Enhanced Treatment Response of Clozapine after Febrile Infection

Enhanced Treatment Response of Clozapine after Febrile Infection

Clozapine is often considered as a “gold-standard” medication for treatment-resistant psychosis. But clozapine has many adverse effects including agranulocytosis, seizures, myocarditis, diabetes, and neuroleptic malignant syndrome. The development of fever is also common in patients treated with clozapine. Fever as a treatment for psychotic symptoms was broadly used in the early 20th century, termed pyrotherapy or pyretotherapy. Initially, the Nobel Prize winner Wagner-Jauregg reported a beneficial effect for patients with neurosyphilis after fever attack through inoculating blood from malaria patients. But the trend has been decreased after the discovery of penicillin and the introduction of convulsion therapies such as electroconvulsive therapy and insulin coma therapy. Here, we present a 49-year-old female patient with schizoaffective disorder who showed an increased response to clozapine after she recovered from fever and pneumonia. Both of her psychotic symptoms and mood condition were improved. This 49-year-old female patient had a medical history of bipolar disorder since 18 years ago. She was hospitalized because of the decreased need for sleep, elevated mood, irritability, grandiosity, auditory hallucination, and referential delusion.