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Stanojkovic T, Zivkovic Zaric R, Lesnjak I, Gajic M, Markovic S, Canovic A, Jankovic Jovanovic K. Treatment of Acute Psychosis Caused by Isotretinoin: Systematic Review. PSYCHIAT CLIN PSYCH 2024; 34:103-108. [PMID: 39165893 PMCID: PMC11332560 DOI: 10.5152/pcp.2024.23778] [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] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 08/22/2024] Open
Abstract
Background Isotretinoin is an oral medicine prescribed for the management of severe acne that is insensitive to conventional therapy, including systemic antibiotics. Acute psychosis refers to a severe mental illness characterized by a loss of touch with realism, visions, delusions, confused thinking, and abnormal behaviors. The study aims to analyze and document these cases to better understand the potential relationship between isotretinoin use and the development of acute psychosis, as well as to find out which therapy is best for treating this problem. Methods We searched the following electronic databases independently with no linguistic or date limit: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and Serbian Citation Index (SCIndeks). Results Our results included 14 studies (13 case reports and 1 cohort study) with 18 individual cases. The oldest patient was 27 years old, and the youngest was 13 years old. Both genders were represented with 9 individuals each. Conclusion We can conclude that, in addition to discontinuation of isotretinoin, therapy with olanzapine and eventually risperidone could improve the symptoms of psychosis caused by isotretinoin.
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Affiliation(s)
- Tijana Stanojkovic
- Department of Pharmacology and Toxicology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
- Medical Military Academy, Belgrade, Serbia
| | - Radica Zivkovic Zaric
- Department of Pharmacology and Toxicology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Ivana Lesnjak
- Department of Pharmacology and Toxicology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
- Clinical Center Kragujevac, Kragujevac, Serbia
| | - Milan Gajic
- Department of Pharmacology and Toxicology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
- General Hospital Pancevo, Pancevo, Serbia
| | - Srecko Markovic
- Department of Pharmacology and Toxicology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
- Institute for Cardiovascular Diseases Dedinje, Belgade, Serbia
| | - Aleksandar Canovic
- Department of Pharmacology and Toxicology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
- Clinical Center Pristina-Gracanica, Serbia
| | - Katarina Jankovic Jovanovic
- Department of Pharmacology and Toxicology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
- Clinical Center Kragujevac, Kragujevac, Serbia
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Albalawi R, Alsahli H, Almutairi N, Alhashemi M. Acute psychosis and behavioural changes with seizure-like hyperactive psychomotor activity secondary to isotretinoin initiation in a healthy young male: case report. Ann Med Surg (Lond) 2024; 86:1708-1710. [PMID: 38463077 PMCID: PMC10923358 DOI: 10.1097/ms9.0000000000001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Acute psychosis is a common brief psychiatric emergency period of delusions, hallucinations, disorganized thoughts and/or speech with or without psychomotor elements, which is not commonly induced by isotretinoin therapy. Dermatologists should counsel the patient before starting the treatment with all new, uncommon side effects, especially neuropsychiatric manifestations before starting this medication. Case presentation A 23-year-old male smoker with a known case of acne vulgaris recently started on isotretinoin for 2 weeks after which he developed abnormal hyperactive psychomotor activity. He was diagnosed with isoteritoin-induced acute psychosis based on clinical findings and exclusion, and valproic acid and olanzapine were initiated. The patient showed significant improvement. Clinical discussion Acute psychosis is a new, unfamiliar side effect presenting after initiation of isotretinoin therapy in young adults who were previously healthy. The mechanism is not well known but is thought to result from a decrease in the adult's neurogenesis or alterations in exposure of the serotonergic neurotransmitter system. Conclusion Isotretinoin is commonly used nowadays for treating young adults. Patients and their families should be counselled about all the psychiatric side effects. Antipsychotics and antiepileptics with mood stabilizers may improve the acute status for patients with isotertoin-induced psychosis.
