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Amisulpride withdrawal akathisia responding to aripiprazole with propranolol in first-onset psychosis: a case report.
- Source :
- BMC Psychiatry; 1/29/2022, Vol. 22 Issue 1, p1-4, 4p, 1 Chart
- Publication Year :
- 2022
-
Abstract
- Background: Akathisia tends to develop as an early complication of antipsychotic treatment in a dose-dependent manner. Although withdrawal akathisia has been reported after the discontinuation or dose reduction of typical antipsychotic drugs, akathisia following atypical antipsychotic drug withdrawal remains a rare phenomenon. Case presentation: A 24-year-old woman with an acute psychotic episode was admitted and initially treated with aripiprazole. The aripiprazole dose was titrated up to 30 mg/day over 9 days and maintained for the next 3 days; however, her psychotic symptoms persisted without change. She was switched to amisulpride, with the dose increased over 2 weeks to 1000 mg/day. Subsequently, although the patient's psychotic episode subsided, her serum prolactin levels increased markedly. After discharge, the amisulpride dose was increased to 1200 mg/day owing to auditory hallucinations and was maintained with quetiapine (100–200 mg/day) and benztropine (1 mg/day) for 13 weeks. Given the potential for hyperprolactinemia as a side effect, the amisulpride dose was reduced to 800 mg/day concurrently with the discontinuation of benztropine; however, these changes resulted in severe restlessness without other extrapyramidal symptoms. The withdrawal akathisia disappeared over 2 weeks after switching to aripiprazole (10 mg/day) with propranolol (40 mg/day) and the patient's prolactin levels had normalized after 6 months of aripiprazole monotherapy. Conclusions: The present case highlights the potential for the development of withdrawal akathisia when the dose of amisulpride is tapered abruptly. Thus, a slow tapering and careful monitoring are recommended when switching from amisulpride to other antipsychotic drugs. Furthermore, this case suggests that changing the regimen to aripiprazole with propranolol may be a potential option for amisulpride withdrawal akathisia superimposed on pre-existing hyperprolactinemia. [ABSTRACT FROM AUTHOR]
- Subjects :
- AMISULPRIDE
PROPRANOLOL
TARDIVE dyskinesia
ARIPIPRAZOLE
ANTIPSYCHOTIC agents
Subjects
Details
- Language :
- English
- ISSN :
- 1471244X
- Volume :
- 22
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 154978879
- Full Text :
- https://doi.org/10.1186/s12888-022-03721-9