Mania Research Articles

Setting the River on Fire: A Study of Genius, Mania, and Character

Setting the River on Fire: A Study of Genius, Mania, and Character

Comparative, Single-Dose, 2-Way Cross-Over Bioavailability Study of Two Olanzapine 10 Mg Tablet Formulations in Healthy Volunteers Under Fasting Conditions.

Objectives: Olanzapine is an atypical antipsychotic that is approved across Europe, the USA, and in many other countries for oral treatment of schizophrenia and acute manic episodes in patients with bipolar disorder as well as for maintenance therapy to prevent recurrence in responders. The objective of the present study was to compare the pharmacokinetics of two 10 mg tablet formulations of Olanzapine following a single oral dose in healthy volunteers under fasting conditions, as per the European Medicine Agency (EMA) guidelines to grant marketing authorization. Methods: This study was a randomized, open-label, two-treatment, two-period, two-sequences, single-dose, cross-over design with a washout period of 14 days. Both the test and the reference products were administered as 10 mg tablets with 240 mL of water after an overnight fast in each study period. A total of twenty blood samples were collected before dosing and within 144 hours after drug administration. Adverse events were monitored, recorded, and evaluated by investigators throughout the study. Results: Of the 24 healthy adult male subjects enrolled, all of them completed both study periods. The geometric mean ratio 90% confidence intervals (CI) for fasting Cmax, AUC0-t, and AUC0-infinity were 94.83-113.71%, 95.04-105.69% and 95.94-107.00%, respectively. The 90% CI for the ratios of the three primary pharmacokinetic parameters (using log-transformed data) were within the range of 80-125%, meeting the regulatory criteria for bioequivalence. Conclusions: The generic Olanzapine was bioequivalent to the reference formulation. It was well tolerated and provides an acceptable alternative to the reference drug.

Expressive writing therapy to a client with low self-esteem, hallucination and post-traumatic syndrome

Schizoaffective is a mental disorder that exhibits psychotic symptoms of schizophrenia and mood disorders which can be depressive episodes, manic episodes, or a mixture of the two episodes. This paper reported a case study of Ms. R, a 24-year-old woman diagnosed with schizoaffective disorder. She has self-esteem problems, hallucinations, and post-traumatic syndrome that interfere with her productivity and social life functions. The generalist psychiatric nursing care process and expressive writing therapy were implemented for her treatment for 18 days. The result supports that the combination of the two interventions positively impacted reducing signs and symptoms of low self-esteem, hallucinations, and anxiety symptoms in a client with schizoaffective. 

EE196 Healthcare Resource Use Among Patients Treated with Lurasidone or Cariprazine for Depressive Episodes Associated with Bipolar I Disorder

Bipolar I disorder (BPD-1) is a chronic mood disorder characterized by manic and depressive episodes that produces a substantial financial burden in the US. This retrospective chart review study compared healthcare resource utilization (HRU) among patients with depressive episodes associated with BPD-1 treated with lurasidone or cariprazine, two atypical antipsychotics approved for treatment of bipolar depression.

Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania

Knowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. To investigate the response to ECT in patients with manic episodes. This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hospital in Sweden and receiving ECT for a manic episode between 2012 and 2019 were considered for inclusion (605 individuals). The outcome, Clinical Global Impression Improvement scale (CGI-I) score, was available in 571 patients. Data from several national registers were combined to determine clinical and sociodemographic factors. Analysis of data occurred from April through September 2021. Patients treated with ECT for a mania were identified from the Q-ECT. Response to ECT was defined by a CGI-I score of 1 (very much improved) or 2 (much improved). Remission was defined as a Clinical Global Impression Severity scale (CGI-S) score of 1 (reference range or not ill) or 2 (minimally ill) within 1 week after ECT. Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology, and comorbidities with response. Among 571 patients with mania treated with ECT (211 [37.0%] men; median [IQR] age, 46 [31-59] years), 482 patients (84.4%) responded to ECT. Comorbid anxiety and obsessive-compulsive disorder (OCD) were associated with lower odds of response to ECT (adjusted odds ratio [aOR], 0.48; 95% CI, 0.25-0.90 and aOR, 0.17; 95% CI, 0.06-0.56, respectively). Patients who were markedly ill (aOR, 2.93; 95% CI, 1.23-7.00), severely ill (aOR, 2.60; 95% CI, 1.06-6.34), or among the most extremely ill (aOR, 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness. This study found that ECT was associated with improvement for mania in clinical settings, with especially high response rates in patients with severe illness and those without comorbid anxiety or OCD.

