title: Neurotoxic syndrome induced by clomipramine plus risperidone in a patient with autistic spectrum disorder: serotonin or neuroleptic malignant syndrome?
abstract: To the best of our knowledge, there are no case studies of serotonin syndrome (SS) in patients with autism spectrum disorder. We report the case of a 33-year-old male who presented SS under the combined use of clomipramine and risperidone. More specifically, within 2 days after clomipramine (10 mg/BID-two times a day) was added to risperidone (4 mg/OD-once a day), mirtazapine 45 mg/OD and alprazolam (0,5 mg/TID-three times a day) he began to present mental, neurological and autonomic symptoms. All his psychopathological manifestations and laboratory findings normalized after the above-mentioned drugs' discontinuation, and the administration of supportive medical care and lorazepam 2,5 mg/TID. The diagnosis of serotonin syndrome was challenging due to the relatively low dose of clomipramine, an increase of risperidone which had taken place before clomipramine administration and clinical symptoms which could be attributed to both serotonin and neuroleptic malignant syndrome.
authors.affiliation: Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 1 Rimini Street, GR-124 62 Athens, Greece.
authors.forename: Kalliopi N
authors.initials: KN
authors.lastname: Nikolaou
authors.affiliation: Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 1 Rimini Street, GR-124 62 Athens, Greece.
authors.forename: Rossetos
authors.initials: R
authors.lastname: Gournellis
authors.affiliation: Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 1 Rimini Street, GR-124 62 Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Michopoulos
authors.affiliation: Second Department of Neurology, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 1 Rimini Street, GR-124 62 Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Dervenoulas
authors.affiliation: Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 1 Rimini Street, GR-124 62 Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Christodoulou
authors.affiliation: Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 1 Rimini Street, GR-124 62 Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Douzenis
keywords: Autism; Clomipramine; Neuroleptic malignant syndrome; Risperidone; Serotonin syndrome