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El Ouni Amami N, Ali-Diabacte H, Ateb S, Ben Rejeb H, Bellis A, Bellis R, Januel D, Bouaziz N. Clozapine-induced cholinergic urticaria: a case report. Ther Adv Psychopharmacol 2024; 14:20451253241241056. [PMID: 38745850 PMCID: PMC11092545 DOI: 10.1177/20451253241241056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/31/2024] [Indexed: 05/16/2024] Open
Abstract
Clozapine, renowned for its efficacy in treatment-resistant schizophrenia, is associated with rare yet potentially severe side effects, including hematological disorders, myocarditis, seizures and gastrointestinal obstruction. Dermatological adverse effects, though less serious, can profoundly impact patients' quality of life. We present the first reported case of cholinergic urticaria induced by clozapine, in a 25-year-old male with treatment-resistant schizophrenia. Four months into clozapine therapy, the patient developed intensely pruritic erythematous lesions triggered by sweating, significantly impairing his daily activities. Despite attempts at management, including dose reduction and antihistamine therapy, the urticaria persisted. However, a favorable outcome was achieved upon switching to quetiapine. This case underscores the importance of recognizing and managing treatment-related adverse effects, even when they arise late in treatment, and highlights the need for individualized therapeutic approaches.We discuss potential mechanisms underlying clozapine-induced cholinergic urticaria and emphasize the significance of patient-centered care in optimizing treatment outcomes in schizophrenia.
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Affiliation(s)
| | | | - Sarra Ateb
- Établissement publique de santé mentale de Ville-Evrard, France
| | | | - Avicenne Bellis
- Établissement publique de santé mentale de Ville-Evrard, France
| | - Reza Bellis
- Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | | | - Noomane Bouaziz
- Établissement public de santé mentale de Ville Evrard, France
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Ajani AA, Olanrewaju FO, Oninla OA, Ibigbami O, Mosaku SK, Onayemi OE, Olasode O. Psychodermatological Disorders in Patients With Primary Psychiatric Conditions: Cross-Sectional Study. JMIR DERMATOLOGY 2023; 6:e47769. [PMID: 37782534 PMCID: PMC10580141 DOI: 10.2196/47769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Psychodermatological disorders (PDs) and their associations with mental health problems are one of the most frequent research themes in dermatology outpatient settings. Surprisingly, very few studies have been conducted to evaluate PDs among patients with primary psychiatric conditions. As such, the relationship between preexisting psychiatric conditions and comorbid PDs is underrepresented in the literature. OBJECTIVE This study examined the prevalence and distribution of PDs among adults with primary psychiatric conditions and determined their association with underlying psychiatric diagnoses. METHODS We conducted a cross-sectional analysis at a tertiary health care facility in southwestern Nigeria. Comorbid PDs were identified and classified using preexisting classification systems. A bivariate analysis was conducted to determine the association between PDs and underlying psychiatric conditions. The level of statistical significance was set at P<.05. RESULTS The study included 107 patients with mental health disorders, of whom 64 (59.8%) were female. The mean age of the patients was 40.73 (SD 13.08) years. A total of 75 (75/107, 70%) patients had at least one comorbid PD. The prevalence of PDs was highest in patients with affective disorders (15/20, 75%) and least in those with schizophrenia (45/66, 68%). PDs associated with delusions or hallucinations and somatoform symptoms were 9 and 13 times more frequent in patients with anxiety disorders compared to those with other psychiatric conditions (P=.01; odds ratio [OR] 9.88, 95% CI 1.67-58.34 and P=.003; OR 13.13, 95% CI 2.34-73.65), respectively. In contrast, patients with schizophrenia were significantly less likely to be diagnosed with dermatoses resulting from delusions or hallucinations (P=.002; OR 0.04, 95% CI 0.00-0.75). A weak but significant negative association was also found between psychophysiological PDs and anxiety disorders (ϕ=-0.236; P=.02). CONCLUSIONS This study provides important insights into the overwhelming burden of psychodermatological conditions in patients with mental health disorders and specific associations with underlying psychiatric diagnosis.
