Clozapine-geïnduceerde cardiomyopathie: een multidisciplinaire afweging

Clozapine-induced cardiomyopathy: a multidisciplinary consideration Background: Schizophrenia is a chronic debilitating disease with a lifetime prevalence of approximately 1%. Up to 30% of these patients do not respond adequately to conventional antipsychotics, leading to treatment-resistant schizophrenia (TRS). Clozapine is the gold standard for TRS but is currently seldomly used due to the need for monitoring and potentially lethal side effects, including clozapine-induced cardiomyopathy (CICM). This case illustrates the diagnosis and treatment of CICM and highlights the need for a multidisciplinary approach. Case presentation: A 49-year-old man with TRS had been treated with clozapine since 2020. Three years later, he developed dyspnea and reduced exercise tolerance. Diagnostic tests, including echocardiography and cardiac MRI, confirmed the diagnosis of non-ischemic dilated cardiomyopathy with a left ventricular ejection fraction of 20%. CICM was suspected after most other causes of heart failure were excluded. After a multidisciplinary evaluation of the pros and cons of clozapine, the antipsychotic was discontinued, and the patient received supportive cardiac medication. Six months after the medication switch, the patient showed improvement in both somatic and psychiatric symptoms. Whether these improvements are due to the switch from clozapine to haloperidol, or respectively the initiation of supportive cardiac medication and the relative rest resulting from the improvement in somatic complaints, is unclear. Conclusion: This case underscores the complexity of diagnosing and treating CICM and the necessity for multidisciplinary collaboration among psychiatrists, cardiologists, and other healthcare providers. Thorough diagnostics and careful consideration of the physical risks and psychiatric benefits of clozapine are essential to ensure optimal treatment for patients with CICM.