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Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia

PURPOSE: Antipsychotic drug treatment can potentially lead to adverse events such as extrapyramidal symptoms (EPSs). If these events persist, they lower patient quality of life. The purpose of this report is to present our experience with such a case, as an example to encourage further study. PATIEN...

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Autores principales: Takada, Ryohei, Yamamuro, Kazuhiko, Kishimoto, Toshifumi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174309/
https://www.ncbi.nlm.nih.gov/pubmed/30323602
http://dx.doi.org/10.2147/NDT.S176478
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author Takada, Ryohei
Yamamuro, Kazuhiko
Kishimoto, Toshifumi
author_facet Takada, Ryohei
Yamamuro, Kazuhiko
Kishimoto, Toshifumi
author_sort Takada, Ryohei
collection PubMed
description PURPOSE: Antipsychotic drug treatment can potentially lead to adverse events such as extrapyramidal symptoms (EPSs). If these events persist, they lower patient quality of life. The purpose of this report is to present our experience with such a case, as an example to encourage further study. PATIENTS AND METHODS: The patient was a 64-year-old male who had been diagnosed with schizophrenia that had been treated with oral antipsychotics for over 40 years. Due to lack of compliance, he was treated with the long-acting injectable antipsychotic, paliperidone palmitate, but developed persistent EPSs after 6 months. He was subsequently treated and monitored in our inpatient facility. RESULTS: Antipsychotic treatment was stopped. After 6 weeks, the patient’s psychosis had worsened, but his EPSs remained unchanged. Levodopa treatment was then started (up to 400 mg/d), which improved his EPSs, so he was restarted on oral antipsychotic therapy (aripiprazole, 6–18 mg/d). His psychotic symptoms improved over 2 months. The improvements in both psychosis and EPSs remained stable. Dopamine transporter scans revealed moderate dopamine transporter loss in the striatum, and computed tomography revealed no sign of brain abnormalities, suggesting that the patient was susceptible to dopamine reductions. CONCLUSION: Paliperidone palmitate can induce EPSs, even if injected only a few times. Although the characteristics of the drug are potential causes, the patient’s predisposition to dopamine perturbations can also influence the outcome. Therefore, adequate awareness is required before injection.
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spelling pubmed-61743092018-10-15 Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia Takada, Ryohei Yamamuro, Kazuhiko Kishimoto, Toshifumi Neuropsychiatr Dis Treat Case Report PURPOSE: Antipsychotic drug treatment can potentially lead to adverse events such as extrapyramidal symptoms (EPSs). If these events persist, they lower patient quality of life. The purpose of this report is to present our experience with such a case, as an example to encourage further study. PATIENTS AND METHODS: The patient was a 64-year-old male who had been diagnosed with schizophrenia that had been treated with oral antipsychotics for over 40 years. Due to lack of compliance, he was treated with the long-acting injectable antipsychotic, paliperidone palmitate, but developed persistent EPSs after 6 months. He was subsequently treated and monitored in our inpatient facility. RESULTS: Antipsychotic treatment was stopped. After 6 weeks, the patient’s psychosis had worsened, but his EPSs remained unchanged. Levodopa treatment was then started (up to 400 mg/d), which improved his EPSs, so he was restarted on oral antipsychotic therapy (aripiprazole, 6–18 mg/d). His psychotic symptoms improved over 2 months. The improvements in both psychosis and EPSs remained stable. Dopamine transporter scans revealed moderate dopamine transporter loss in the striatum, and computed tomography revealed no sign of brain abnormalities, suggesting that the patient was susceptible to dopamine reductions. CONCLUSION: Paliperidone palmitate can induce EPSs, even if injected only a few times. Although the characteristics of the drug are potential causes, the patient’s predisposition to dopamine perturbations can also influence the outcome. Therefore, adequate awareness is required before injection. Dove Medical Press 2018-10-02 /pmc/articles/PMC6174309/ /pubmed/30323602 http://dx.doi.org/10.2147/NDT.S176478 Text en © 2018 Takada et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Case Report
Takada, Ryohei
Yamamuro, Kazuhiko
Kishimoto, Toshifumi
Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_full Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_fullStr Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_full_unstemmed Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_short Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_sort long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174309/
https://www.ncbi.nlm.nih.gov/pubmed/30323602
http://dx.doi.org/10.2147/NDT.S176478
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