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Affiliation(s)
- Atinuke Arinola Ajani
- Department of Dermatology and Venereology, Obafemi Awolowo University, Ile Ife, Nigeria
| | | | | | - Olanrewaju Ibigbami
- Department of Dermatology and Venereology, Obafemi Awolowo University, Ile Ife, Nigeria
| | | | | | - Olayinka Olasode
- Department of Dermatology and Venereology, Obafemi Awolowo University, Ile Ife, Nigeria
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3
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Deshmukh RP. Olanzapine-induced reversible skin eruption. Indian J Psychiatry 2023; 65:607-609. [PMID: 37397850 PMCID: PMC10309265 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_568_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/01/2022] [Accepted: 04/12/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Rohit P Deshmukh
- Department of Psychiatry, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India. E-mail:
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Borojevic N, Dawud M, Xiao J, Yun Y. Long-acting injectable paliperidone palmitate induced severe cutaneous allergic reaction in a patient with first episode delusional disorder tolerating oral paliperidone regimen: a case report. BMC Psychiatry 2022; 22:734. [PMID: 36434603 PMCID: PMC9700998 DOI: 10.1186/s12888-022-04347-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/29/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Paliperidone is a second-generation antipsychotic agent that is effective in the treatment of schizophrenia and schizoaffective disorder as well as an adjunct to mood stabilizers and antidepressants for bipolar and depressive disorders. Paliperidone is available in both oral and injection forms. Here we report an unexpected case of cutaneous allergic reaction induced by paliperidone long-acting injection (LAI) following oral tolerance. CASE PRESENTATION A 55-year-old man with first episode delusional disorder was treated with paliperidone tablets with tolerance. On day seven he received the paliperidone LAI and developed an allergic reaction in minutes including flushing of the face, widespread urticaria with mild airway constriction. The allergic symptoms were relived following the administration of antihistamine within several minutes. CONCLUSION The allergic reaction that occurred post administration of the paliperidone LAI but not the oral tablets suggest it is likely due to the excipients in the formulation of the LAI rather than paliperidone itself. This case highlights the necessity of monitoring allergic reactions in psychiatric patients when converting from oral to LAI format of paliperidone.
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Affiliation(s)
- Natasa Borojevic
- grid.414366.20000 0004 0379 3501Box Hill Hospital, Eastern Health, Box Hill, VIC Australia
| | - Midya Dawud
- grid.416536.30000 0004 0399 9112Pharmacy Department, Northern Hospital, Epping, VIC Australia
| | - Junhua Xiao
- grid.1027.40000 0004 0409 2862School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC Australia ,grid.1018.80000 0001 2342 0938School of Allied Health, La Trobe University, Bundoora, VIC Australia
| | - Yang Yun
- Northern Area Mental Health Service, Northern Hospital, Epping, VIC, Australia.
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Ali E, Sachdeva A, Passi S. Risperidone-induced maculopapular rashes in a child. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bipolar Patients and Bullous Pemphigoid after Risperidone Long-Acting Injectable: A Case Report and a Review of the Literature. Brain Sci 2021; 11:brainsci11111386. [PMID: 34827385 PMCID: PMC8615919 DOI: 10.3390/brainsci11111386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022] Open
Abstract
Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients' physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications.
