Evidence map›Paper›PMID 40933150›Full record

ArticleWorld journal of psychiatry2025

Diagnostic algorithm for clozapine-induced myocarditis: A systematic review.

Yassir Mahgoub, Rawan Alhau, Yumna Magzoub, Aya Ali, Eptihal Nour, Mustafa E E Saeed, Sameera G M Mohamed, Ahmed O S Hassan, Omaima Ali

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Article in World journal of psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Yassir MahgoubDepartment of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States. ymahgoub@pennstatehealth.psu.edu.
Rawan AlhauDepartment of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States.
Yumna MagzoubDepartment of Psychiatry, University of Khartoum, Faculty of Medicine, Khartoum 11111, Sudan.
Aya AliDepartment of Psychiatry, University of Khartoum, Faculty of Medicine, Khartoum 11111, Sudan.
Eptihal NourDepartment of Psychiatry, Shendi University, Faculty of Medicine, Khartoum 11111, Sudan.
Mustafa E E SaeedDepartment of Psychiatry, National Ribat University, Faculty of Medicine, Khartoum 11111, Sudan.
Sameera G M MohamedDepartment of Psychiatry, University of Bahri, College of Medicine, Khartoum 11111, Sudan.
Ahmed O S HassanDepartment of Psychiatry, Cairo University Kasr Alainy Faculty of Medicine, Cairo 11956, Al Qāhirah, Egypt.
Omaima AliDepartment of Medicine, Division of Cardiology, Penn State College of Medicine, Hershey, PA 17033, United States.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClozapine, the gold standard for resistant schizophrenia, is underused due to risks like clozapine-induced myocarditis (CIM). Non-specific biomarkers and inconsistent imaging, and the significant overlap with clozapine-induced pneumonia (CIP) lead to misdiagnosis and premature discontinuation.

aimTo develop a diagnostic algorithm for CIM to enhance accuracy, differentiate from CIP, and guide safe clozapine rechallenge.

methodsA systematic review of 119 PubMed studies (published between 1990 and April 2025) was conducted in accordance with PRISMA guidelines. The review analyzed CIM diagnosis and rechallenge outcomes, with a focus on biomarkers, imaging, and collaboration with cardiology.

resultsCIM diagnosis relies on troponin and C-reactive protein; electrocardiography and echocardiography are inconsistently applied, and cardiac magnetic resonance imaging (CMR) is underused. Rechallenge was successful in 64.7% to 68.9% of 136 cases, with 2.9% resulting in fatal outcomes. Up to 65% of presumed CIM cases lack confirmation. A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation, with echocardiography as an alternative.

conclusionA protocol involving multidisciplinary collaboration among computed tomography, CMR, and cardiology improves CIM diagnosis. Slow titration prevents CIM; adjust the dose for CIP and discontinue for confirmed CIM.

Indexed as

ClozapineMultidisciplinary managementMyocarditisPneumoniaProtocolRechallenge

Identifiers

PMID40933150
PMCPMC12417972

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.