present paper, we reported the case of a 39 year-old patient with chronic-hallucinatory schizophrenia who developed symptomatic pancreatitis during the clozapine dose titration performed to reach the therapeutic range. Diagnosis of pancreatitis was suggested by clinical examination and abnormal laboratory values of pancreatic enzymes and confirmed by C-T scan and ultrasonography. The causal incrimination of clozapine in this case seems likely as all other possible causes of pancreatitis were excluded, as AP developed shortly after the introduction of the drug and as the pancreatic enzymes normalized after clozapine was stopped. No rechallenge to confirm the causal relationship was however attempted. So far, only eight cases of acute pancreatitis have been reported in association with clozapine use. Clozapine is an atypical antipsychotic drug which belongs to the chemical class of dibenzodiazepines. The mechanism by which clozapine could produce acute pancreatitis remained unclear. Nevertheless, we advocate a careful biological follow-up (measuring periodically the concentrations of amylase, lipase and triglycerides) during the treatment by clozapine.
Assuntos
Clozapina/efeitos adversos , Pancreatite/induzido quimicamente , Esquizofrenia Paranoide/tratamento farmacológico , Doença Aguda , Adulto , Clozapina/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Seguimentos , Humanos , Assistência de Longa Duração , Masculino , Testes de Função Pancreática , Pancreatite/diagnóstico , Pancreatite/terapia , Medição de Risco , Esquizofrenia Paranoide/diagnóstico , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
The law of June 26, 1990 (protection measure of the mental patients) has replaced the old law of collocation of 1850 (review in 1873). Conceived in the line of the principles of the European Convention of the Humans right, it constitutes an important reform of the involuntary treatment of the mental patients and recalls, without any doubt, that the patient is prone of right. The article describes the scope of application of the law of June 26, 1990, and the methods of initiation of a protection measure. Then, the measure in a hospital environment (ordinary procedure and urgent procedure), as well as the measure in a family environment are approached in their waning. Furthermore, the role of the general practitioner is evoked at the various stages of the procedure.
