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Risperidone induced neutropenia in a 75-year-old man

INTRODUCTION: We discuss the case of a 75-year-old man with no psychiatric history, presenting with complex auditory hallucinations, both commentary and imperative, delusions of persecution and prejudice, severe anxiety, modified behaviour, and altered sleep patterns. OBJECTIVES: The patient was sta...

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Detalles Bibliográficos
Autores principales: Nistor, D., Horosan, L., Giurgiuca, A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566940/
http://dx.doi.org/10.1192/j.eurpsy.2022.1869
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author Nistor, D.
Horosan, L.
Giurgiuca, A.
author_facet Nistor, D.
Horosan, L.
Giurgiuca, A.
author_sort Nistor, D.
collection PubMed
description INTRODUCTION: We discuss the case of a 75-year-old man with no psychiatric history, presenting with complex auditory hallucinations, both commentary and imperative, delusions of persecution and prejudice, severe anxiety, modified behaviour, and altered sleep patterns. OBJECTIVES: The patient was started on oral risperidone, with favourable evolution of symptoms after reaching a daily dose of 3 mg/day. After three weeks of treatment, the laboratory results showed a low number of neutrophils. Interdisciplinary approach and examinations which included both clinical and paraclinical evaluation concluded that another cause of neutropenia was highly unlikely. METHODS: The patient was switched to olanzapine, with gradually increasing doses up to 10 mg/day. A significant improvement of the neutrophils’ level was noticed, with a return to normal parameters after a few days. Nevertheless, the clinical course was unfavourable, with reoccurrence of auditory hallucinations and delusions in two weeks’ time. Decision to rechallenge was made, with careful monitoring of the blood test results, particularly neutrophil levels. Risperidone was started at low doses of 0.5 mg/day and gradually increased up to 2 mg/day. RESULTS: Seven days after risperidone reinitiation laboratory tests showed normal absolute neutrophil count. However, another week later, neutrophils fell again out of the normal range. CONCLUSIONS: The patient was discharged with haloperidol, with adequate control of symptoms and no adverse reactions. DISCLOSURE: No significant relationships.
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spelling pubmed-95669402022-10-17 Risperidone induced neutropenia in a 75-year-old man Nistor, D. Horosan, L. Giurgiuca, A. Eur Psychiatry Abstract INTRODUCTION: We discuss the case of a 75-year-old man with no psychiatric history, presenting with complex auditory hallucinations, both commentary and imperative, delusions of persecution and prejudice, severe anxiety, modified behaviour, and altered sleep patterns. OBJECTIVES: The patient was started on oral risperidone, with favourable evolution of symptoms after reaching a daily dose of 3 mg/day. After three weeks of treatment, the laboratory results showed a low number of neutrophils. Interdisciplinary approach and examinations which included both clinical and paraclinical evaluation concluded that another cause of neutropenia was highly unlikely. METHODS: The patient was switched to olanzapine, with gradually increasing doses up to 10 mg/day. A significant improvement of the neutrophils’ level was noticed, with a return to normal parameters after a few days. Nevertheless, the clinical course was unfavourable, with reoccurrence of auditory hallucinations and delusions in two weeks’ time. Decision to rechallenge was made, with careful monitoring of the blood test results, particularly neutrophil levels. Risperidone was started at low doses of 0.5 mg/day and gradually increased up to 2 mg/day. RESULTS: Seven days after risperidone reinitiation laboratory tests showed normal absolute neutrophil count. However, another week later, neutrophils fell again out of the normal range. CONCLUSIONS: The patient was discharged with haloperidol, with adequate control of symptoms and no adverse reactions. DISCLOSURE: No significant relationships. Cambridge University Press 2022-09-01 /pmc/articles/PMC9566940/ http://dx.doi.org/10.1192/j.eurpsy.2022.1869 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Nistor, D.
Horosan, L.
Giurgiuca, A.
Risperidone induced neutropenia in a 75-year-old man
title Risperidone induced neutropenia in a 75-year-old man
title_full Risperidone induced neutropenia in a 75-year-old man
title_fullStr Risperidone induced neutropenia in a 75-year-old man
title_full_unstemmed Risperidone induced neutropenia in a 75-year-old man
title_short Risperidone induced neutropenia in a 75-year-old man
title_sort risperidone induced neutropenia in a 75-year-old man
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566940/
http://dx.doi.org/10.1192/j.eurpsy.2022.1869
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