Psychosis following anti-obesity treatment with rimonabant.
BACKGROUND
In this report, we present the case of a patient with a relapse of schizophrenia following an episode of depression and increased anxiety after antiobesity treatment with rimonabant, a cannabinoid type 1 receptor antagonist.


METHODS
After 4 weeks of treatment the patient developed psychiatric symptoms, i.e. depressed mood and elevated anxiety. Four months after the discontinuation of rimonabant, the patient presented with psychotic symptoms fulfilling ICD-10 criteria of paranoid schizophrenia. Antipsychotic treatment with quetiapine was initialized. A stable recovery took further 4 weeks in which combined treatment with quetiapine and ziprasidone was given.


CONCLUSIONS
The course of the illness suggests that the continuous affective symptoms, which were most likely a side effect of rimonabant, may have triggered the psychosis analogous to the stress-diathesis model of schizophrenia. As a consequence, rimonabant may not be the first choice in obese patients with a history of schizophrenia due to a potentially increased risk of a relapse via an indirect mechanism.
Ugur
Tarik
T
Department of Psychiatry and Psychotherapy, Rhine State Hospital, University of Duisburg-Essen, Germany. Tarik.Ugur@uni-duisburg-essen.de
Bartels
Marius
M
Kis
Bernhard
B
Scherbaum
Norbert
N
D000328:Adult; D019440:Anti-Obesity Agents / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D009765:Obesity / Q000188:drug therapy*; D010880:Piperidines / Q000009:adverse effects*; D011720:Pyrazoles / Q000009:adverse effects*; D012008:Recurrence; D000077285:Rimonabant; D012563:Schizophrenia, Paranoid / Q000139:chemically induced*
D019440:Anti-Obesity Agents; D010880:Piperidines; D011720:Pyrazoles; D000077285:Rimonabant