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Saha B, Gupta I, Dayal S, Chhabra S. A Rare Case of Risperidone Induced Reticular Palmar Pigmentation. Indian Dermatol Online J 2021; 12:183-184. [PMID: 33768051 PMCID: PMC7982035 DOI: 10.4103/idoj.idoj_315_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/12/2020] [Accepted: 06/22/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Barnita Saha
- Department of Skin and VD, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Isha Gupta
- Department of Skin and VD, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Surabhi Dayal
- Department of Skin and VD, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Sonia Chhabra
- Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Ekinci O, Gunes S. Risperidone-induced bruise-like rash in a child. Ann Saudi Med 2020; 40:436-438. [PMID: 33007170 PMCID: PMC7532059 DOI: 10.5144/0256-4947.2020.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Adverse cutaneous reactions are rarely seen with antipsychotics. Exanthematous eruptions, skin pigmentation changes, photosensitivity, urticaria, and pruritus have been previously reported. We report a bruise-like rash in a 4-year-old boy with risperidone use. The rash disappeared on discontinuation and then reappeared after re-initiating the medication. Clinicians should be aware of a bruise-like skin rash as a rare adverse effect of risperidone. This is especially important for pediatric cases where physical abuse may be suspected. SIMILAR CASES PUBLISHED: None.
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Affiliation(s)
- Ozalp Ekinci
- From the Department of Child and Adolescent Psychiatry, University of Health Sciences and Medical Faculty, Istanbul, Turkey
| | - Serkan Gunes
- From the Department of Child and Adolescent Psychiatry, Hatay State Hospital, Hatay, Turkey
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10
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Gürbüz HGA, Seçinti DD, Neze H. Clozapine-induced late-onset angioedema. Indian J Psychiatry 2020; 62:95-96. [PMID: 32001938 PMCID: PMC6964462 DOI: 10.4103/psychiatry.indianjpsychiatry_379_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/18/2018] [Accepted: 10/02/2019] [Indexed: 11/23/2022] Open
Abstract
Clozapine is an atypical antipsychotic which is generally used as a second line antipsychotic drug in clinical practice due to its side effects. It is known that Clozapine may induce hypersensitivity reaction, angioedema at the beginning of the treatment, late onset angioedema related to clozapine treatment is very rare in the literature. In this case report, we present a 19 years old man who was admitted to psychiatry with clozapine induced periorbital edema. He was receiving clozapine 200 mg per day for last two years when he applied to psychiatry. After reducing daily dose of clozapine to 150 mg, his periorbital edema regressed. It should be known that clozapine induced angioedema may develop not only at the beginning of the treatment but also during the treatment and may regress with dose reduction.
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Affiliation(s)
- Hatice Gözde Akkin Gürbüz
- Department of Child and Adolescent Psychiatry, Kartal Dr. Lütfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Dilara Demirpence Seçinti
- Department of Child and Adolescent Psychiatry, Şanliurfa Research and Training Hospital, Şanliurfa, Turkey
| | - Handan Neze
- Department of Child and Adolescent Psychiatry, Kartal Dr. Lütfi Kirdar Research and Training Hospital, Istanbul, Turkey
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Shah B, Levenson JL. Use of psychotropic drugs in the dermatology patient: When to start and stop? Clin Dermatol 2018; 36:748-755. [DOI: 10.1016/j.clindermatol.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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13
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Cary JH, Li BS, Maibach HI. Dorsal hand skin hyperpigmentation following oral olanzapine (Zyprexa) use. Contact Dermatitis 2018; 79:254-255. [DOI: 10.1111/cod.13059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- John H. Cary
- Louisiana State University School of Medicine; New Orleans Louisiana
| | - Becky S. Li
- Howard University College of Medicine; Washington District of Columbia
| | - Howard I. Maibach
- Department of Dermatology; University of California, San Francisco, School of Medicine; San Francisco California
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14
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Clozapine-Induced Phototoxicity: An Unusual Side Effect of Atypical Antipsychotics. Case Rep Dermatol Med 2018; 2018:9242515. [PMID: 30046495 PMCID: PMC6036849 DOI: 10.1155/2018/9242515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Clozapine is a second-generation antipsychotic used for treatment-refractory schizophrenia. Photosensitivity is a major concern when prescribing typical antipsychotics, while atypical antipsychotics are thought to be less photosensitive. Case Report We report a 27-year-old military personnel who developed a phototoxic drug reaction after using clozapine for schizophrenia. Conclusion Recognition of rare but possible ability of atypical antipsychotics to cause photosensitivity is pertinent to patients care and proper counseling.
