Chart review for potential features of myocarditis, pericarditis, and cardiomyopathy in children and adolescents treated with clozapine.
ABSTRACT Clozapine is known to cause cardiac side effects, including myocarditis, pericarditis, and cardiomyopathy. Prompted by a case of clozapine-related pericarditis in an adolescent, we undertook a retrospective chart review to discover whether any unrecognized cases of myocarditis, pericarditis, or cardiomyopathy were among the children, adolescents, and young adults we had treated with clozapine. The sample comprised a total of 36 patients, who were monitored regularly over a period ranging from 2.5 to 79 months. The average observation period was 7.5 months. Patients were assessed for potential indicators of myocarditis, pericarditis, or cardiomyopathy. In more than 66% of all patients, at least one of several parameters potentially indicative of pericarditis, myocarditis, or cardiomyopathy was abnormal in at least one instance during the observation period. In all cases in which abnormalities were discovered, the abnormalities were found to be unspecific for myocarditis, pericarditis, or cardiomyopathy. With the exception of the case which prompted our study, none of the patients were found to have developed any such disorder in the course of further treatment with clozapine.
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ABSTRACT: This study proposed an inexact credibility constrained programming (ICCP) to deal with multi-formats of uncertainties in parameters and variables for an agricultural water planning system. The study system includes three subareas with different crop distributions. The redundant water in the wet season can be stored in the reservoir and utilized in the dry season. The ICCP method can reflect not only inexact uncertainties in the objective function, variables and parameters, but also fuzzy uncertainties in the right-hand side. Interval credibility levels which represent satisfaction degrees of the constraints can be analyzed. Scenario analysis is conducted to analyze possible events in wet and dry years. The resulting solutions can provide stable intervals for the objective function and decision variables with different levels of risk when violating the constraints.Resources Conservation and Recycling 02/2011; 55(4):441-447. · 2.69 Impact Factor
- Zeitschrift Fur Kinder-und Jugendpsychiatrie Und Psychotherapie - Z KINDER JUGENDPSYCHIAT PSYCH. 01/2009; 37(4):231-367.
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ABSTRACT: The use of clozapine (CLZ) for treatment-resistant schizophrenia is well established in adults. However, it is seldom used in youth with early onset schizophrenia (EOS) largely because of lack of clarity about its risk benefit ratio. This review synthesises and evaluates available evidence regarding the efficacy and tolerability of CLZ in EOS with the aim to assist clinical decision-making. We conducted a systematic review of the primary literature on the clinical efficacy and adverse drug reactions (ADRs) observed during CLZ treatment in EOS. We also identified relevant practice guidelines and summarised current guidance. CLZ showed superior efficacy than other antipsychotics in treating refractory EOS patients; short-term clinical trials suggest an average improvement of 69% on the Brief Psychiatric Rating Scale that was sustained during long-term follow-up (up to 9 years). No fatalities linked to CLZ treatment were reported. Sedation and hypersalivation were the most common complaints, reported by over 90% of patients. Other common ADRs (reported in 10-60% of patients) were enuresis, constipation, weight gain, and non-specific EEG changes. Less common ADRs (reported in 10-30% of patients) were akathisia, tachycardia and changes in blood pressure. Neutropenia was reported in 6-15% of cases but was usually transient while agranulocytosis was rare (<0.1%). Seizures were also uncommon (<3%). Metabolic changes were relatively common (8-22%) but emergent diabetes was not frequently observed (<6%). Overall the rate of discontinuation was low (3-6%). Current guidelines recommend the use of CLZ in EOS patients who have failed to respond to two adequate trials with different antipsychotics and provide detailed schedules of assessments to evaluate and assess potential ADRs both prior to initiation and throughout CLZ treatment. Available data although limited in terms of number of studies are consistent in demonstrating that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored.European Psychiatry 10/2013; · 3.21 Impact Factor