Aging in bipolar disorder: Cognitive performance and clinical factors based on an adulthood-lifespan perspective

BackgroundThe evolution of cognitive performance throughout the lifespan in bipolar disorder (BD) is understudied. This cross-sectional study aims to describe the cognitive performance across age groups. MethodsA sample of 654 participants was recruited for this study (BD = 432 and healthy controls -HC- =222). Three subgroups, divided according to age range (18 to 35, 36 to 49, and ≥50 years old) were analyzed after administering a comprehensive neuropsychological battery including six cognitive domains. Demographic, clinical, and psychosocial functioning data were also analyzed. Generalized linear models (GLM) with age, diagnostic group, and age × group as main effects were carried out to examine their potential association on cognitive domains. Subsequently, a GLM in the BD sample was conducted to analyze interactions of several clinical variables by age on each cognitive domain. ResultsMain effects of diagnostic group and age were found in all cognitive domains. Significant group × age effect interaction was found for attention domain (p = 0.02) demonstrating a worse cognitive evolution across age in BD, driven by older age, but not in HC. Significant interaction effects of higher number of manic episodes and older age were also found in attention and verbal memory. Older age was also associated with a longer duration of illness, higher number of episodes, more somatic comorbidities, and poorer psychosocial functioning. ConclusionsThese results suggest that older age was associated with a selective cognitive decline in BD in the attentional domain. These findings highlight the importance of developing interventions targeting cognitive dysfunction throughout the BD adulthood lifespan.

Resilience Moderates the Associations between Bipolar Disorder Mood Episodes and Mental Health

Resilience could moderate the impact of bipolar disorder (BD) on patients’ quality of life (QoL) and psychosocial functioning. This study aimed to (1) explore the relationships between bipolar disorder mood episodes (depression, [hypo]mania, and euthymia) and mental health outcomes of QoL, personal recovery, impaired work, and psychosocial functioning in individuals with BD; and (2) determine whether resilience domains were moderators of these associations. A clinical adult sample of 97 individuals diagnosed with BD (63.90% female, mean age = 45.02 years) completed a battery of BD-specific measures of resilience and mental health-related variables. Multiple regression showed that self-management of BD resilience domain moderated the negative relationship between (hypo)manic episode and personal recovery. Furthermore, self-confidence moderated the positive relationships between (hypo)manic and depressive episodes and impaired functioning. We suggest that BD patients experiencing (hypo)manic or depressive episodes may improve their mental health and wellbeing through interventions that promote disorder-specific resilience factors.

The nosological status of unipolar mania and hypomania within UK Biobank according to objective and subjective measures of diurnal rest and activity.

There is uncertainty whether unipolar mania is a discrete sub-type of bipolar disorder. Disrupted rest/activity rhythms are a key feature of bipolar disorder (BD) but have not been well characterised in unipolar mania/hypomania (UM). We compared subjective and objective rest/activity patterns, demographic and mental health outcomes across BD, UM and control groups. UK residents aged 37-73 years were recruited into UK Biobank from 2006 to 2010. BD, UM and control groups were identified via a mental health questionnaire. Demographic, mental health and subjective sleep outcomes were self-reported. Accelerometery data were available for a subset of participants, and objective measures of sleep and activity were derived. A greater proportion of males met UM criteria, and more females were in the BD group. Both BD and UM groups had poor mental health outcomes vs. controls. Objectively measured activity differed between all three groups: UM had highest levels of activity and BD lowest. The UM group had shorter sleep duration compared to controls. Subjective rest/activity measures showed that both mood disorder groups (compared to controls) had later chronotype preference, more disturbed sleep and increased difficulty getting up in the morning. However, the UM group were more likely to report an early chronotype compared to BD and control groups. BD and UM share features in common, but key differences support the proposition that UM may be a distinct and more clinically homogenous disorder. UM was characterised by a higher proportion of males, early chronotype, increased activity and shorter sleep duration.

