Serotonin Syndrome in Elderly Patients Treated for Psychotic Depression with Atypical Antipsychotics and Antidepressants: Two Case Reports

CNS Spectrums ◽  
2007 ◽  
Vol 12 (8) ◽  
pp. 596-598 ◽  
Author(s):  
Izchak Kohen ◽  
Marc L. Gordon ◽  
Peter Manu
Keyword(s):  
Elderly Patients ◽  
Atypical Antipsychotic ◽  
Mental Status ◽  
Atypical Antipsychotics ◽  
Serotonin Syndrome ◽  
Case Reports ◽  
Antipsychotic Treatment ◽  
Psychotic Depression ◽  
Medical Inpatient ◽  
First Case

ABSTRACTWe report two cases of serotonin syndrome in elderly patients during treatment of psychotic depression with atypical antipsychotics and antidepressants. The first case is a 69-year-old man who was admitted for depression with psychosis and treated with trazodone, risperidone, and sertraline. Subsequently, he developed myoclonus, tremor, cogwheel rigidity, and diaphoresis. The second case is a 72-year-old female initially admitted to a medical inpatient unit for a change in mental status that presented as increased confusion, lethargy, slurred speech, and a fever of 101.5°. She had been on phenelzine and quetiapine. In both cases, all symptoms resolved within 24 hours of the psychotropics being stopped. In both cases, we believe that serotonin syndrome was produced by a combination of an antidepressant and an atypical antipsychotic. There have been several case reports of serotonin syndrome from similar combinations of antidepressant and atypical antipsychotic treatment. Clinicians treating elderly patients with a combination of serotonergic antidepressants and atypical antipsychotics for psychotic depression should be aware of the potential for serotonin syndrome.

scholarly journals Antipsychotic Effects on Cortical Morphology in Schizophrenia and Bipolar Disorders

2020 ◽  
Vol 14 ◽  
Author(s):  
Ruiqi Feng ◽  
Fay Y. Womer ◽  
E. Kale Edmiston ◽  
Yifan Chen ◽  
Yinshan Wang ◽  
...  
Keyword(s):  
Atypical Antipsychotic ◽  
Cortical Thickness ◽  
Atypical Antipsychotics ◽  
Structural Changes ◽  
Middle Temporal Gyrus ◽  
Antipsychotic Treatment ◽  
Illness Duration ◽  
Cortical Thinning ◽  
Age Related

Background: Previous studies of atypical antipsychotic effects on cortical structures in schizophrenia (SZ) and bipolar disorder (BD) have findings that vary between the short and long term. In particular, there has not been a study exploring the effects of atypical antipsychotics on age-related cortical structural changes in SZ and BD. This study aimed to determine whether mid- to long-term atypical antipsychotic treatment (mean duration = 20 months) is associated with cortical structural changes and whether age-related cortical structural changes are affected by atypical antipsychotics.Methods: Structural magnetic resonance imaging images were obtained from 445 participants consisting of 88 medicated patients (67 with SZ, 21 with BD), 84 unmedicated patients (50 with SZ, 34 with BD), and 273 healthy controls (HC). Surface-based analyses were employed to detect differences in thickness and area among the three groups. We examined the age-related effects of atypical antipsychotics after excluding the potential effects of illness duration.Results: Significant differences in cortical thickness were observed in the frontal, temporal, parietal, and insular areas and the isthmus of the cingulate gyrus. The medicated group showed greater cortical thinning in these regions than the unmediated group and HC; furthermore, there were age-related differences in the effects of atypical antipsychotics, and these effects did not relate to illness duration. Moreover, cortical thinning was significantly correlated with lower symptom scores and Wisconsin Card Sorting Test (WCST) deficits in patients. After false discovery rate correction, cortical thinning in the right middle temporal gyrus in patients was significantly positively correlated with lower HAMD scores. The unmedicated group showed only greater frontotemporal thickness than the HC group.Conclusion: Mid- to long-term atypical antipsychotic use may adversely affect cortical thickness over the course of treatment and ageing and may also result in worsening cognitive function.

