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Improvement of Persistent Cenesthopathy and Depersonalization After Treatment with Brexpiprazole in Schizophrenia Reiji Yoshimura, Atsuko Ikenouchi, Yuki Konishi

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Improvement of Persistent Cenesthopathy and Depersonalization After Treatment with Brexpiprazole in Schizophrenia Reiji Yoshimura, Atsuko Ikenouchi, Yuki Konishi Letter to the Editor CNPT11(2020)43-44 Improvement of persistent cenesthopathy and depersonalization after treatment with brexpiprazole in schizophrenia Reiji Yoshimura, Atsuko Ikenouchi, Yuki Konishi Department of Psychiatry, University of Occupational and Environmental Health, Japan Received May 18, 2020 / Accepted May 18, 2020 / Published June 12, 2020. Letter to the Editor feeling his skull was melting, and the cenesthopa- thy was often accompanied with depersonalization. Somatic hallucination is defined as the false sensa- He was first administered risperidone at 4mg/day. tion of an occurrence in the body. When the hallu- Auditory hallucinations, persecutory delusions, psy- cination is grotesque and visceral, it is classified as chomotor excitement, disorganized behavior, and a cenesthopathy [1]. Cenesthopathy presents comor- agitation gradually ameliorated with treatment. bidly to various other psychiatric diseases including However, his cenesthopathy associated with deper- schizophrenia, major depression, and somatoform sonalization persisted. Treatment with risperidone disorders [2]. It is interesting to note that cenestho- was changed to olanzapine at 20mg/day, and he pathy is likely influenced by culture, with one complained of hyperphagia without improvement of study reporting that, of the seven unique countries his cenesthopathy or depersonalization. Olanzapine from which patients were recruited, those from was tapered and ceased and he was started on blo- Ghana and those with chronic schizophrenia were nanserin, which was gradually increased to 16mg/ significantly more likely to report cenesthesia [3]. day. His cenesthopathy and depersonalization did Herein, we present a case of persistent cenesthopa- not respond to blonanserin. Thus, brexpiprazole was thy associated with depersonalization, which im- prescribed after blonanserin was tapered. On the proved drastically when treated with brexpiprazole. day 14 after starting brexpiprazole and increased to Written informed consent was obtained from the 2mg/day, he reported his cenesthopathy was slightly patient for publication of this case report. relieved, stating that the melting feeling in his scalp was weaker than before. On day 28 of treatment, Case report: The patient was a 41-year-old Japa- his cenesthopathy was completely resolved. The de- nese male diagnosed with schizophrenia, based on personalization also improved. He reported he DSM-5 criteria 15 years ago. He demonstrated per- could feel the world more clearly than before. He sistent active commentary auditory hallucinations, has been well without relapse at 2 mg/day of brex- persecutory delusions, disorganized behavior, cen- piprazole. esthopathy, depersonalization, and agitation. His de- velopment and past history of physical illness were To our knowledge, this is the first report of persis- unremarkable. The initial presentation of his psy- tent cenesthopathy associated with depersonaliza- chosis consisted of commentary auditory hallucina- tion responding to brexpiprazole in a patient with tions, delusions of persecution, psychomotor excite- chronic schizophrenia. It has been reported that ment, disorganized behavior, cenesthopathy associ- cenesthopathy may also occur in patients with ated with depersonalization, and restlessness. The Parkinson’s disease during dopamine agonist and patient’s cenesthopathy was consist of perceiving or anti-parkinsonian drug treatment [4]. A case report Corresponding author: Reiji Yoshimura, Department of Psychiatry, University of Occupational and Environ- mental Health, Japan, Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; tel: +81-93-691- 7253, fax: +81-93-692-4894, E-mail: [email protected] 43 Brexpiprazole and cenesthopathy Reiji Yoshimura et al. exists in which quetiapine improved strange tactile book of psychiatry (5th edition). Williams and hallucinations, similar to cenesthopathy, in a patient Wilkins, Balitmore, 1989. with Parkinson’s disease [5]. The mechanism by [2] Takahashi T, Fuke T, Washizuka S, Hanihara which brexpiprazole, but not risperidone, olanzap- T, Amano N. A Review of Recent Case Re- ine, or blonanserin improve cenesthopathy and de- ports of Cenesthopathy in Japan. Psychogeriat- personalization in chronic schizophrenia remains rics. 2013; 13: 196-198. unknown. The differences between pharmacological [3] Bauer SM, Schanda H, Karakula H, Olajossy- profiles among brexpiprazole, which possesses par- Hilkesberger L, Rudaleviciene P, Okribelash- tial agonistic effects on D2 and 5-HT1A, and also po- vili N, Chaudhry HR, Idemudia SE, Gscheider tent antagonistic activity on 5-HT2A, and the other S, Ritter K, Stompe T. Culture and the preva- antipsychotics may contribute its efficacy. Further lence of hallucinations in schizophrenia. research in similar clinical situations should be con- Compr Psychiatry. 2011; 52: 319-325. ducted to examine the effectiveness of brexpipra- [4] Kataoka H, Sawa N, Sugie K, Ueno S. Can zole for the management of cenesthopathy. dopamine agonists trigger tactile hallucinations in patients with Parkinson’s disease? J Neurol CONFLICT OF INTEREST Sci. 2014 5; 347: 361-363. [5] Lenka A, Reddy YCJ, Pal PK. Isolated tactile none hallucination in a patient with Parkinson’s dis- ease: Quetiapine conquers the snakes and stones. Asian J Psychiatr. 2018; 35: 34-35. REFERENCES [1] Kaplan HI, Sadock BJ. Comprehensive text- 44.
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