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8Th International Congress on Psychopharmacology & 4Th International Symposium on Child and Adolescent Psychopharmacology

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8Th International Congress on Psychopharmacology & 4Th International Symposium on Child and Adolescent Psychopharmacology Case Reports 8th International Congress on Psychopharmacology & 4th International Symposium on Child and Adolescent Psychopharmacology CASE REPORTS [Abstract:0003][Psychopharmacology] Quetiapine associated with angioedema Taha Can Tuman1, Bengu Altunay Tuman2, Betul Sereflican2, Osman Yildirim1 1Department of Psychiatry, Abant Izzet Baysal University, School of Medicine, Bolu, Turkey 2Department of Dermatology, Abant Izzet Baysal University, School of Medicine, Bolu, Turkey e-mail address: [email protected] Quetiapine is an atypical antipsychotic indicated for the treatment of schizophrenia and bipolar disorder, both manic and depressive episodes. Quetiapine is also widely off label used for treatment of various psychiatric disorders. Angioedema is characterized with swelling of deep dermis and subcutaneous tissues without itching, often seen around the eyes, lips and genitals where subcutaneous tissue is loose. Histamine and bradykinin release by stimulation of mast cells via foods, drugs, infections, and physical stimuli lead vascular permeability and dilatation. Drug-related angioedema is most commonly seen with ACE inhibitors and NSAIDs. Here, we report a male patient of angioedema associated with quetiapine use. Case: A 36 year-old male patient with a 12 years follow-up diagnosis of bipolar disorder presented to our outpatient clinic with symptoms of reduced sleep, hyperactivity, irritability, restlessness, excessive talkativeness, distractibility, flight of ideas, grandiose, and mystic delusions. His physical and laboratory examinations (complete blood count, renal and hepatic function tests, urinalysis, electrolytes, thyroid function tests, and sedimentation rate), electrocardiography, and magnetic resonance imaging were normal. The patient was diagnosed with bipolar disorder, manic episode with psychotic features according to the DSM-5. Quetiapine 100 mg/day was started in the first day of the hospitalization. The dose was titrated to 200 mg/day in the 2nd day and 400 mg/day in the 3rd day. On the 4th day after introduction of quetiapine, facial swelling and periorbital edema was observed in his physical examination. He had no symptoms of pruritus or any infections. The patient was consulted with dermatology and was diagnosed with angioedema. Repeated laboratory tests were unremarkable. He had no medical and family history of angioedema and allergies. There were no other medical or herbal drug use by the patient. Quetiapine was stopped. Facial and periorbital edema was subsided within 2 days. Risperidone was started and titrated to 6 mg/day. No cutaneous drug reactions were observed. Naranjo Probability Scale revealed a score of 6, probable adverse effect caused by quetiapine. Drug re-challenge was not considered because of angioedema can be fatal when involving the larynx. The diagnosis was compatible with “quetiapine associated angioedema”. Facial and periorbital edema was subsided again within 3 days. The patient was discharged from the hospital in complete remission with risperidone 6 mg/ day. On his follow-up visits, no skin reactions were observed. To our knowladge, this is the first case report of angioedema associated with quetiapine. In literature, several antipsychotics (e.g., haloperidol, droperidol, chlorpromazine, clozapine, risperidone, olanzapine, ziprasidone, and paliperidone) were found to be associated with angioedema. Angioedema associated with drug use, is usually IgE mediated and usually occurs in the first week of drug therapy. As in our case, angioedema usually resolves within 24- 48 hours after cessation of the drug and recurs in case the same drug is given again. Keywords: quetiapine, angioedema, antipsychotics Bulletin of Clinical Psychopharmacology 2016;26(Suppl. 1):S278 S278 Klinik Psychopharmacology Bulteni - Bulletin of Clinical Psychopharmacology, Volume 26, Supplement 1 (April 01, 2016, pp. S1-S496) Case Reports [Abstract:0007][Schizophrenia and other psychotic disorders] Sulfasalazine-induced major depressive disorder with psychotic features Ali Kandeger, Ozkan Guler, Gunes Devrim Kicali Department of Psychiatry, Selcuk University, Konya, Turkey e-mail address: [email protected] Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown cause and affects mainly the spine, but can also affect other joints. Ankylosing spondylitis is the prototype of spondyloarthropathies that affects approximately 0.49% of the Turkish population and 0.9% of the world population. Non-steroid anti-inflammatory drugs are the primary treatment of choice. Sulfasalazine is a disease- modifying antirheumatic