An Exhausting Job: A Story of Psychiatric Disability in University as Performativity (Dis)Rupture

Who gets to perform the identity of student? How does the process of obtaining accommodations affect a student’s sense of belonging in university? What messages do faculty attitudes send to students who seek accommodations for psychiatric disability? To facilitate addressing these questions, this article uses the fictional short story form to explore one student’s journey to receive accommodations in her classes during a manic episode of bipolar disorder. Drawing data from literature review and researcher lived experience, the story seeks to portray the complexity of navigating higher education’s disability services system. The story-as-research aims to build empathy through inviting readers to place themselves in the mind of the main character, to consider the messages she receives about (non)belonging from faculty who view accommodations from different standpoints. The article offers insight into the complex interplay of internalized stigma, passing as (dis)abled, and navigating discourses within an educational institution. Keywords: psychiatric disability, higher education, fiction-based research, performativity, accommodations

Clinical Aspects of Manic Episodes After SARS-CoV-2 Contagion or COVID-19.

As COVID-19 pandemic spread all over the world, it brought serious health consequences in every medical field, including mental health. Not only healthcare professionals were more prone to develop anxiety, depression, and stress, but the general population suffered as well. Some of those who had no prior history of a psychiatric disease developed peculiar symptoms following infection with SARS-CoV-2, mostly because of psychological and social issues triggered by the pandemic. People developed traumatic memories, and hypochondria, probably triggered by social isolation and stress. Infection with SARS-CoV-2 has influenced the mental health of psychiatric patients as well, exacerbating prior psychiatric conditions. In this review, we focus on analyzing those cases of mania in the context of bipolar disorder (BD) reported after COVID-19 disease, both in people with no prior psychiatric history and in psychiatric patients who suffered an exacerbation of the disease. Results have shown that COVID-19 may trigger a pre-existing BD or unmask an unknown BD, due to social and psychological influences (decreased social interaction, change in sleep patterns) and through biological pathways both (neuroinflammation and neuroinvasion through ACE-2 receptors expressed in the peripheral and central nervous systems (PNS and CNS respectively). No direct correlation was found between the severity of COVID-19 disease and manic symptoms. All cases presenting severe symptoms of both diseases needed specific medical treatment, meaning that they concur but are separate in the treatment strategy needed. This review highlights the importance of a now widespread viral disease as a potential agent unmasking and exacerbating bipolar mood disorder, and it can hopefully help physicians in establishing a rapid diagnosis and treatment, and pave the road for future research on neuroinflammation triggered by SARS-CoV-2.

Quality of Life And Disability of Patients With Bipolar Disorder According To Treatment Response

Bipolar Disorder (BD) is a lifelong, chronic mental illness with recurrent depressive, manic, hypomanic, or mixed episodes, with euthymic periods between episodes. The inadequate response is defined as the ineffectiveness of the drug from two different groups, despite being used sufficient dose and duration for the specific attack of the disease. BD is also related to impairment in functionality and disability. Most studies have demonstrated marked deterioration of quality of life and disability in patients with BD, even if they are clinically considered euthymic. Our study aims to determine the factors affecting the response to treatment and compare the quality of life and disability in patients with bipolar disorder. Our study included 150 patients with BD between 18-65 years who applied to the Dicle University Faculty of Medicine Psychiatry Clinic. Patients were divided into two groups according to treatment response. Sociodemographic Data Form, Clinical Global Impression Scale (CGI), Sheehan Disability Scale (SDS), World Health Organization Quality of Life Scale (WHOQOL-27) were applied to the participants. Inadequate response group had higher mood episodes, number of hospitalization, inadequate family support, non-adherence to treatment, suicide attempt, psychiatric comorbidity, late-onset treatment, and higher mean CGI-S and SDS subscales scores and lower mean WHOQOL-BREF 27 score. Inadequate response to treatment was associated with worse functionality and disability. Inadequate response related factors such as misdiagnosis, late diagnosis, late treatment, low adherence to treatment, missed psychiatric comorbidity, and inadequate family support should be minimized. Treatment should aim not only to remission symptoms but also aim complete functional recovery and no disability in work, social life, and family life/home responsibilities.

