Teška pneumonija izazvana antipsihotičnim lekovima - šta ne odgovara, pacijent ili lek?

Abstract

Introduction: Antipsychotic drugs are generally categorized as typical antipsychotics (sometimes referred to as first-generation or conventional antipsychotics, or neuroleptics) and atypical antipsychotics; both are approved for the treatment of acute and chronic psychoses (i.e, schizophrenia), mania, agitation, and other psychiatric disorders. In 2005 the US Food and Drug Administration issued a warning about the increased risk of all-cause mortality associated with atypical antipsychotic use in elderly patients with dementia. Community acquired pneumonia (CAP) was one of the most frequently reported causes of death. The same warning was extended to typical antipsychotics in 2008 with extension to people with or without dementia. Case report: We present a 65-year-old Caucasian woman who was admitted to hospital due to massive pneumonia. She was suffered forschisophrenia 15-years and at moment of admission she was in remission. She had continuously high fever up to 40 degrees. All collected cultures (blood, sputum, urine, smear of aspirating catheter) were negative. She was treated with various antibiotics without improvement. After changing antipsychotic drugs, she showed slow improvement until total recovery after 3 months. Discussion and conclusion: Antipsychotic-associated CAP seems to be a clinically relevant issue in frail elderly patients, as consistently documented in several epidemiologic investigations. No clear evidence exists for an increased risk of pneumonia in younger patients treated with antipsychotics. In elderly populations, the increase in risk is dose-dependent, and is more pronounced in the early phases of treatment. Future studies should better define the mechanism underlying antipsychotic-induced pneumonia and identify subgroups of antipsychotic users at higher risk of developing pneumonia.