drug used in the treatment of AS. Sulfasalazine may cause central nervous system adverse effects such as serious psychiatric problems including mania, depression, and psychosis, and these symptoms have been reported to occur only infrequently. This present case reports a male patient who presented due to major depressive disorder with psychotic features. He had been receiving 1000 mg/day sulfasalazine for AS while he developed serious psychiatric symptoms. Case: The patient was a 46 year-old male, married with two children, works as a security guard, and high school graduate. The patient presented to our psychiatry outpatient clinic due to psychiatric symptoms like depressed mood, disturbed sleep and appetite, severe anxiety, and parapid thoughts like he was being followed. His psychiatric examination revealed that he was wide-awake and that his orientation and cooperation were good, though he spoke much slower than he was used to. His mood and affect were depressed. He had delusions of persecution and reference. The patient’s medical history showed that he had been diagnosed as having AS. He had been prescribed 500 mg/day sulfasalazine and treatment was increased to 1000 mg/day. After he was prescribed sulfasalazine, his depressive symptoms increased in 2 months. He had visited our outpatient clinic 3 months after the onset of sulfasalazine treatment with his severe psychiatric symptoms such as depressive mood, delusions of persecution and reference. The rheumatologist had discontinued his sulfasalazine treatment after rheumatology consultation. We started an outpatient treatment by prescribing sertraline 50 mg/day and olanzapine 10 mg/day, and arranged a follow-up appointment in 10 days. On follow-up examination, we realized that he had started using the medications as instructed. His psychotic symptoms disappeared and depressive symptoms diminished significantly in 1 month. It was concluded that sulfasalazine could be responsible for the psychiatric symptoms due to fact that they disappeared upon the discontinuation of sulfasalazine. He was followed up with the diagnosis of ‘substance -induced depressive disorder’ according to DSM-5. He was examined monthly during the follow-up period. It has been a year since he was diagnosed by our outpatient clinic and he has exhibited no psychiatric symptoms so far. After the patient started taking antidepressant and antipsychotic drugs, a rapid disappearance of severe psychiatric symptoms led us to conclude that this improvement might not be simply related to use of drugs but probably due to discontinuation of sulfasalazine. Also, neither the patient nor his family members had a history of psychiatric disorders. For these reasons, we considered a correlation between sulfasalazine use and appearance of psychiatric symptoms. With this in mind, we reviewed the current literature and found three psychiatric cases in association with sulfasalazine. Keywords: depression, psychosis, sulfasalazine Bulletin of Clinical Psychopharmacology 2016;26(Suppl. 1):S279 [Abstract:0019][Psychopharmacology] Lithium intoxication and neuroleptic malignant syndrome induced by aripiprazole: a case report Huriye Ersen, Fulya Maner Department of Psychiatry, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey e-mail address: [email protected] Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic complication associated with the use of neuroleptic agents and characterized by a distinctive clinical syndrome of fever, rigidity, autonomic nervous system dysfunction, and mental status change. Indeed, second-generation antipsychotics (SGAs) were originally assumed to be free from the risk of causing NMS, however several cases of NMS induced by SGAs (SGA-NMS) have been reported. We herein presented a patient suffering from bipolar disorder who had developed NMS with using aripiprazole and lithium. Klinik Psychopharmacology Bulteni - Bulletin of Clinical Psychopharmacology, Volume 26, Supplement 1 (April 01, 2016, pp. S1-S496) S279 Case Reports Case: A 45 year-old female presented to our clinic with the diagnosis of bipolar disorder; the complaints of increased energy, decreased need for sleep, unusual talkativeness, and racing thoughts. She had a history of subsequent hospitalizations for four times after an initial diagnosis of bipolar disorder was made 18 years ago. She was hospitalized for seven days and maintained with lithium 1200 mg/ day, aripiprazole 30 mg/day, biperiden 2 mg/day for this manic episode. One week after her discharge, she presented to the psychiatric emergency unit with insomnia, fatigue, rigidity, confusion, fever, and tremors. Investigations revealed the leukocytosis (WBC: 14.4 µ/l) concomitant with an elevated creatinine phosphokinase (CK) level of 535 IU/L (normal:<200 IU/L) and a high lithium level of 1.75 mEq/L (normal: 0.6-1.2 mEq/L). In light of her fever, encephalopathy,
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