Biological determinants of functioning in euthymic patients with Bipolar Disorder: A multicentric 3-year cohort study

IntroductionBipolar disorder is related with functional impairment in euthymia. The contribution of biological functions such as sleep, sexual functioning; or the presence of obesity on this loss remain understudied.ObjectivesThe aim of this work was to study the influence of biological determinants in context with clinical and demographical determinants of functioning in a 3-year cohort of euthymic BD patients.MethodsIn this multicentric study 67 euthymic adult bipolar outpatients were followed during three years. Functioning was assessed with FAST, insomnia severity with Oviedo Sleep Questionnaire (OSQ) and, sexual functioning with Changes on Sexual Functioning Questionnaire (CSFQ-14) and obesity was expressed as body mass index (BMI). The basal effect of sleep, sexual functioning and obesity (Time 0) on FAST (Time 3) was analyzed with a mixed ordinal regression model including time effect, age, sex, number of manic and depressive episodes, euthymia length, and comorbidity with personality disorder. Change in functioning (Time 3 to 0) was analyzed in another mixed model also considering the difference in biological determinants (Time 3 to 0) and the presence of mood episodes during the period.ResultsA basal worse sexual functioning, a higher severity of insomnia and a higher BMI predicted a worse functioning at three years (p=0.005, p=0.043, p=0.05 respectively). Regarding FAST difference from Time0 to 3, only having a manic episode related to an impairment on functioning (p=0.027).ConclusionsSexual functioning, quality of sleep and BMI are predictors of functioning in euthymia in BD. Manic episodes in the following contribute to impairments on functioning more than depressive episodes.DisclosureNo significant relationships.

Role of MAOI drugs as triggers of manic episodes in bipolar disorders: A case report and a narrative review

IntroductionUse of Monoamine Oxidase Inhibitors (MAOIs) has experimented an important reduction in recent years, being replaced by other antidepressant drugs (ADs) associated with a better safety profile. Its use has been restricted to instructed professionals treating resistant and atypical depression. Thus, treatment-emergent affective switch (TEAS) induced by MAOIs is a rare event nowadays.ObjectivesTo describe a manic episode associated to a one-year-long treatment with phenelzine, a MAOI agent.MethodsWe present the case of a 47-year-old man hospitalized in our acute psychiatric unit after presenting compatible clinical symptoms with a manic episode. He showed severe irritability, decreased need for sleep, pressured speech, increased energy and goal-directed activities. The patient had started phenelzine a year ago for the treatment of major depressive episode resistant to previous pharmacological essayed treatments. No previous history of TEAS was reported, although he had already taken other ADs and mood-stabilizer treatments in the past.ResultsSeveral studies reported the effectiveness of MAOIs for the treatment of monopolar depressive episodes resistant to other ADs, especially when atypical symptoms were observed. Data on the use of MAOIs for the treatment of drug-resistant bipolar depressive episodes is scarce. Few studies have described a good response without showing and increased risk of TEAS.ConclusionsAs MAOIs have fallen out of favour with modern psychiatry, there is scarce evidence on the prevalence of TEAS in patients undergoing treatment with these drugs. Further research is needed in order to accurately define these complex relationships.DisclosureNo significant relationships.

Lurasidone in treatment of manic episode

Introduction Lurasidone is an atypical antipsychotic used in the treatment of schizophrenia and bipolar depression. Both indications are approved by the FDA nowadays, whereas in Europe it is only approved for schizophrenia. Lurasidone has been barely studied for the treatment of acute mania, nonetheless it is sometimes used off-label.ObjectivesA case of a patient with a manic episode treated with lurasidone is presented, in order to provide further evidence on this topic.MethodsThe patient is a 43 year-old-woman with diagnosis of type I bipolar disorder, personality disorder and borderline intellectual functioning, resident in our Hospital’s long-stay psychiatric rehabilitation unit. She was previously under treatment with venlafaxine 75 mg/day, valproate 1500 mg/day and levomepromazine 25 mg on demand; remaining stable for months. The patient presented an episode consisting on agitation, irritability, verbiage, tachyphase, verbal aggressiveness and behavioral disturbances. Psysical restraint was needed for one day long and zuclopenthixol acetate 50 mg IM was administered twice within 5 days for the acute agitation. Venlafaxine was immediately withdrawn and lurasidone was progressively introduced up to 111 mg daily.ResultsApproximately 3 weeks after the treatment adjustment, the patient reached the psychopatological stabilty.ConclusionsAntidepressive withdrawal and introduction of Lurasidone were effective to treat the acute manic episode in this patient. It has been previosuly suggested that lurasidone caused improvement in emergent manic symptoms in patients with bipolar depression, and in subsyndromal hypomanic symptoms in patients with mixed features of depression. However, no studies have been made yet to evaluate the efficacy of lurasidone in acute mania.DisclosureI received financing from Angelini Pharma, Casen Recordati, Janssen, Exeltis and Otsuka.