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15
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Güler HA, Türkoğlu S, Güler D. Maculopapular rash associated with risperidone in a child. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1468639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Hasan Ali Güler
- Department of Child and Adolescent Psychiatry, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Serhat Türkoğlu
- Department of Child and Adolescent Psychiatry, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Dilara Güler
- Department of Dermatology, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
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16
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Abstract
Objective: To better understand cutaneous photosensitivity reactions, a review of its etiologic factors, clinical characteristics, pathogenesis, and treatment modalities was undertaken. Methods: Articles discussing the above aspects of phototoxic and photoallergic reactions were used to demonstrate what is currently known about photoinduced reactions and how to treat them. Results: Upon interaction of solar UV radiation with the chemical that is present in significant levels on the skin, one of two known reactions may occur in susceptible patients: a phototoxicity and/or photoallergy. Phototoxic and photoallergic reactions can be diagnosed separately on the basis of pathogenesis, clinical characteristics, and histology. Examples of drugs capable of inducing a phototoxic reaction include amiodarone, retinoids, nonsteroidal antiinflammatory agents, diuretics, and antibiotics. Substances known to cause a photoallergic response are fragrances, sunscreens, topical antimicrobials, NSAID, and psychiatric medications, such as chlorpromezine. Conclusion: Photoinduced reactions produced by exogenous chemicals are common skin disorders. Definitive therapy requires identifying and removing the offending agent, either the photosensitizing chemical or light. The use of fully protective clothing and a sunscreen of high SPF are important measures when light exposure is inevitable.
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Affiliation(s)
- Lela Lankerani
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
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Karimi K, Lindgren TH, Koch CA, Brodell RT. Obesity as a risk factor for malignant melanoma and non-melanoma skin cancer. Rev Endocr Metab Disord 2016; 17:389-403. [PMID: 27832418 DOI: 10.1007/s11154-016-9393-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The dramatic increases in incidence of both obesity and many cancers including skin cancer emphasize the need to better understand the pathophysiology of both conditions and their connections. Melanoma is considered the fastest growing cancer and rates of non-melanoma skin cancer have also increased over the last decade. The molecular mechanisms underlying the association between obesity and skin cancer are not clearly understood but emerging evidence points to changes in the tumor microenvironment including aberrant cell signaling and genomic instability in the chronic inflammatory state many obese individuals experience. This article reviews the literature linking obesity to melanoma and non-melanoma skin cancer.
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Affiliation(s)
- K Karimi
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - T H Lindgren
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - C A Koch
- Division of Endocrinology, University of Mississippi Medical Center, Jackson, MS, USA
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
| | - Robert T Brodell
- Department of Dermatology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Abstract
Adverse skin reactions are an important type of adverse drug reactions which have been reported with a wide variety of psychotropics including both typical and atypical antipsychotics. Like typical antipsychotics, atypical antipsychotics such as olanzapine, risperidone, and paliperidone have been documented to cause skin reactions. Reports of aripiprazole-induced skin reactions are sparse. We report a case of skin rash that developed after starting aripiprazole in a male patient suffering from schizophrenia and which remitted after the drug was stopped.
