Case report: Chlorpromazine and deep venous thrombosis

COVID-19 and Antipsychotic Therapy: Unraveling the Thrombosis Risk

In the context of the COVID-19 pandemic, this study investigates the potential correlation between the increased use of antipsychotic medications and the rising incidence of venous thromboembolism (VTE). As psychiatric disorders surged, the consequential escalation in antipsychotic drug use raised concerns about thrombotic risks. We conducted a comprehensive literature review using PubMed, focusing on articles that intersected COVID-19, antipsychotic medication, and thrombosis. This approach allowed for a nuanced examination of the historical and recent data on antipsychotic drugs and their association with thrombotic events. Our findings reveal a notable link between the use of antipsychotic medications, particularly second-generation antipsychotics, and an increased risk of VTE, including pulmonary embolism and deep vein thrombosis. This association was evident, despite variations in study designs and populations. The study underscores the need for cautious medication management in psychiatric care, especially during pandemic conditions like COVID-19, to mitigate thrombotic risks. It advocates a personalized approach to prescribing antipsychotics, considering individual patient factors and comorbidities, to balance the benefits against potential thrombotic complications.

Pulmonary Embolism during a Retrial of Low-dose Clozapine

Pulmonary emboli (PE) are increasingly recognized as an adverse effect of clozapine. However, little is known about the characteristics or mechanisms of clozapine-associated PE. We present a case of a 34-year-old with treatment-refractory schizophrenia who developed rhabdomyolysis during his first clozapine trial. During re-trial on a lower dose than his initial trial, the patient developed chest pain that he attributed to “pacemakers.” The pleuritic description and associated tachycardia prompted medical workup and the patient was ultimately diagnosed with a clozapine-associated PE. The patient’s only risk factors for PE were obesity and tobacco use, while his hypercoagulability workup was unrevealing. Clozapine use was continued at a lower dose following these adverse effects given inefficacy of other agents in managing the patient’s psychotic symptoms. The patient experienced significant relief of psychotic symptoms with continued clozapine therapy and a course of electroconvulsive therapy. The patient’s presentation was unusual in that it occurred during a retrial of clozapine, after the initial trial was stopped when he developed rhabdomyolysis. This case demonstrates the importance of maintaining vigilance for PE in patients on clozapine as well as not dismissing somatic complaints in patients experiencing psychosis. Additionally, given his history rhabdomyolysis, an uncommon adverse effect of clozapine, the development of a second uncommon adverse effect (PE) raises the question of whether these events may be associated.

Deep vein thrombosis on the fourth day of risperidone therapy

Deep vein thrombosis has been recognised as a complication of antipsychotic treatment and is reported to be more common with atypical antipsychotics. Risperidone is a second-generation atypical antipsychotic and there have been case reports of risperidone-associated deep vein thrombosis, most of them reporting the complication from 2 weeks to a few months of initiation of therapy. Here, we are reporting a case of deep vein thrombosis in a male patient in his early forties with paranoid schizophrenia, which presented on the fourth day of starting risperidone therapy. This case is being reported to highlight the fact that deep vein thrombosis can occur as early as fourth day of initiation of risperidone therapy, that too at a low dose (2 mg/day). The case also emphasises the importance of monitoring these patients for this rare but potentially serious adverse effect from the first day itself after initiation of a new antipsychotic.