scholarly journals Antipsychotic treatment of primary delusional parasitosis

2007 ◽  
Vol 191 (3) ◽  
pp. 198-205 ◽  
Author(s):  
Peter Lepping ◽  
Ian Russell ◽  
Roland W Freudenmann
Keyword(s):  
Atypical Antipsychotics ◽  
Case Reports ◽  
Antipsychotic Treatment ◽  
Randomised Trials ◽  
Limited Evidence ◽  
Delusional Parasitosis ◽  
Full Remission ◽  
Remission Rates ◽  
Delusional Disorder Somatic Type ◽  
Typical And Atypical Antipsychotics

BackgroundLittle is known about the treatment of delusional parasitosis with typical and atypical antipsychotics.AimsTo evaluate the effectiveness of typical and atypical antipsychotics in primary delusional parasitosis (delusional disorder, somatic type).MethodA systematic review was conducted.ResultsNo randomised trials were found and hence we collected the best evidence from 16 other trials and case reports, separating primary from other forms of delusional parasitosis. Studies using typical antipsychotics showed partial or full remission in between 60 and 100% of patients. Analysis of selected patients with primary delusional parasitosis showed that typical and atypical antipsychotics were effective in the majority, but that remission rates did not differ significantly between typical and atypical antipsychotics.ConclusionsIn the absence of controlled trials there is limited evidence that antipsychotics are effective in primary delusional parasitosis. Rigorous studies are needed to evaluate their effectiveness and to compare typical and atypical antipsychotics directly.

The impact of weight gain associated with atypical antipsychotic use in schizophrenia

2004 ◽  
Vol 16 (3) ◽  
pp. 113-123 ◽  
Author(s):  
Pierre Chue ◽  
Raphael Cheung
Keyword(s):  
Weight Gain ◽  
Weight Management ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Current Data ◽  
Antipsychotic Treatment ◽  
Metabolic Disturbances ◽  
Obesity And Diabetes ◽  
The Impact ◽  
Selection Of

Background:Atypical antipsychotics offer clear advantages in the management of schizophrenia, compared with conventional neuroleptics, but weight gain is a significant adverse effect with some of these agents.Objective:To review the literature on weight gain associated with atypical antipsychotic treatment in schizophrenia.Methods:Relevant sources were identified from Medline searches to February 2003 using combinations of keywords including ‘schizophrenia’, ‘antipsychotics’, ‘weight gain’, ‘adverse events’, ‘obesity’, and ‘diabetes’.Results:Most atypical antipsychotics induce some weight gain, but the magnitude of the effect varies markedly. The greatest increases are seen with clozapine and olanzapine: risperidone has a slight effect, comparable with that of conventional neuroleptics, while ziprasidone and aripiprazole appear from current data to have little effect. In addition, atypical antipsychotics have been associated with metabolic disturbances, particularly glucose dysregulation and dyslipidemia. These effects tend to be more marked with olanzapine and clozapine than with other agents. Weight gain associated with atypical antipsychotics imposes substantial morbidity, in addition to that associated with schizophrenia itself. Furthermore, weight gain can significantly impair patients' quality of life, and leads to non-adherence with treatment. Effective weight management should include the selection of an appropriate atypical antipsychotic and for effective weight management, as well both diet and exercise, formal weight management programs tailored to the needs of schizophrenic patients may be useful, and some patients may benefit from weight-reducing drugs.Conclusions:Weight gain associated with atypical antipsychotics is a common problem that requires effective management. The selection of an agent with a low risk of weight gain, such as risperidone or ziprasidone, is central to such management.

