Wei-Chen Chuang1, Chun-Yen Chen1, Shin-Chang Kuo1, Tien-Yu Chen1, Yi-Wei Yeh2. 1. Wei-Chen Chuang, M.D., is Pediatrist, Division of Pediatrics, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, and Chief Resident, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei. Chun-Yen Chen, M.D., is Attending Psychiatrist; Shin-Chang Kuo, M.D., is Attending Psychiatrist; Tien-Yu Chen, M.D., is Chief Resident; and Yi-Wei Yeh, M.D., is Attending Psychiatrist, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center. 2. Wei-Chen Chuang, M.D., is Pediatrist, Division of Pediatrics, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, and Chief Resident, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei. Chun-Yen Chen, M.D., is Attending Psychiatrist; Shin-Chang Kuo, M.D., is Attending Psychiatrist; Tien-Yu Chen, M.D., is Chief Resident; and Yi-Wei Yeh, M.D., is Attending Psychiatrist, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center. ywyeh@ndmctsgh.edu.tw.
Abstract
PURPOSE: A case of rapid-onset mania after initiating amisulpride in a patient with schizophrenia and cerebral disease is reported. SUMMARY: A 19-year-old Taiwanese man had a 1-year history of schizophrenia, paranoid type, and cerebral palsy. His only medication was a 12-week course of risperidone 6 mg orally daily. His positive symptoms of auditory hallucinations and paranoid delusions improved markedly, but negative symptoms of inattention, avolition, and anhedonia continued. His motor disability and athetosis of the hand related to cerebral palsy also worsened during risperidone therapy. After a discussion with the patient's guardian, conversion of antipsychotic therapy from risperidone to amisulpride was commenced. On days 1-8 of the conversion, amisulpride 400 mg was given orally daily. The daily risperidone dose on days 1, 2, and 3 was 6, 4, and 2 mg, respectively; risperidone was discontinued after day 3. On day 4, the patient exhibited a euphoric mood, with persistent laughing, expansive self-esteem, extreme talkativeness, flight of ideas, distractibility, and psychomotor agitation. On day 8, the amisulpride dosage was increased to 800 mg orally daily and his manic symptoms worsened. On day 17, amisulpride was withheld and risperidone 4 mg daily was resumed. The manic symptoms subsided within three days after the cessation of amisulpride. The patient was maintained on risperidone 4 mg daily for six months without any further hypomanic or manic symptoms. CONCLUSION: A 19-year-old man with schizophrenia and underlying cerebral disease developed rapid-onset mania after risperidone was replaced with amisulpride. The reaction resolved soon after amisulpride was discontinued and treatment with risperidone was reinstituted.
PURPOSE: A case of rapid-onset mania after initiating amisulpride in a patient with schizophrenia and cerebral disease is reported. SUMMARY: A 19-year-old Taiwanese man had a 1-year history of schizophrenia, paranoid type, and cerebral palsy. His only medication was a 12-week course of risperidone 6 mg orally daily. His positive symptoms of auditory hallucinations and paranoid delusions improved markedly, but negative symptoms of inattention, avolition, and anhedonia continued. His motor disability and athetosis of the hand related to cerebral palsy also worsened during risperidone therapy. After a discussion with the patient's guardian, conversion of antipsychotic therapy from risperidone to amisulpride was commenced. On days 1-8 of the conversion, amisulpride 400 mg was given orally daily. The daily risperidone dose on days 1, 2, and 3 was 6, 4, and 2 mg, respectively; risperidone was discontinued after day 3. On day 4, the patient exhibited a euphoric mood, with persistent laughing, expansive self-esteem, extreme talkativeness, flight of ideas, distractibility, and psychomotor agitation. On day 8, the amisulpride dosage was increased to 800 mg orally daily and his manic symptoms worsened. On day 17, amisulpride was withheld and risperidone 4 mg daily was resumed. The manic symptoms subsided within three days after the cessation of amisulpride. The patient was maintained on risperidone 4 mg daily for six months without any further hypomanic or manic symptoms. CONCLUSION: A 19-year-old man with schizophrenia and underlying cerebral disease developed rapid-onset mania after risperidone was replaced with amisulpride. The reaction resolved soon after amisulpride was discontinued and treatment with risperidone was reinstituted.