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Affiliation(s)
- Rawan Albalawi
- Department of Adult Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hamoud Alsahli
- Department of Adult Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Naif Almutairi
- Department of Adult Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Greenwell AM, Gorsi HS. Isotretinoin-induced psychosis in a child on treatment for high-risk neuroblastoma. Pediatr Blood Cancer 2023; 70:e30142. [PMID: 36546323 DOI: 10.1002/pbc.30142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Alyssa M Greenwell
- Department of Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Hamza S Gorsi
- Department of Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan, USA.,Central Michigan University School of Medicine, Mt Pleasant, Michigan, USA
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Bremner JD. Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6:100230. [PMID: 37168254 PMCID: PMC10168661 DOI: 10.1016/j.jadr.2021.100230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Isotretinoin (13-cis-retinoic acid, marketed under the names Accutane, Roaccutane, and others) is an effective treatment for acne that has been on the market for over 30 years, although reports of neuropsychiatric side effects continue to be reported. Isotretinoin is an isomer of the active form of Vitamin A, 13-trans-retinoic acid, which has known psychiatric side effects when given in excessive doses, and is part of the family of compounds called retinoids, which have multiple functions in the central nervous system. Methods The literature was reviewed in pubmed and psychinfo for research related to isotretinoin and neuropsychiatric side effects including depression, suicidal thoughts, suicide, mania, anxiety, impulsivity, emotional lability, violence, aggression, and psychosis. Results Multiple case series have shown that successful treatment of acne with isotretinoin results in improvements in measures of quality of life and self esteem However, studies show individual cases of clinically significant depression and other neuropsychiatric events that, although not common, are persistent in the literature. Since the original cases of depression were reported to the United States Food and Drug Administration, numerous cases have been reported to regulatory agencies in the United Kingdom, France, Ireland, Denmark, Australia, Canada, and other countries, making isotretinoin one of the top five medications in the world associated with depression and other neuropsychiatric side effects. Clinicians are advised to warn patients of the risks of neuropsychiatric side effects with isotretinoin which may arise from the medication itself, and not just as a side effect of acne or youth.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, and Department of Radiology and Imaging Sciences, Emory University School of Medicine, VA Medical Center, Decatur, GA, United States
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Cruañes-Monferrer J, Ramírez-Andreo A, Monte-Serrano J, Sánchez-de-Las-Matas-Meca M. [Isotretinoin-induced psychotic disorder]. Semergen 2021; 47:495-497. [PMID: 34257010 DOI: 10.1016/j.semerg.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Affiliation(s)
- J Cruañes-Monferrer
- Departamento de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España.
| | - A Ramírez-Andreo
- Departamento de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España
| | - J Monte-Serrano
- Servicio de Dermatología y Venereología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Elhusein B, Elkhaled W, Khoodoruth MAS, Kumar R, Al Abdulla M. Isotretinoin-induced psychotic episode in a 17-year-old adolescent male. SAGE Open Med Case Rep 2020; 8:2050313X20931342. [PMID: 32612830 PMCID: PMC7307393 DOI: 10.1177/2050313x20931342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
Abstract
Isotretinoin, a synthetic vitamin A derivative, is primarily used in the
management of severe nodulocystic acne. Since its introduction, isotretinoin has
been linked with various psychiatric side effects. In particular, depression and
suicidality have been extensively reported as side effects. This case report
features a young male who developed a first psychotic episode within 3 months of
starting isotretinoin therapy. The patient was hospitalized, and organic
pathologies and use of psychoactive substances that could explain his
presentation were ruled out. After stopping isotretinoin and starting olanzapine
10 mg, the psychotic symptoms remitted completely within 2 weeks. This case
highlights the need for increased vigilance toward psychiatric manifestations of
isotretinoin. In addition, it suggests that secondary psychosis should be
considered as a differential diagnosis by clinicians, especially in patients
with no past psychiatric history or family history of mental illness.
