Cases reported "Akathisia, Drug-Induced"

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1/25. Phenomenology and treatment of agitation.

    Agitation is a troublesome, common symptom in major depression that can be difficult to manage. It is sometimes a side effect of antidepressant treatment and may occasionally represent a mixed bipolar episode. If agitation fails to respond to an antidepressant alone, treatment may be augmented with a benzodiazepine, a neuroleptic, or lithium. Preliminary evidence indicates that divalproex, which has been found useful for bipolar disorder and for agitation associated with Alzheimer's disease, may also be effective for agitated depression. A controlled trial is now underway.
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ranking = 1
keywords = bipolar disorder, depression
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2/25. Restlessness in suboccipital muscles as a manifestation of akathisia.

    Antipsychotic-induced akathisia is primarily manifested as restlessness, particularly expressed in the legs. Consequently, rating scales and the research criteria of DSM-IV regard restlessness in the legs as the major sign of akathisia, although it has been suggested that such restlessness may occur in other areas of the body. A case of antipsychotic-induced akathisia is reported where the region of inner restlessness (the subjective component) was identified in posterior cervical muscles. The patient was initially suspected to be experiencing somatic delusions and the dose of antipsychotic medication was increased. This did not improve the symptoms, and upon careful questioning about his head discomfort, the patient acknowledged that he felt an inner restlessness in the suboccipital muscles. The restlessness ceased with intramuscular biperiden and subsequent discontinuation of antipsychotic medication. This case suggests that subjective restlessness may occur in muscle groups that are not usually associated with akathisia. Thus, this report may assist clinicians in the diagnosis of akathisia that could be overlooked or misdiagnosed as somatic delusions or the worsening of the patient's psychosis.
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ranking = 2.9388742674654
keywords = psychosis
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3/25. Quetiapine-Induced extrapyramidal side effects in patients with Parkinson's disease: case report.

    Although quetiapine is the antipsychotic of choice for the psychosis associated with Parkinson's disease (PD) and often is also helpful for sleep, we report two cases of quetiapine-induced extrapyramidal side effects. The patients described were unusual in their frailty and severity of illness and may not represent the majority of patients with PD.
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ranking = 2.9388742674654
keywords = psychosis
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4/25. Neuromotor dysfunction in early psychosis.

    Neuromotor dysfunction, particularly extrapyramidal signs and symptoms (EPSS), plays an important role in the assessment and treatment of patients in the early stages of psychotic disorders such as schizophrenia. By blocking dopamine D2 receptors, antipsychotic medications can produce EPSS, including tardive dyskinesia. EPSS is also observed in a third or more of patients first presenting with a psychotic disorder, prior to initiation of antipsychotic pharmacotherapy. This suggests that abnormalities in neuromotor control may be an integral component of the brain mechanisms associated with psychosis. Atypical antipsychotic agents can alleviate psychosis without inducing EPSS. Preexisting EPSS may be corrected.
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ranking = 17.633245604792
keywords = psychosis
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5/25. Akathisia, panic, agoraphobia, and major depression following brief exposure to metoclopramide.

    Psychiatric complications from nonpsychiatric medications are common. Our understanding of these phenomena is often limited, due to the relative infrequency of their occurrence for individual agents and the complexity of the pharmacological systems involved. This case report presents a patient who developed psychiatric sequelae following the administration of metoclopramide. Akathisia, panic disorder, agoraphobia, and major depressive disorder all developed sequentially after only 2 days of exposure to metoclopramide, leading to months of disability. Dopaminergic blockade was implicated as the precipitating pharmacological event. The pharmacology of benzamides is reviewed, as is the literature concerning benzamide-induced extrapyramidal and psychiatric symptoms. Finally, potential pharmacological mechanisms regarding these complications are discussed, with particular attention to the role of interactions between dopaminergic and serotonergic systems.
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ranking = 1.043742576552
keywords = depression
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6/25. clozapine-induced akathisia in children with schizophrenia.

