Letter to the Editor 87

DOI: 10.4274/Npa.y6310

Psychotic Disorder due to Withdrawal of Barbexaclone Barbeksaklon Yoksunluğuna Bağlı Psikotik Bozukluk

Murat KULOĞLU1, Sevda KORKMAZ2, Sadullah SAĞLAM3, Murad ATMACA1 1Fırat University Hospital Psychiatry Clinic, Elazığ, Turkey 2Elazığ Psychiatry Hospital, Psychiatry Clinic, Elazığ, Turkey 3Elazığ Psychiatry Hospital, Neurology Clinic, Elazığ, Turkey

Dear Editor, which became generalized. He had approximately 3-4 seizures a year. It was learned that the patient who had these complaints Barbexaclone (Maliasin®) is an antiepileptic drug which is for the last three days discontinued barbexaclone two days composed of phenobarbital and salt compound of before the onset of the symptoms. Epileptic seizure was not propylhexedrine which is known to be a central nervous system described in the initial period of the complaints. The patient who stimulant . It has been reported that psychotic symptoms may had no previous history of psychiatric disease had no physical rarely develop during treatment with phenobarbital and other illness except for epilepsy. Complete blood count, biochemical antiepileptic drugs (1). Although there are case reports in the tests and thyroid function tests were within normal limits. On literature about development of addiction with barbexaclone (2), neurological examination, his consciousness was open, he had there is no information about development of psychotic disorder full orientation to place, time and person. However, full with discontinuance after long-term use. In our article, we aimed cooperation could not be established with the patient because of to present a patient who developed psychotic symptoms and active psychotic symptoms. The patient had disarthric speech. some behavioral changes with sudden discontinuance of On psychiatric examination, it was observed that he had barbexaclone. intermittent agitations, paranoid thoughts and delusions of M.K 38-year-old, married, has three children, primary school persecution. The diagnosis of delirium was excluded, since graduate male patient. He presented to the emergency orientation to place, time and person in the patient was complete department with complaints including nervousness, peculiar on examination of orientation performed during the periods speech and behavior, tendency to harm himself and his relatives, when delusions and hallucinations were present. No sensibility and suspiciousness. According to the information pathological finding was found on brain magnetic resonance obtained from his family, the patient had these complaints for the imaging and electroencephalography (EEG). Personality test last three days. He tried to burn his house a few hours ago, broke could not be performed, since the patient was not cooperated. the glasses of the cars in the district and was brought to our Amisulpride 200 mg/day was started considering ‘’Psychotic clinic by the police, since he did not accept treatment. He had no disorder related to use of psychoactive substance’’ (progressing communication with his environment for approximately 20 years. with delusions-starting at the time of discontinuance) according He used barbexaclone 100 mg/day and carbamazepine 800 to the American Psychiatry Association, Mental Disorders mg/day for treatment of complex partial seizures accompanied Diagnostic and Statistical Manual IV-TR (3) because of the fact by meaningless walking and mouth-tongue automatisms some of that there was no secondary factor explaining the condition