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Affiliation(s)
- Santanu Nath
- Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Sajjadur Rehman
- Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Kamal Narayan Kalita
- Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Aparajeeta Baruah
- Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
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Chew J, Cheong S, Tay L. Quetiapine-Induced Cutaneous Vasculitis: Diagnostic Challenges and Therapeutic Implications. J Am Geriatr Soc 2016; 64:1137-8. [PMID: 27225367 DOI: 10.1111/jgs.14107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Justin Chew
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
| | - Selina Cheong
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | - Laura Tay
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
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Affiliation(s)
- Priya Janardhana
- Department of Pharmacology, Mysore Medical College and Research Institute, K. R. Hospital, Mysore, Karnataka, India
| | - Anil Kumar Mysore Nagaraj
- Department of Psychiatry, Mysore Medical College and Research Institute, K. R. Hospital, Mysore, Karnataka, India. E-mail:
| | - P L Basavanna
- Department of Pharmacology, Mysore Medical College and Research Institute, K. R. Hospital, Mysore, Karnataka, India
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22
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Lai YW, Chou CY, Shen WW, Lu ML. Pityriasis rosea-like eruption associated with clozapine: a case report. Gen Hosp Psychiatry 2012; 34:703.e5-7. [PMID: 22516218 DOI: 10.1016/j.genhosppsych.2012.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/29/2012] [Accepted: 03/05/2012] [Indexed: 11/25/2022]
Abstract
Adverse cutaneous drug reactions (ACDRs) are common in clinical practice and occur in about 5% of antipsychotic-treated patients. Most ACDRs are benign, but a small percentage of them are serious and life threatening. Pityriasis rosea (PR)-like eruption is a common cutaneous adverse reaction related to many drugs. Clozapine, a complex neurotransmitter receptor-binding in antipsychotic agent, is usually used for treatment-resistant schizophrenia. Clozapine-related ACDRs have been reported frequently, but clozapine-induced PR-like eruption has been reported once in the literature. We report a 54-year-old male patient with chronic schizophrenia who had received clozapine for 28 days and developed generalized skin rashes, high fever, and elevated values in liver function tests. His clozapine was immediately discontinued. He received acute managements with steroid and antihistamine, and his symptoms were relieved after treatment. This case report can be used to remind clinicians of keeping in mind the potential of clozapine-associated ACDRs.
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Affiliation(s)
- Ya-Wen Lai
- Department of Psychiatry, Taipei Medical University-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
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Abstract
Adverse cutaneous reactions are one of the most frequent types of adverse drug reactions, and have been reported with a wide range of psychotropics including typical and atypical antipsychotics. However the majority of adverse cutaneous reactions are relatively minor, and severe reactions are relatively rare. Aripiprazole is a third-generation atypical antipsychotic that has been available in the UK for over seven years. Here the author reports the first reported case of a lichenoid drug reaction to aripiprazole, a severe and potentially life-threatening adverse cutaneous reaction that required medical and surgical intervention.
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Affiliation(s)
- Caroline Parker
- CNWL NHS FT, St Charles Hospital, Exmoor Street, London W10 6DZ, UK
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Chae BJ, Kang BJ. Rash and desquamation associated with risperidone oral solution. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 10:414-5. [PMID: 19158986 DOI: 10.4088/pcc.v10n0511e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Borras L, Huguelet P. A case report of photosensitivity to amisulpride. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 9:153. [PMID: 17607344 PMCID: PMC1896311 DOI: 10.4088/pcc.v09n0211f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pariente A, Sanctussy DJR, Miremont-Salamé G, Moore N, Haramburu F, Fourrier-Réglat A. Factors associated with serious adverse reactions to cholinesterase inhibitors: a study of spontaneous reporting. CNS Drugs 2010; 24:55-63. [PMID: 20030419 DOI: 10.2165/11530300-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Cholinesterase inhibitors are used in Alzheimer's disease, mostly in elderly persons with co-morbidities and receiving co-medications that could increase the risk of serious adverse reactions. OBJECTIVE To identify factors associated with serious adverse drug reactions (ADRs) in patients treated with cholinesterase inhibitors. METHODS All ADRs associated with donepezil, rivastigmine or galantamine were identified in the French pharmacovigilance database, from the launching of these drugs to January 2007. Serious ADRs (SADRs) were those that led to death, hospitalization or