Homoeopathic Treatment of a Case of Mania with Psychotic Features

AbstractMania is an abnormal feature of bipolar affective disorder, which can cause emotional, functional and cognitive impairment with a direct impact on the quality of life of the patient. A case reported in the outpatient department of the National Homoeopathy Research Institute in Mental Health with symptoms of violence, hurting her sister and mother, abusiveness, irritability, anger, impulsiveness, gesturing with hands, self-laughing and self-talking, tendency to run away from home, sleeplessness, fear of being poisoned and reduced appetite. The case was diagnosed by the consultant psychiatrist as manic episode with psychotic feature as per the International Classification of Diseases-10 Diagnostic Criteria for Research. At the time of admission, the Young Mania Rating Scale scored 36. Carcinosinum 200 was prescribed, but no relief was obtained. So, Sepia officinalis 200 was selected as the second prescription. The social functioning and quality of life of the patient improved. There is no recurrence of a manic episode in the past 1 year. The outcome report of this case shows that the individualised homoeopathic treatment for mania with psychotic features got full remission without the support of any adjunctive therapy or conventional medication.

Psychopathological and temperamental features of Late Onset versus Early Onset Bipolar Disorder

IntroductionAge at onset of type-I bipolar disorder (BD-I) typically averages 12-24 years, is older among patients with type-II-BD (BD-II), even though generally before 50-years-old (EOBD). Clinical observation of late-onset BD (LOBD) posed some questions regarding a differential phenotypic/psychopathological manifestations and affective temperaments between LOBD vs EOBD.ObjectivesA case-control pilot-study was carried out to investigate psychopathological, clinical and temperamental features of a psychogeriatric cohort of LOBD and EOBD subjects.MethodsOut of 74 enrolled patients, 64 patients (31 EOBD, 33 LOBD) were included and administered an ad hoc socio-demographic datasheet, BPRS, CGI, GAF, HAM-D, GDS, MSRS, MRS, MOCA and TEMPS-M.ResultsLOBD is significantly associated with higher rates of BD-II diagnosis (X2 = 26.1, p<.001), depressive (p=0.05) and mixed states (p=0.011), higher comorbid anxiety levels and depressive affective temperament (p<.001); while clinical manifestations of geriatric EOBD is significantly associated with higher endocrinological (X2 = 7.815, p=.005) and metabolic comorbidity (X2 = 6.896, p=.009), a diagnosis of BD-I, manic episodes and hyperthymic (p=.001) affective temperaments. GDS and MSRS total scores were significantly higher in LOBD (respectively, p<.001 and p=.008).ConclusionsFurther studies with larger sample sizes and a control group should verify whether LOBD is a distinct psychopathological entity from EOBD and evaluate differences (if any) in terms of prognosis and treatment between EOBD and LOBD.DisclosureNo significant relationships.

Pro Perspective

Four sets of arguments are supporting the idea that compulsory admissions should be possible in anorexia nervosa, as much as it is other in psychiatric disorders. Indeed, if nobody challenges the use of compulsory treatments for patients with acutte schizophrenia or a manic episodes, it is because the usual rational for compulsory admission relies on (1) the severity of the disorder (a need), (2) the capacity of hospitalisation to really improve patients and prognosis (a utility), associated to the fact that (3) the disorder alters the capacity to spontaneously ask for care (a rational), and (4) the possible danger of the present medical conditions for others (a protection). We will explain that these four points are clearly being equivalent for anorexia nervosa compared to other psychiatric disorders, with some subtilities that modify their expression, but not the spirit of these rationals. We will then propose that a much easier way to understand the paicity of use of this hospitalisation modalities is related to the strange position of anorexia nervosa, a metabo-psychiatric disorder, namely a complex disorder at the interface of somatic and psychiatric disorder. We will conclude in promoting a step-by-step procedure to reuce the risk of abuse, and facilitate the paradoxical “acceptance” of a “forced” hospitalisation.DisclosureNo significant relationships.

