Diagnostic error regarding the cause of cytopenia when increasing psychotropic drugs: two case reports

Abstract Several psychotropic drugs can cause cytopenia, especially after increasing dosages or initiating treatment. However, cytopenia in patients with psychiatric disorders can also be due to other conditions such as leukemia. In this report, we discuss two cases of cytopenia that occurred during the adjustment of psychotropic medications in patients with severe psychiatric illness. The initial diagnosis in each case was drug-induced cytopenia; however, later, the cause of cytopenia was found to be acute promyelocytic leukemia, which was successfully treated in collaboration between a psychiatrist and a hematologist. When cytopenia is observed while increasing the dosage of psychotropic drugs, suspicious drugs should be discontinued, though the possibility that cytopenia could be due to other reasons should be considered. If there are no signs of recovering blood cells or if cytopenia is severe, psychiatrists should consult hematologists promptly. In the treatment of leukemia patients with severe psychiatric symptoms, a therapeutic environment where psychiatrists and hematologists can collaborate in dealing with the severe psychiatric symptoms is very important, because the success or failure in dealing with psychiatric symptoms can directly lead to the death of the patient.