Differential response of psychotic and obsessive symptoms to risperidone in an adolescent.
A 13-year-old boy with psychotic, depressive, and obsessive-compulsive symptoms initially presented with auditory and visual hallucinations and a lifetime of excessive worries about contamination. Family history was significant for schizophrenia and compulsive behavior. When treated with clomipramine 100 mg daily (plasma level 85 ng/mL), obsessive-compulsive symptoms but not the hallucinations improved significantly, and racing thoughts and grandiosity developed later. Haloperidol 0.5 mg daily reduced the psychotic symptoms but was poorly tolerated, and then trifluoperazine 3 mg daily was ineffective, so clomipramine was discontinued (without worsening of OCD symptoms). Trifluoperazine in combination with lithium 1500 mg daily (0.9 meq/L), and then with the addition of carbamazepine 250 mg daily (3.7 micrograms/mL), was only partially helpful. Dose reductions in any medication led to increased psychotic symptoms within days. Trifluoperazine was then replaced by risperidone 3 mg twice daily. Within 2 weeks of starting risperidone, psychotic symptoms ceased but the patient experienced an incapacitating exacerbation of obsessive-compulsive symptoms, experiencing the most severe symptoms in his illness. Sertraline 50 mg reduced the OCD symptoms only briefly. After 5 months on risperidone, risperidone and sertraline were discontinued, and the obsessive-compulsive symptoms significantly decreased within 2 weeks. These clinical observations suggest that even when risperidone has a therapeutic antipsychotic effect, it may exacerbate obsessive-compulsive symptoms in predisposed adolescents.
Dryden-Edwards
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RC
Kennedy Krieger Institute, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231, USA.
Reiss
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AL
D015057:1-Naphthylamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002997:Clomipramine / Q000627:therapeutic use; D006212:Hallucinations / Q000188:drug therapy; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy*; D011618:Psychotic Disorders / Q000188:drug therapy*; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline; D014268:Trifluoperazine / Q000627:therapeutic use
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D014268:Trifluoperazine; D015057:1-Naphthylamine; D006220:Haloperidol; D018967:Risperidone; D002997:Clomipramine; D020280:Sertraline