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Clozapine induced diarrhea

Published online by Cambridge University Press:  23 March 2020

S. Ramos-Perdigues
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M.J. Gordillo
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
C. Caballero
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
S. Latorre
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
S.V. Boned
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M.T. Sanchez
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
P. Torres
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M. Guisado
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
E. Contreras
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M. De Almuedo
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
E. Esmeralda
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
E. Sanchez
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M. Segura
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
A. Fernandez
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
C. Torres
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
G. Herrero
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M. Tur
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
C. Merino
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain

Abstract

Introduction

Clozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.

Objectives

We describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.

Aims

Discuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.

Methods

We present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.

Results

At the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)

Conclusions

Diarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-Poster viewing: Consultation liaison psychiatry and psychosomatics
Copyright
Copyright © European Psychiatric Association 2017
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