title: [Drug-induced asterixis].
abstract: A 54-year-old woman with acute schizoaffective psychosis was treated with lithium carbonate (1,350 mg daily) and zuclopenthixol. On admission, clozapine was added (250 mg daily). Because extrapyramidal symptoms (rigor, akinesia) developed, she was additionally given biperiden retard (4 mg daily) from the fourth hospital day onwards. Eleven days after admission she began to complain of "unsteadiness" and "tremors" in her arms and she had asterixis (flapping tremor) on holding up her arms. The electromyogram showed electrical pauses of 60-120 ms, typical for asterixis. There were no significant metabolic or organic cerebral changes that could have accounted for the symptoms which presumably had been induced by the drugs even though their dosage was not unusual. The symptoms in fact regressed completely after the clozapine dose had been reduced, at first to 125 mg then to 50 mg. Previous experience has suggested that the risk of asterixis is particularly high when lithium and clozapine are taken together.
authors.affiliation: Psychiatrische Abteilung Sektor, OO-Landes-Nervenklinik Wagner-Jauregg, Linz.
authors.forename: H
authors.initials: H
authors.lastname: Rittmannsberger
authors.forename: F
authors.initials: F
authors.lastname: Leblhuber
mesh_terms: D001712:Biperiden / Q000009:adverse effects / Q000627:therapeutic use; D003006:Clopenthixol / Q000009:adverse effects / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004576:Electromyography; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy*; D014202:Tremor / Q000139:chemically induced* / Q000503:physiopathology
chemical_list: D001712:Biperiden; D016651:Lithium Carbonate; D003006:Clopenthixol; D003024:Clozapine
vernacular_title: Medikamentös ausgelöste Asterixis.