    Akathisia is a relatively rare side effect with the newer atypical antipsychotic agents, particularly clozapine, and is easily misdiagnosed in children. As children are often unable to describe their symptoms verbally, their akathisia can be misdiagnosed as worsening of their psychosis, prompting an unnecessary increase in their neuroleptic dose. Two cases of childhood-onset schizophrenia associated with clozapine-induced akathisia responsive to beta-blocker treatment are described. Akathisia should be considered in all cases of apparent nonresponse to atypical antipsychotics.
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ranking = 2.9388742674654
keywords = psychosis
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7/25. Akathisia as a side effect of antipsychotic treatment with quetiapine in a patient with Parkinson's disease.

    Due to its low profile for extrapyramidal side-effects, quetiapine has become an alternative to clozapine in the treatment of dopamimetic psychosis in patients with Parkinson's disease (PD). We describe the case of a patient with PD who developed severe akathisia, a common complication with classical antipsychotics, with quetiapine.
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ranking = 2.9388742674654
keywords = psychosis
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8/25. fluoxetine dose-increment related akathisia in depression: implications for clinical care, recognition and management of selective serotonin reuptake inhibitor-induced akathisia.

    We report the case of a 22-year-old woman presenting major depressive episode with severe akathisia after an increase in fluoxetine. The patient developed severe restlessness and de novo suicidal ideation approximately 1 week after the dosage of fluoxetine was doubled, 1 year on from when the drug was first introduced. This case illustrates the importance of being alert to movement disorders in patients treated with selective serotonin reuptake inhibitors. The clinical implications are discussed. A management strategy based on the evidence in the existing literature is suggested.
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ranking = 1.043742576552
keywords = depression
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9/25. Transient psychosis in an immune-competent patient after oral trimethoprim-sulfamethoxazole administration.

    We describe a rare adverse reaction to trimethoprim-sulfamethoxazole (TMP-SMX; Septra, Bactrim) in an immune-competent female adolescent. She was prescribed TMP-SMX for a urinary tract infection, which she had developed while being treated in the hospital for an extensive leg cellulitis. Shortly after receiving her third dose of TMP-SMX, she developed an acute altered mental status with agitation as well as vivid visual and auditory hallucinations. After prompt discontinuation of TMP-SMX, the patient slowly began to improve and was able to return to her baseline mental status within 10 days. No residual mental status changes were present. Despite the recent emergence of multidrug-resistant bacterial pathogens, TMP-SMX, one of the first-generation broad-spectrum antibiotics, continues to be widely prescribed, in part because of its low cost and its easy availability. It is generally well tolerated and is associated with relatively few adverse effects. More common toxicities associated with TMP-SMX include hypersensitivity reactions, bone marrow suppression, and gastrointestinal side effects. central nervous system toxicity is very rare; when reported, it has been in an immune-compromised or an elderly patient.
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ranking = 11.755497069862
keywords = psychosis
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10/25. Agitated dysphoria after late-onset loss of response to antidepressants: a case report.

    BACKGROUND: Antidepressants can sometimes cause agitation, particularly in patients with bipolar disorder, but concern about such effects is generally limited to the first weeks and months of treatment. METHOD: Demonstration of the occurrence of agitated dysphoria after loss of response to an antidepressant following continuous administration through 7 years of euthymia; with a worsening on dose increase; and recurrence of agitation on re-exposure 1 year later; in a patient whose previous dysthymia and recurrent depressions had no recognizable manic or hypomanic features. RESULTS: Only when the antidepressant was removed, twice, was treatment an atypical antipsychotic and lithium effective. CONCLUSION: An antidepressant which has been effective for as long as 7 years may still carry risk of inducing agitated dysphoria, even in apparently unipolar depression. In some patients, clinical vigilance for antidepressant-induced dysphoria may be warranted for extended periods of time.
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ranking = 1
keywords = bipolar disorder, depression
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