prolongation of hospitalization, or that were life threatening. A multiple logistic regression analysis was used to identify factors associated with seriousness in the reported adverse reactions. RESULTS We identified 773 reports of ADRs related to cholinesterase inhibitor use, among which 438 (57%) concerned SADRs. The median age of patients was 80 years (interquartile range: 75-84 years); 65.1% were women. The most represented ADRs were those responsible for CNS disorders (17.0%), gastrointestinal disorders (16.2%) and cardiac rhythm disorders (11.2%). Factors associated with an increased risk of SADRs were: age (odds ratio [OR] 1.92; 95% CI 1.22, 3.02 for subjects aged 85 years and over), use of atypical antipsychotics (OR 2.15; 95% CI 1.04, 4.46), use of conventional antipsychotics (OR 2.06, 95% CI 1.10, 3.85), use of antihypertensive drugs (OR 2.11; 95% CI 1.47, 3.02) and use of drugs targeting the alimentary tract and metabolism (OR 1.62; 95% CI 1.06, 2.46). The use of benzodiazepines (long-acting or others), antidepressants (tricyclic or others) or antiarrhythmic drugs was not associated with the reporting of SADRs. CONCLUSIONS An increased risk of SADRs related to cholinesterase inhibitors was associated with the use of antipsychotics (with no difference between conventional and atypical antipsychotics), drugs targeting the alimentary tract/metabolism and antihypertensive drugs. It was not associated with the use of other psychotropic drugs, other non-psychotropic CNS drugs or with the use of antiarrhythmic agents. The association with drugs targeting the alimentary tract and metabolism could result from a protopathic bias or reflect the particular sensitivity to serious nausea and vomiting in patients already treated for gastrointestinal disorders. These results confirm that attention needs to be paid to patients receiving both cholinesterase inhibitors and antipsychotics.
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Affiliation(s)
- Antoine Pariente
- Service de Pharmacologie, INSERM U657, BP 36, Université Victor Segalen Bordeaux 2, Bordeaux, France.
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Abstract
The incidence of allergic reactions to antipsychotic agents is not well known but would be expected to be low. However, pharmacy records at a large state psychiatric hospital indicated surprisingly high rates of such allergies. We hypothesized that these high rates of reported allergies in the pharmacy database would not be supported by clinical history, but rather that they represented other side effects or past uncritical acceptance of casual patient reports. Method. Patients listed as having experienced allergies to antipsychotic medications were interviewed by two psychiatrists and any clinical evidence that suggested an allergy was noted. Results. Of 585 patients who were hospitalized on the day the data were reviewed, 138 patients (23.6%) were identified by the pharmacy as allergic to an antipsychotic medication, 79 of whom were available and consented to be interviewed. Of these 79 patients, 7 (8.9%) provided evidence of a true allergy and 12 (15.2%) provided evidence that suggested a remote possibility of an allergy. Of the 60 "allergic" patients who provided no evidence of an allergy, 57% reported a non-allergic adverse drug reaction (ADR) that may have accounted for the allergy assignment and 32% reported possible symptoms that might have done so. Length of stay was possibly associated with an unsupported allergy designation (p <0.07). Reported allergies to other psychotropic agents (p <0.02) or to nonpsychotropic agents (p <0.07) were associated with evidence of a "true" allergy to an antipsychotic agent. Conclusions. Allergies to antipsychotic medications may be much less common than suggested by clinical records. The examination of focused clinical histories from patients who have been reported to experience such "allergies" would likely expand the pool of available medications for many patients.
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Burke GV, Wong DA, Saunders CS, Pierre JM. Self-limited erythema multiforme with risperidone. Gen Hosp Psychiatry 2009; 31:295-6. [PMID: 19410111 DOI: 10.1016/j.genhosppsych.2008.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 08/21/2008] [Accepted: 08/22/2008] [Indexed: 11/19/2022]
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Ben Djebara M, Worbe Y, Schüpbach M, Hartmann A. Aripiprazole: a treatment for severe coprolalia in "refractory" Gilles de la Tourette syndrome. Mov Disord 2008; 23:438-40. [PMID: 18067182 DOI: 10.1002/mds.21859] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Coprolalia is one of the most distressing symptoms in Gilles de la Tourette syndrome. We report on a 28-year-old man with severe coprolalia at the forefront of symptoms, which had a dramatic impact on his social and professional life and that did not fluctuate for years. Moreover, he presented hypersensitivity to neuroleptics. The use of aripiprazole, as a last resort, induced a 75% of improvement of his symptoms with good tolerance. This suggests that aripiprazole constitutes a valuable therapeutic in coprolalia. Moreover, its biochemical class specificity makes it an alternative for patients hypersensitive to other classes of neuroleptics.