Manic episode following SARS-COV-2 Infection

IntroductionIn December 2019, infection with the novel coronavirus (SARS-CoV-2) was first reported in the city of Wuhan, China. Although generally recognized for its often fatal respiratory problems, other neuropsychiatric complications are receiving increasing attention.ObjectivesWe will try through a clinical case to explain the psychiatric disorders in the context of this infection, and to highlight the two main explanatory theories of psychiatric disorders, in relation with the SARS-Cov-2 infection.MethodsWe report here a case of SARS-CoV-2 infection in a 54-year-old female patient with no specific pathological history, including psychiatric, who presented a fever, anosmia, and asthenia in the absence of any respiratory signs. Her PCR came back positive and her chest CT scan was normal.The patient was treated with paracetamol with vitamin C,with good clinical improvement. She came 15 days later to the psychiatric emergency room with psychomotor excitement. The patient was motorically unstable, could not hold still, her mimicry was hypermobile, contact with her was familiar, she was logorrheic with flight of ideas,she verbalized multiple projects, her mood was euphoric and her sleep was disturbed. Her blood tests were unremarkable.ResultsThe diagnosis of manic episode was retained, and the patient was put on Olanzapine 10 mg, sodium Valproate 1g and Lorazepam 2.5 mg in degression with good clinical improvement.ConclusionsAlthough the data in the literature remain scarce concerning the impact of this virus on mental health, we will try through this clinical case to explain the psychiatric disorders in the context of this viral epidemic, due to stress and inflammation.DisclosureNo significant relationships.

Post-stroke mania

IntroductionApproximately one-third of stroke survivors develop poststroke depression. Post-stroke mania is relatively rare, with a prevalence of less than 2%. One review of case reports of late-onset mania in 2015 demonstrated that 51% of the patients had established vascular risk factors. In 28% of cases, the treatment of underlying organic cause contributed to successful remission of the manic episode.ObjectivesFor this review, we aimed to compile published case reports from the past 20 years to review late-onset mania as one of the neuropsychiatric outcomes of stroke and its management.Methodsliterature search on Pubmed, PsychInfo, and Embase utilizing keywords combinations: Bipolar, Manic, Mania, Secondary, Stroke, Poststroke, Post-stroke, Elderly, Old, Late onset, Late-onset, Lateonset, Hemisphere, Brain, Vascular, Infarction.ResultsAmong the 17 case reports, the age of onset of manic episode ranged from 47 to 86 with a mean of 67 years. Of the 17 cases, the right hemisphere was the most frequently affected (14/17, 82%), with cerebrovascular lesion involving the left hemisphere in 3 cases (17.6%).ConclusionsClinicians should consider mania secondary to an organic cause in patients presenting with focal or soft neurological signs or symptoms, manic episode with atypical symptoms such as visual or olfactory hallucinations, altered mental status, disorientation, impairment in memory or cognition, unusual age of onset for bipolar disorder, or unusual illness course such as single episode of mania or poor response to psychopharmacologic treatment. Some reviews suggest combination of mood stabilizers and second-generation antipsychotics. Benzodiazepines recommended as an adjunctive drug for acute management such as agitation, aggressive behavior or disinhibition.DisclosureNo significant relationships.

Clozapine induced myocarditis: a case report

IntroductionClozapine is one of the most effective antipsychotic drugs. On the other hand, it can cause serious side effects which have to be monitored. An adverse effect is myocarditis, a type B Clozapine reaction that can be fatal if it is not early diagnosed.ObjectivesTo report a case of a patient with Clozapine induced myocarditis.MethodsA 48 years old women with a schizoaffective disorder was admitted to our Hospital due to a clinical decompensation. She had a manic episode with psychotic symptoms (persecutory delusions and auditive hallucinations). Clozapine was introduced after there were no improvement with Olanzapine, Risperidone and Valproic Acid. A dose increase was made reaching 100 mg/day the first week and 200 mg/day the second week. The third week she started with a 39ºC fever, decreased oxygen saturation, leukocytosis (9560 103/mm3), elevated PCR (210 mg/l) and elevated troponins (52,88 ng/l). EKG and other medical tests did not show alterations. There was not found a clear etiology, so Clozapine was retired as a cautionary measure. The differential diagnosis for etiology included viral infections, Clozapine induced myocarditis or idiopathic.ResultsA few days after the withdrawal of Clozapine, cardiac symptoms improved, suggesting it was the most probable etiology.ConclusionsAlthough it is not very likely to occur, it is important to consider myocarditis as a sever Clozapine side effect.DisclosureNo significant relationships.