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Affiliation(s)
- Bushra Elhusein
- Mental Health Services-Consultation Liaison Psychiatry-Hamad Medical Corporation, Doha, Qatar
| | - Walid Elkhaled
- Mental Health Services-Consultation Liaison Psychiatry-Hamad Medical Corporation, Doha, Qatar
| | | | - Rajeev Kumar
- Mental Health Services-Consultation Liaison Psychiatry-Hamad Medical Corporation, Doha, Qatar
| | - Majid Al Abdulla
- Mental Health Services-Consultation Liaison Psychiatry-Hamad Medical Corporation, Doha, Qatar
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Suuberg A. Psychiatric and Developmental Effects of Isotretinoin (Retinoid) Treatment for Acne Vulgaris. CURRENT THERAPEUTIC RESEARCH 2019; 90:27-31. [PMID: 30828405 PMCID: PMC6383167 DOI: 10.1016/j.curtheres.2019.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND An association between isotretinoin (13-cis-retinoic acid, sold under trade names including Accutane [Hoffmann-La Roche Inc, Basel, Switzerland]) and birth defects, depression, and suicide is well documented but controversial. A link to psychosis and exacerbation of bipolar symptoms is less extensively addressed in the literature. OBJECTIVE Given recent conceptualization of psychotic disorders as neurodevelopmental, and current interest in possible shared etiology of different neurodevelopmental disorders such as psychosis, autism, and intellectual disability, this review concurrently examines the literature on developmental (primarily teratogenic) and psychiatric side effects of isotretinoin exposure. The goal of concurrent review is to identify shared mechanisms in the literature that may inform future efforts to clarify the neurocognitive and psychiatric effects of isotretinoin exposure at different developmental stages or given different genetic backgrounds. METHODS Literature was obtained by PubMed search for the term isotretinoin in combination with each of the terms psychosis, psychiatric, and teratogenic. Resulting articles met inclusion criteria for review if they addressed psychiatric side effects of isotretinoin treatment or the neurobehavioral teratology of isotretinoin. RESULTS The association of isotretinoin exposure with prenatal developmental toxicity is well established. Although numerous reports also link isotretinoin treatment with psychiatric side effects, this association remains controversial. CONCLUSIONS The extent to which isotretinoin influences pediatric and adult development and cognition, and whether and why certain individuals may be susceptible to psychiatric side effects, remains to be clarified. Curr Ther Res Clin Exp. 2019; 80:XXX-XXX).
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Oliveira JM, Sobreira G, Velosa J, Telles Correia D, Filipe P. Association of Isotretinoin With Depression and Suicide: A Review of Current Literature. J Cutan Med Surg 2017; 22:58-64. [DOI: 10.1177/1203475417719052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acne vulgaris, a condition that can affect people at any age, is the most common cause of referral to a dermatologist. Isotretinoin (ITT) is the most effective treatment available, but serious adverse effects, including a possible association with depression and suicide, limit its use. We review the current literature regarding the association of ITT with depression and suicide. Case reports and database studies show a clear association, and this association is biologically plausible. Although prospective studies have opposite results, limitations make them unsuitable to identify a subgroup of patients who may be at risk of developing depression or suicidal ideation with ITT. Overall, it seems some people might be at risk, particularly those with a personal or family history of mental disorder, but further studies are needed to identify those patients who would benefit from an early referral to a mental health professional when ITT is initiated. Currently, no conclusions can be drawn, and it seems appropriate to regularly screen all patients on ITT for depressive symptoms and suicidal ideation and promptly refer them to a mental health professional if any are found.
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Affiliation(s)
| | | | - Jorge Velosa
- Dr Nélio Mendonça Hospital, Funchal, Portugal
- Beatriz Ângelo Hospital, Loures, Portugal
| | - Diogo Telles Correia
- Santa Maria Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Paulo Filipe
- Santa Maria Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Le Moigne M, Bulteau S, Grall-Bronnec M, Gerardin M, Fournier JP, Jonville-Bera AP, Jolliet P, Dreno B, Victorri-Vigneau C. Psychiatric disorders, acne and systemic retinoids: comparison of risks. Expert Opin Drug Saf 2017; 16:989-995. [PMID: 28657366 DOI: 10.1080/14740338.2017.1344641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The link between isotretinoin, treatment of a severe form of acne, and psychiatric disorders remains controversial, as acne itself could explain the occurrence of psychiatric disorders. This study aims at assessing the disproportionality of psychiatric adverse events reported with isotretinoin in the French National PharmacoVigilance Database, compared with other systemic acne treatments and systemic retinoids. MATERIALS AND METHODS Data were extracted from the French National PharmacoVigilance Database for systemic acne treatments, systemic retinoids and drugs used as comparators. Each report was subjected to double-blind analysis by two psychiatric experts. A disproportionality analysis was performed, calculating the number of psychiatric ADRs divided by the total number of notifications for each drug of interest. RESULTS Concerning acne systemic treatments: all 71 reports of severe psychiatric disorders involved isotretinoin, the highest proportion of mild/moderate psychiatric adverse events was reported with isotretinoin (14.1%). Among systemic retinoids, the highest proportion of severe and mild/moderate psychiatric events occurred with isotretinoin and alitretinoin. CONCLUSION Our study raises the hypothesis that psychiatric disorders associated with isotretinoin are related to a class effect of retinoids, as a signal emerges for alitretinoin. Complementary studies are necessary to estimate the risk and further determine at-risk populations.
