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Abstract：
Psychiatric polypharmacy involves the use of two or more psychotropic medications to manage a mental and emotional condition. The prevalence of psychotropic polypharmacy has been increasing since the 1990s and has been attributed to the rise in multiple psychiatric conditions presenting in one patient. However, as the prevalence of polypharmacy increases to maximize therapeutic advantages, so does the adverse effect profile of those drugs used in combination, leading to very life-threatening effects such as agranulocytosis. Thus, we report a case of agranulocytosis secondary to polypharmacy in a patient with a history of multiple complex psychiatric conditions. The patient is a 20-year-old female with a past medical history of major depressive disorder, borderline personality disorder, post-traumatic stress disorder, anxiety disorder, hypothyroidism, and ulcerative colitis. Her psychiatric conditions were managed with multiple medications including chlorpromazine, and clozapine was recently added a month prior to admission. Upon admission, the patient was hemodynamically stable and febrile, with complaints of generalized body aches and myalgia. Laboratory results showed profound leukopenia with a white blood cell count of 1.0x103/uL and a neutrophil number of 0.02x103/uL. The patient was admitted to the hospital for neutropenic sepsis and was aggressively treated with intravenous antibiotics. Her clozapine and chlorpromazine were discontinued. In this report, we discuss the association between chlorpromazine and clozapine use and agranulocytosis, emphasizing the importance of regular monitoring and heightened awareness for patients on these medications. This case also underscores the necessity for cautious polypharmacy medication management in individuals with complex psychiatric conditions, highlighting the potential life-threatening consequences of polypharmacy in this population.
摘要：
精神病学多重用药涉及使用两种或多种精神药物来管理精神和情绪状况。自1990年代以来，精神药物复方的患病率一直在增加，这归因于一名患者出现的多种精神疾病的增加。然而,随着多重用药的流行增加，以最大限度地提高治疗优势，这些药物联合使用的不良反应也是如此，导致非常危及生命的影响，如粒细胞缺乏症。因此，我们报道了1例多重用药后继发粒细胞缺乏症的患者,该患者有多种复杂的精神病史.患者是一名20岁女性，既往有重度抑郁症病史，边缘性人格障碍,创伤后应激障碍,焦虑症,甲状腺功能减退,和溃疡性结肠炎.她的精神状况用多种药物治疗，包括氯丙嗪，最近在入院前一个月加入了氯氮平。一被录取,患者血流动力学稳定，发热，伴有全身疼痛和肌痛。实验室结果显示白细胞严重减少，白细胞计数为1.0x103/uL，中性粒细胞数为0.02x103/uL。患者因中性粒细胞减少性败血症入院，并积极接受静脉抗生素治疗。停用氯氮平和氯丙嗪。在这份报告中,我们讨论了氯丙嗪和氯氮平使用与粒细胞缺乏症之间的关系，强调定期监测和提高患者对这些药物的认识的重要性。此案例还强调了在患有复杂精神病的个人中谨慎进行多重用药管理的必要性。强调在这一人群中多重用药的潜在危及生命的后果。
