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A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia

The functional status of an individual with schizophrenia is the defining factor in their quality of life and is closely associated with cognitive abilities, which are impaired in individuals with schizophrenia and considered to be the core symptom of the disorder. The use of psychopharmacotherapy c...

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Autores principales: Pjevac, Milica, Korošec Hudnik, Liam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425236/
https://www.ncbi.nlm.nih.gov/pubmed/37583839
http://dx.doi.org/10.3389/fpsyt.2023.1222177
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author Pjevac, Milica
Korošec Hudnik, Liam
author_facet Pjevac, Milica
Korošec Hudnik, Liam
author_sort Pjevac, Milica
collection PubMed
description The functional status of an individual with schizophrenia is the defining factor in their quality of life and is closely associated with cognitive abilities, which are impaired in individuals with schizophrenia and considered to be the core symptom of the disorder. The use of psychopharmacotherapy can also have a significant impact on cognitive functioning. The relationship between clozapine treatment and cognitive impairment in individuals with schizophrenia is an intricate one. While some studies have reported a positive effect of clozapine on learning and memory, other studies have found that patients treated with clozapine experienced a decline in cognitive functioning in particular areas. In particular, attention and memory have been shown to deteriorate with rising plasma levels of clozapine. This effect may be attributed to its anticholinergic effect. A reduction in the medication related to anticholinergic burden has been previously found to improve cognitive abilities. In the presented case, we describe a psychotic relapse with delirium symptoms in a patient on clozapine treatment with potentially toxic clozapine blood level. The symptoms of delirium subsided after a clozapine dose adjustment. Gradually lowering the initially very high anticholinergic burden improved the patient's cognitive functioning.
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spelling pubmed-104252362023-08-15 A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia Pjevac, Milica Korošec Hudnik, Liam Front Psychiatry Psychiatry The functional status of an individual with schizophrenia is the defining factor in their quality of life and is closely associated with cognitive abilities, which are impaired in individuals with schizophrenia and considered to be the core symptom of the disorder. The use of psychopharmacotherapy can also have a significant impact on cognitive functioning. The relationship between clozapine treatment and cognitive impairment in individuals with schizophrenia is an intricate one. While some studies have reported a positive effect of clozapine on learning and memory, other studies have found that patients treated with clozapine experienced a decline in cognitive functioning in particular areas. In particular, attention and memory have been shown to deteriorate with rising plasma levels of clozapine. This effect may be attributed to its anticholinergic effect. A reduction in the medication related to anticholinergic burden has been previously found to improve cognitive abilities. In the presented case, we describe a psychotic relapse with delirium symptoms in a patient on clozapine treatment with potentially toxic clozapine blood level. The symptoms of delirium subsided after a clozapine dose adjustment. Gradually lowering the initially very high anticholinergic burden improved the patient's cognitive functioning. Frontiers Media S.A. 2023-07-31 /pmc/articles/PMC10425236/ /pubmed/37583839 http://dx.doi.org/10.3389/fpsyt.2023.1222177 Text en Copyright © 2023 Pjevac and Korošec Hudnik. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Pjevac, Milica
Korošec Hudnik, Liam
A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia
title A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia
title_full A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia
title_fullStr A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia
title_full_unstemmed A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia
title_short A case report—“When less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia
title_sort case report—“when less is more”: controlled inpatient reduction of anticholinergic burden in a patient with clozapine-resistant schizophrenia
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425236/
https://www.ncbi.nlm.nih.gov/pubmed/37583839
http://dx.doi.org/10.3389/fpsyt.2023.1222177
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