Case of catatonia associated with paliperidone
Journal
Psychiatry and Clinical Neurosciences
Journal Volume
70
Journal Volume
70
Journal Issue
8
Journal Issue
8
Start Page
366
ISSN
1323-1316
Date Issued
2016-08-01
Author(s)
Abstract
Neuroleptic-induced catatonia has mostly been attributed to high-potency conventional antipsychotics.1 However, published case reports have documented the occurrence of catatonia with atypical antipsychotics.1Herein, we present a case of catatonia developed after paliperidone titration to a therapeutic dose in a schizophrenic patient without physical illness. Miss A, a 28-year-old woman, was diagnosed with paranoid schizophrenia at age 27. The psychotic symptoms responded well to risperidone at first. No extrapyramidal symptoms or catatonia had been reported while on risperidone. However, because of irregular drug compliance, the symptoms were aggravated, and the antipsychotic was shifted to oral paliperidone (up to 9 mg/day). However, mutism, immobility, and severe rigidity developed acutely 6 weeks afterwards. Her vital signs were stable; there was no abnormality in laboratory examinations, head computed tomography (CT) or electroencephalography (EEG). Her mutism and immobility persisted after i.m. biperiden injection was given, and did not disappear until 4 days after paliperidone was discontinued and oral lorazepam was up-titrated to 3 mg/day for suspected catatonia. The patient was discharged with her baseline mental status with quetiapine 75 mg/day 3 weeks after admission. There was no recurrence of catatonia during 6 months of follow-up. This case has demonstrated catatonia after taking paliperidone for 6 weeks. With the absence of hyperthermia, neuroleptic malignant syndrome was less likely. Limited response to an anticholinergic excluded acute dystonia. Also, no organicity was revealed on CT or EEG, there was no catatonic presentation of schizophrenia by history, and the patient was not exposed to agents other than the regular regimen of paliperidone before developing catatonia. These phenomena indicate that the catatonia might be related to paliperidone. Two cases of oral paliperidone-related catatonia have been reported. An 84-year-old woman and a 51-year-old man presented with severe rigidity and mutism after taking a single dose of paliperidone each, at 3 and 6 mg, respectively.2, 3 A diagnosis of dementia with Lewy bodies was made in the latter case. The clinical course of these cases implied that catatonia symptoms might improve within hours to days and may not respond to lorazepam, diphenhydramine, or benztropine. Unlike in previous reports, the catatonia in our case occurred after 6 weeks of paliperidone titration, instead of at drug initiation or immediately upon drug titration. Our patient was much younger than the previous cases and had no pre-existing vulnerability to movement disorders induced by antipsychotics. In conclusion, catatonia could be observed several weeks after titration to a therapeutic dose of paliperidone in a patient without other psychiatric or medical comorbidity. Prompt discontinuation of the implicated drug and giving benzodiazepines are beneficial in patients presenting with catatonic symptoms associated with antipsychotics. A signed consent from the patient authorizing publication has been obtained. The authors declare no conflicts of interest or funding. Chao-Ying Tu, MD,1,3 Yi-Ling Chien, MD1,2 and Wei-Lieh Huang, MD, MS1,2,3 1Department of Psychiatry, National Taiwan University Hospital, 2Department of Psychiatry, National Taiwan University College of Medicine, Taipei and 3Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan Email: [email protected]
SDGs
Other Subjects
biperiden; lorazepam; paliperidone; quetiapine; risperidone; adult; case report; catatonia; computer assisted tomography; disease severity; drug dose titration; drug safety; electroencephalography; female; human; immobility; Letter; medication compliance; muscle rigidity; mutism; paranoid schizophrenia; patient compliance; treatment outcome; treatment response; treatment withdrawal
Publisher
Blackwell Publishing
Type
letter