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Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report

Buspirone is commonly used to treat generalized anxiety disorder and demonstrates a limited side-effect profile compared to other anxiolytics. Buspirone is considered generally safe, and neuropsychiatric adverse reactions are uncommon. There are rare clinical case reports that suggest buspirone-indu...

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Autores principales: Apeldoorn, Samuel, Chavez, Rebecca, Haschemi, Freshta, Elsherif, Kareem, Weinstein, David, Torrico, Tyler
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9981973/
https://www.ncbi.nlm.nih.gov/pubmed/36873224
http://dx.doi.org/10.3389/fpsyt.2023.1129489
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author Apeldoorn, Samuel
Chavez, Rebecca
Haschemi, Freshta
Elsherif, Kareem
Weinstein, David
Torrico, Tyler
author_facet Apeldoorn, Samuel
Chavez, Rebecca
Haschemi, Freshta
Elsherif, Kareem
Weinstein, David
Torrico, Tyler
author_sort Apeldoorn, Samuel
collection PubMed
description Buspirone is commonly used to treat generalized anxiety disorder and demonstrates a limited side-effect profile compared to other anxiolytics. Buspirone is considered generally safe, and neuropsychiatric adverse reactions are uncommon. There are rare clinical case reports that suggest buspirone-induced psychosis. We present a case of buspirone worsening psychosis for a patient psychiatrically hospitalized for an episode of decompensated schizoaffective disorder. The patient had a primary diagnosis of schizoaffective disorder and was treated with antipsychotics during this hospitalization, but his symptoms worsened when buspirone was administered on two separate occasions. During the first trial of buspirone, the patient exhibited traits of increased aggression, odd behaviors, and paranoia. The buspirone was discontinued after the patient admitted to hiding his pills to later consume through nasal ingestion. The second trial resulted in repeated exacerbated symptoms of paranoia related to food and substantially decreased oral intake. Considering its complex mechanism of action, buspirone is suggested to derive its neuropharmacological effects through 5-HT1A receptors. However, the drug also has been found to mediate dopamine neurotransmission. Buspirone acts as an antagonist at presynaptic dopamine D2, D3, and D4 receptors. Yet, contrary to expected outcomes, it was unable to produce antipsychotic effects and instead resulted in a substantial increase in dopaminergic metabolites. The route of administration may also play a role in the enhancement of the buspirone’s effects, particularly considering that after first-pass metabolism, buspirone has approximately 4% oral bioavailability. Intranasal administration of buspirone leads to faster drug absorption by direct transport from the nasal mucosa to the brain and increased bioavailability.
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spelling pubmed-99819732023-03-04 Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report Apeldoorn, Samuel Chavez, Rebecca Haschemi, Freshta Elsherif, Kareem Weinstein, David Torrico, Tyler Front Psychiatry Psychiatry Buspirone is commonly used to treat generalized anxiety disorder and demonstrates a limited side-effect profile compared to other anxiolytics. Buspirone is considered generally safe, and neuropsychiatric adverse reactions are uncommon. There are rare clinical case reports that suggest buspirone-induced psychosis. We present a case of buspirone worsening psychosis for a patient psychiatrically hospitalized for an episode of decompensated schizoaffective disorder. The patient had a primary diagnosis of schizoaffective disorder and was treated with antipsychotics during this hospitalization, but his symptoms worsened when buspirone was administered on two separate occasions. During the first trial of buspirone, the patient exhibited traits of increased aggression, odd behaviors, and paranoia. The buspirone was discontinued after the patient admitted to hiding his pills to later consume through nasal ingestion. The second trial resulted in repeated exacerbated symptoms of paranoia related to food and substantially decreased oral intake. Considering its complex mechanism of action, buspirone is suggested to derive its neuropharmacological effects through 5-HT1A receptors. However, the drug also has been found to mediate dopamine neurotransmission. Buspirone acts as an antagonist at presynaptic dopamine D2, D3, and D4 receptors. Yet, contrary to expected outcomes, it was unable to produce antipsychotic effects and instead resulted in a substantial increase in dopaminergic metabolites. The route of administration may also play a role in the enhancement of the buspirone’s effects, particularly considering that after first-pass metabolism, buspirone has approximately 4% oral bioavailability. Intranasal administration of buspirone leads to faster drug absorption by direct transport from the nasal mucosa to the brain and increased bioavailability. Frontiers Media S.A. 2023-02-17 /pmc/articles/PMC9981973/ /pubmed/36873224 http://dx.doi.org/10.3389/fpsyt.2023.1129489 Text en Copyright © 2023 Apeldoorn, Chavez, Haschemi, Elsherif, Weinstein and Torrico. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Apeldoorn, Samuel
Chavez, Rebecca
Haschemi, Freshta
Elsherif, Kareem
Weinstein, David
Torrico, Tyler
Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report
title Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report
title_full Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report
title_fullStr Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report
title_full_unstemmed Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report
title_short Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report
title_sort worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: a case report
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9981973/
https://www.ncbi.nlm.nih.gov/pubmed/36873224
http://dx.doi.org/10.3389/fpsyt.2023.1129489
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