San Bdo

Entre los paciente con esquizofrenia, alrededor de un 20% se considera resistente al tratamiento, aunque esto es difícil de definir. La clozapina sigue siendo el antipsicótico más efectivo, pero nose considera de primera línea debido a sus variados y potencialmente fatales efectos secundarios como la agranulocitosis, neumonía aspirativa, íleo, DM2, miocarditis y cardiomiopatía.A pesar de esto, la clozapina sigue siendo la droga de elección en el tratamiento de la esquizofrenia resistente con tazas de respuesta de hasta un 60%. (a pesar de la no respuesta a lostratamientos previos). Esto sugiere un mecanismo único y diferente de acción.
Los mecanismos mediados inmunológicamente se han sugerido por los efectos secundarios del fármaco.(Michelsen and Meyer, 2007). However, cloza- pine remains the drug of choice for treatment resistant schizophrenia with response rates of up to 60%, despite non-response to prior antipsy- choticmedications. Interestingly, clozapine only shows this superiority in treatment resistant patients (Lieberman et al., 2003; Woerner et al., 2003), suggesting a unique and different mechanism of actioncom- pared to other antipsychotics and that treatment resistant patients may have converging biological abnormalities.
Notably, immunological mediated mechanisms have been suggested for someof the side effects of clozapine, including agranulocytosis (Whiskey and Taylor, 2007), myocarditis (Merrill et al., 2005), pericardi- tis (Merrill et al., 2005), and serositis (Mouaffak et al.,2009). In addition, more than 50% of patients experience another possibly immunologically mediated condition, benign hyperthermia (Lowe et al., 2007). This self-limiting side-effect occurs afterapproximately 1–2weeks of treat- ment and is accompanied by flu-like symptoms and lasts for 2–4days (Tham and Dickson, 2002). Often, clozapine is discontinued for a few days or the dose is reduced, but the...