Corres pon den ce Address/ Ya z›fl ma Ad re si: Murat Kuloğlu MD, Fırat University Hospital Psychiatry Clinic, Elazığ, Turkey Gsm: +90 533 413 98 97 E-mail: [email protected] Recei ved/Ge li ştari hi: 14.09.2011 Accep ted: 24.03.2012 © Archi ves of Neuropsy chi atry, publis hed by Gale nos Publis hing. / © Nö rop si ki yat ri Ar şi vi Der gi si, Ga le nos Ya yı ne vi ta ra f›n dan ba s›l m›fl t›r. 88 Kuloğlu et al. Archi ves of Neuropsy chi atry 2013; 50: 87-88 Psychotic Disorder due to Withdrawal of Barbexaclone Nörop si ki yat ri Arfli vi 2013; 50: 87-88 except for the drug he used and the information obtained from to abuse especially drugs which are effective on the central his history. Carbamazepine 800 mg/day which he used as nervous system. It is thought that the property of barbexaclone antiepileptic treatment was continued. Diazepam 15 mg/day was which leads to off label use of the drug arises from its sedative or added considering the risk of epileptic seizure and phenobarbital anxiolytic effect (2). It has been reported that the reason that withdrawal symptoms. Withdrawal symptoms were not antiepileptic addiction does not develop in epileptic patients is observed during the follow-up period of approximately 1 month. the fact that the expectations related with the drug are related Laboratory tests were within normal limits. During the following with the anticonvulsant effect rather than the psychotropic follow-up period of 6 months, no precursor, residual or psychotic effect (9). symptom was observed. Conclusively, considering the fact that sudden Although psychosis picture is frequently observed in the discontinuance of barbexaclone which is known to have an course of epilepsy, the fact that no epileptic seizure was addiction potential (10) may be related with psychotic process described before the psychotic attack, epileptiform activity was and the physician’s attention in terms of psychotic disorder or not observed on EEG recordings, the patient had no previous similar psychiatric side effects while using antiepileptic drugs history of psychotic attack and responded to antipsychotic will be beneficial in the diagnosis and treatment. treatment better and experienced the attack following sudden discontinuation of barbexaclone suggested that the psychotic References picture might be related with sudden discontinuation of the drug rather than psychosis which may be observed during the course 1. Lancman M. Psychosis and peri-ictal confusional states. Neurology 1999; of epilepsy. 53:33-38. 2. Sezgin E, Evren C, Çınar ÖG, Küçükgöncü S, Kılıç Bayram M. Antiepileptik, Neuropsychiatric symptoms may be observed in relation Barbeksaklon (Maliasin®) bağımlılığı olan iki olgu. Düşünen Adam with antiepileptic drugs. Although barbexaclone is a drug which Psikiyatri ve Nörolojik Bilimler Dergisi 2010; 23:128-132. is as efficient as phenobarbital and tolerated better, it carries a 3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth ed. Text revision (DSM-IV-TR). Washington: APA, risk of addiction in terms of propylhexedrine which is the other 2000. component of the drug and its abuse is observed because of its 4. Darcın AE, Dilbaz N, Okay IT. Barbexaclone abuse in a cannabis ex-user. amphetamine-like stimulant effect and structural similarity (4). In Subst Abus 2010; 31:270-272. the literature, sudden death (5), soft tissue demage (6) and brain 5. Anderson RJ, Garza HR, Garriott JC, Dimaio V. Intravenous prophylhexedrine (Benzedrex) abuse and sudden death. Am J Med 1979; stem involvement characterized with diplopia (7) have been 67:15-20. reported with propylhexedrine. In addition, cases of addiction 6. Mancusi-Ungaro HR Jr, Decker WJ, Forshan VR, Blackwell SJ, Lewis SR. have been described with use of barbexaclone. Darçin et al. (4) Tissue injuries associated with parenteral propylhexedrine abuse. J Toxicol Clin Toxicol 1983-1984; 21:359-372. reported use of barbexaclone with the aim of relaxation in a 7. Fornazzari L, Carlen PL, Kapur BM. Intravenous abuse of propylhexedrine patient who was an old cocaine user. Sezgin et al. (2) presented (Benzedrex) and the risk of brainstem dysfunction in young adults. Can J two patients who were diagnosed with barbexaclone abuse for Neurol Sci 1986; 13:337-339. the aim of calming down and relaxation and barbexaclone 8. Yaris F, Kadioglu M, Kesim M, Ulku C, Yaris E, Kalyoncu NI. Barbexaclone use in pregnancy. Saudi Med J 2004; 25:245-246. addiction. Unlike these negative effects, Yaris et al. (8) reported 9. Uhlmann C, Fröscher W. Low risk of development of substance dependence that no teratogenic effect was observed in the infant of a mother for barbiturates and clobazam prescribed as antiepileptic drugs: results who used barbexaclone during pregnancy unwittingly. from a questionnaire study. CNS Neurosci Ther 2009; 15:24-31. 10. Torta R, Keller R. Behavioral, psychotic, and anxiety disorders in epilepsy: It has been recognized that individuals who have a etiology, clinical features, and therapeutic implications. Epilepsia 1999; 40 personal or familial history of substance abuse have a tendency (Suppl 10):2-20.