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Affiliation(s)
- Mouna Ben Djebara
- Centre d'Investigation Clinique, Fédération de Neurologie, Paris, France
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Abstract
Antipsychotic medications are commonLy associated with adverse cutaneous reactions (ACRs) in approximately 5% of patients. Angio-oedema accompanying urticaria is one of the most serious ACRs. The 36-year-old female patient who was diagnosed with ;Paranoid schizophrenia' 6 years ago, was commenced on ziprasidone 120 mg/day. On day 30 of the treatment, the patient presented urticarial papules and plaques all over the body and angio-oedema in the face. The patient was diagnosed as ;Urticaria + Angio-oedema'. The development of ACRs after the initation of ziprasidone monotherapy, disappearance of lesions after the discontinuation of this antipsychotic, and positive intradermal skin test all suggests a possible causal relationship between ACRs and ziprasidone. To our knowledge, this is the first reported case of urticaria and angio-oedema due to ziprasidone monotherapy. Ziprasidone is a valid and effective choice amongst antipsychotic medications, but this case calls for caution regarding ACRs at the time of prescribing.
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Affiliation(s)
- Cengiz Akkaya
- Uludag University Medical Faculty, Psychiatry Department, Bursa, Turkey.
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Abstract
OBJECTIVE To better understand cutaneous photosensitivity reactions, a review of its etiologic factors, clinical characteristics, pathogenesis, and treatment modalities was undertaken. METHODS Articles discussing the above aspects of phototoxic and photoallergic reactions were used to demonstrate what is currently known about photoinduced reactions and how to treat them. RESULTS Upon interaction of solar UV radiation with the chemical that is present in significant levels on the skin, one of two known reactions may occur in susceptible patients: a phototoxicity and/or photoallergy. Phototoxic and photoallergic reactions can be diagnosed separately on the basis of pathogenesis, clinical characteristics, and histology. Examples of drugs capable of inducing a phototoxic reaction include amiodarone, retinoids, nonsteroidal antiinflammatory agents, diuretics, and antibiotics. Substances known to cause a photoallergic response are fragrances, sunscreens, topical antimicrobials, NSAID, and psychiatric medications, such as chlorpromezine. CONCLUSION Photoinduced reactions produced by exogenous chemicals are common skin disorders. Definitive therapy requires identifying and removing the offending agent, either the photosensitizing chemical or light. The use of fully protective clothing and a sunscreen of high SPF are important measures when light exposure is inevitable.
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Affiliation(s)
- Lela Lankerani
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Abstract
Of all the psychotropic medications currently available, the mood-stabilizing agents have the highest incidence of severe and life-threatening adverse cutaneous drug reactions (ACDRs). An exanthematous eruption in a patient treated with a mood-stabilizing agent should be viewed as possibly being the initial symptom of a severe and life-threatening ACDR, such as a hypersensitivity reaction, Stevens-Johnson syndrome, or toxic epidermal necrolysis. The combination of mood-stabilizing agents may increase the risk of such reactions. The mood-stabilizing agents addressed in this article are carbamazepine, lithium carbonate, valproic acid, topiramate, lamotrigine, gabapentin, and oxcarbazepine. Prior to the initiation of a mood stabilizer, the potential benefits, risks, and adverse effects should be communicated to the patient. If possible, slow dose escalation should be attempted by the physician. Patients should also be advised to seek medical attention if they suspect a drug-induced skin reaction. If the physician suspects a severe ACDR, the offending agent should be removed immediately.
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Affiliation(s)
- Julia K Warnock
- University of Oklahoma Health Sciences Center, Tulsa, Oklahoma 74135, USA.
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