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Affiliation(s)
- M Le Moigne
- a Dermato-Oncology Unit , University Hospital Hôtel-Dieu , Nantes , France
| | - S Bulteau
- b Addictology and Psychiatry Department , 'Behavioral Addictions/Complex Affective Disorders' Clinical Investigation Unit , Nantes , France
| | - Marie Grall-Bronnec
- b Addictology and Psychiatry Department , 'Behavioral Addictions/Complex Affective Disorders' Clinical Investigation Unit , Nantes , France.,c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France
| | - M Gerardin
- d Clinical Pharmacology Department , CEIP, University Hospital Hôtel-Dieu , Nantes , France
| | | | - A P Jonville-Bera
- c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France.,f Regional Pharmacovigilance Center, Department of Clinical Pharmacology , University Hospital of Tours , Tours , France
| | - Pascale Jolliet
- c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France.,d Clinical Pharmacology Department , CEIP, University Hospital Hôtel-Dieu , Nantes , France
| | - Brigitte Dreno
- a Dermato-Oncology Unit , University Hospital Hôtel-Dieu , Nantes , France
| | - C Victorri-Vigneau
- c INSERM UMR 1246 , University of Nantes and Tours , Nantes et Tours , France.,d Clinical Pharmacology Department , CEIP, University Hospital Hôtel-Dieu , Nantes , France
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Valderrama F, Gómez A, Restrepo D. [Isotretinoin Therapy for Acne Vulgaris and First Episode Psychosis in an Adolescent Patient]. ACTA ACUST UNITED AC 2016; 46:50-54. [PMID: 28193374 DOI: 10.1016/j.rcp.2016.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/01/2016] [Accepted: 06/29/2016] [Indexed: 01/20/2023]
Affiliation(s)
| | - Andrea Gómez
- Estudiante de Internado de Medicina, Universidad CES, Medellín, Colombia
| | - Diana Restrepo
- Departamento de Psiquiatría, Universidad CES, Medellín, Colombia
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Suarez B, Serrano A, Cova Y, Baptista T. Isotretinoin was not associated with depression or anxiety: A twelve-week study. World J Psychiatry 2016; 6:136-142. [PMID: 27014604 PMCID: PMC4804262 DOI: 10.5498/wjp.v6.i1.136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/20/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the frequency and severity of depression and/or anxiety in isotretinoin (ITT)-treated subjects and in a non-ITT control group.
METHODS: Sixty consecutively-admitted non-psychiatric outpatients with acne were assigned to either ITT at a fixed dose of 30 mg/d (n = 36) or “other treatment” group (OT; n = 24). The Zung depression or anxiety scales (with cut-off points), two locally developed scales for depression (GeDepr) and anxiety (Ansilet) (without cut-off points) and clinical global impression scales of acne severity were administered at baseline and at weeks 6 and 12 of treatment. Data was analyzed with the chi-squared test and covariance analysis.
RESULTS: Gender distribution, age, marital status and education level did not differ between both treatment groups. The frequency of depression, as defined by the Zung scale cut-off points was similar in the ITT and in the non-ITT groups: Weeks 6 and 12: 8.3% in both groups, P = 0.9. The frequency of anxiety was similar in the groups as well: Week 6: ITT = 8.3%; OT = 0.0%, P > 0.05; week 12: ITT = 11.1%, OT = 4.2%, P > 0.05. The scores in both scales’ sets did not differ between the treatment groups at any evaluation time point (P > 0.05). Five ITT-treated subjects (13.8%) and two from the OT-treated group (8.3%) developed clinically significant anxiety and/or depression during treatment (P > 0.05).
CONCLUSION: Our study confirms the safety of ITT regarding psychological side effects in regular dermatological patients. Susceptible subjects may exist but their identification requires additional strategies.
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