Risperidone treatment in elderly patients with dementia: relative risk of cerebrovascular events versus other antipsychotics

2005 ◽  
Vol 17 (4) ◽  
pp. 617-629 ◽  
Author(s):  
Sanford Finkel ◽  
Chris Kozma ◽  
Stacey Long ◽  
Andrew Greenspan ◽  
Ramy Mahmoud ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Atypical Antipsychotics ◽  
Reference Group ◽  
Wide Spectrum ◽  
Patient Characteristics ◽  
Antipsychotic Treatment ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Significant Difference ◽  
Treatment Alternatives

Background:The possibility that low-dose antipsychotic treatment is associated with increased risk of cerebrovascular events (CVEs) in elderly patients with dementia has been raised. The objective was to determine whether risperidone is associated with an increased risk of CVEs relative to other commonly considered alternative treatments.Methods:An analysis of Medicaid data from 1999 to 2002, representing approxi-mately 8 million enrollees from multiple states, was conducted. The primary outcome was the incidence of acute inpatient admission for a CVE within 3 months following initiation of treatment with atypical antipsychotics (risperidone, olanzapine, quetiapine, or ziprasidone), haloperidol, or benzo-diazepines.Results:Descriptive analyses found similar rates of incident CVEs across evaluated agents. Multivariate analyses found no differences in comparisons of risperidone with olanzapine or quetiapine. Risperidone and other antipsychotics as a group were also not associated with a higher odds ratio (OR) of incident CVE than either haloperidol or benzodiazepines. With risperidone as the reference group: olanzapine, OR=1.05, 95% CI 0.63–1.73; quetiapine, OR=0.66, 95% CI 0.23–1.87; haloperidol, OR=1.91, 95% CI 1.02–3.60; benzodiazepines, OR=1.97, 95% CI 1.30–2.98. With benzodiazepines as the reference group, the OR of incident CVE for all antipsychotics as a class was 0.49, 95%CI 0.35–0.69.Conclusions:This study found no significant difference in the incidence of CVEs between patients taking risperidone and those taking other atypical antipsychotics. Risperidone and all atypical antipsychotics were not associated with higher risk than two common treatment alternatives (haloperidol and benzodiazepines). These findings do not support the conclusion that risperidone is associated with a higher risk of CVE than other available treatment alternatives. The data also suggest that patient characteristics other than antipsychotic use are more significant predictors of CVEs. Given the relatively low rates of incident CVEs, a larger sample of patients with groups closely balanced on a wide spectrum of potential risk factors could provide a more precise assessment of risk.

Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease

2018 ◽  
Author(s):  
Adam P. Mecca ◽  
Rajesh R. Tampi
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Side Effects ◽  
Adverse Events ◽  
Atypical Antipsychotic ◽  
Clinical Case ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Multicenter Trial ◽  
Antipsychotic Treatment

This chapter provides a summary of the Clinical Antipsychotic Trials of Intervention Effectiveness—Alzheimer’s disease (CATIE-AD), a multicenter trial that investigated whether atypical antipsychotics are an effective treatment for psychosis, aggression, or agitation in outpatients with Alzheimer’s disease. The chapter briefly reviews the study design, as well as implications and limitations. A relevant clinical case concludes the chapter. In summary, atypical antipsychotic use for up to 36 weeks did not lead to clinical improvement based on time to discontinuation, or symptom reduction. Risk of discontinuation due to adverse events and side-effects with worse with antipsychotic treatment compared to placebo. In patients with psychosis, agitation, or aggression due to Alzheimer’s disease, the efficacy of atypical antipsychotics is questionable and their use comes with considerable risks of side effects and adverse events.

Deep vein thrombosis on the fourth day of risperidone therapy

2021 ◽  
Vol 14 (3) ◽  
pp. e239569
Author(s):  
Kavitha Konnakkaparambil Ramakrishnan ◽  
Mithila George
Keyword(s):  
Adverse Effect ◽  
Deep Vein Thrombosis ◽  
Atypical Antipsychotics ◽  
Low Dose ◽  
Case Reports ◽  
Paranoid Schizophrenia ◽  
Antipsychotic Treatment ◽  
Vein Thrombosis ◽  
Initiation Of Therapy ◽  
Deep Vein

Deep vein thrombosis has been recognised as a complication of antipsychotic treatment and is reported to be more common with atypical antipsychotics. Risperidone is a second-generation atypical antipsychotic and there have been case reports of risperidone-associated deep vein thrombosis, most of them reporting the complication from 2 weeks to a few months of initiation of therapy. Here, we are reporting a case of deep vein thrombosis in a male patient in his early forties with paranoid schizophrenia, which presented on the fourth day of starting risperidone therapy. This case is being reported to highlight the fact that deep vein thrombosis can occur as early as fourth day of initiation of risperidone therapy, that too at a low dose (2 mg/day). The case also emphasises the importance of monitoring these patients for this rare but potentially serious adverse effect from the first day itself after initiation of a new antipsychotic.

