Neutropenia and Agranulocytosis in Chinese Patients Prescribed Clozapine

OBJECTIVES

To examine the rate of neutropenia and agranulocytosis, and the pattern of development of these 2 disorders among Chinese patients prescribed clozapine treatment in a local psychiatric unit.

METHODS

Patients who were receiving clozapine when they were under the care of Pamela Youde Nethersole Eastern Hospital Psychiatric Unit, Hong Kong, from 1 January 1997 to 31 December 2012 and who developed neutropenia and agranulocytosis from 1 January 1997 to 30 June 2013 were retrospectively reviewed.

RESULTS

A total of 13 patients out of 980 clozapine recipients developed neutropenia and 3 developed agranulocytosis during treatment. Half of them were aged > 50 years and three quarters were female. The majority of patients who developed neutropenia and agranulocytosis were prescribed > 1 psychotropic medication in addition to clozapine. Half of the incidents occurred in the first 18 weeks of clozapine treatment.

CONCLUSION

Long-term monitoring of white cell count is necessary during clozapine treatment. The concurrent use of clozapine with other potentially leukopenic psychotropic drugs should be limited.

Psychiatric morbidity in Chinese women after cervical cancer treatment in a regional gynaecology clinic

OBJECTIVES

To identify the prevalence and factors associated with psychiatric disorders in Chinese cervical cancer survivors.

METHODS

A cross-sectional study was conducted from May 2011 to April 2012 at the specialist gynaecology outpatient clinic at Pamela Youde Nethersole Eastern Hospital, Hong Kong. All cervical cancer patients who had completed treatment were consecutively recruited. They were interviewed using the Chinese-Bilingual Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Research version. Socio-demographic data and clinical information were collected from the patients and their hospital records were reviewed.

RESULTS

A total of 113 patients were recruited into the study. The point prevalence of psychiatric disorders as a group in cervical cancer survivors was 37%. The point prevalence of depressive disorders, anxiety disorders, and schizophrenia were 31%, 16%, and 2%, respectively. Major depressive disorder was the most common mood disorder and generalised anxiety disorder the most common anxiety disorder. Younger age, a history of psychiatric illness, fatigue, menopausal symptoms, and pain were independent predictors of current psychiatric disorders.

CONCLUSION

Psychiatric disorders, predominantly depressive and anxiety disorders, are common in Chinese cervical cancer survivors. Identification of independent predictors can help gynaecologists detect these disorders earlier and arrange appropriate interventions.