scholarly journals Efficacy and Safety of Atypical Antipsychotics for Behavioral and Psychological Symptoms of Dementia Among Community Dwelling Adults

2018 ◽  
Vol 33 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Katy E. Trinkley ◽  
Allison M. Sturm ◽  
Kyle Porter ◽  
Milap C. Nahata
Keyword(s):  
Adverse Events ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Psychological Symptoms ◽  
Community Dwelling ◽  
Antipsychotic Treatment ◽  
Efficacy And Safety ◽  
Duration Of Treatment ◽  
Antipsychotic Therapy ◽  
Behavioral And Psychological Symptoms

Introduction: Options for the treatment of the behavioral and psychological symptoms of dementia (BPSD) are limited. Atypical antipsychotics are often used but have questionable efficacy and are generally considered high risk. Therefore, the objective of this study is to evaluate the efficacy and safety of using any atypical antipsychotic for the treatment of BPSD among outpatients. Methods: Retrospective observational study of an academic outpatient memory disorders clinic. Participants included any community-dwelling patient with a diagnosis of dementia, not trauma induced, with documented BPSD treated with an atypical antipsychotic for at least 2 weeks. Medical records were reviewed from January 1, 1990 to March 23, 2010. Safety outcomes were documented from the time of antipsychotic initiation, and behavioral/psychological efficacy outcomes were documented beginning 2 weeks after antipsychotic therapy was initiated, until the last documentation available. Results: A total of 87 distinct antipsychotic treatment periods for 81 unique patients were included. Antipsychotic treatment was continued for more than a year in 33% of patients and only 17% of patients discontinued antipsychotic treatment over the entire period. The behavioral/psychological outcomes improved for 24 (28%) treatments, remained stable for 17 (20%) treatments, and worsened for 46 (53%) treatments. Adverse events were reported by 53% of patients, with the most common adverse events being metabolic, fall related, type, and vascular. Few adverse events were severe. The odds ratio of adverse events per every 90-day increase in duration of treatment was 1.20 ( P = 0.02). Conclusion: Antipsychotic treatment improved behavioral/psychological symptoms for less than one-third of patients and increased the potential risk of adverse events for more than half of patients.

Aripiprazole-induced tardive dyskinesia treated with quetiapine: a case report

2011 ◽  
Vol 23 (4) ◽  
pp. 188-190 ◽  
Author(s):  
Nesrin B. Tomruk ◽  
Omer Saatcioglu ◽  
Eren Yildizhan ◽  
Nihat Alpay
Keyword(s):  
Case Report ◽  
Tardive Dyskinesia ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Case Reports ◽  
Antagonistic Effect ◽  
Rapid Improvement ◽  
Second Generation Antipsychotics ◽  
Agonistic Effect ◽  
Unique Mechanism

Tomruk NB, Saatcioglu O, Yildizhan E, Alpay N. Aripiprazole-induced tardive dyskinesia treated with quetiapine: a case report.Background: Tardive dyskinesia (TD) is a serious, potentially irreversible side effect of antipsychotics. Although the risk is smaller, atypical antipsychotics still pose a risk. Aripiprazole is an atypical antipsychotic with a unique mechanism of action. It has a partial agonistic effect on the presynaptic D2 dopamine autoreceptor and antagonistic effect at postsynaptic D2 receptors.Method: There have been a few case reports of aripiprazole-induced TD. A case of aripiprazole-induced TD successfully treated with another atypical antipsychotic, quetiapine, is described and discussed in line with the recent literature.Results: TD showed rapid improvement with discontinuation of aripiprazole and initiation of quetiapine.Conclusion: Further studies are needed to ascertain the differential effects and side effects of second-generation antipsychotics in terms of TD.

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