Premature thelarche in an 8-year-old girl following prolonged use of risperidone

Autor: Anne M, White, Anne L, White, Rajinderpal, Singh, Theodor, Rais, Barbara J, Coffey
Rok vydání: 2014
Předmět:
Zdroj: Journal of child and adolescent psychopharmacology. 24(4)
ISSN: 1557-8992
Popis: [Author Affiliation]Presenters: Anne M. White. 1 The University of Toledo College of Medicine and Health Sciences, Toledo, Ohio.Rajinderpal Singh. 1 The University of Toledo College of Medicine and Health Sciences, Toledo, Ohio.Theodor Rais. 1 The University of Toledo College of Medicine and Health Sciences, Toledo, Ohio.Discussant: Barbara J. Coffey. 2 Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, New York.Address correspondence to: Barbara J. Coffey, MD, MS, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, E-mail: Barbara.coffey@mssm.eduChief Complaint and Presenting ProblemL. is an 8 ½-year-old Caucasian girl who had been diagnosed with psychotic disorder-not otherwise specified (NOS) referred by her parents for psychiatric evaluation for premature breast development following prolonged use of risperidone.History of Present IllnessAccording to parents, L. first reported hearing voices when she was around 5 years old. In the past L. reportedly said that the voices told her to disobey her parents or to not do her homework. Her mother reported that L. also complained of visual hallucinations, comprised of seeing faces of unknown children and adults. L.'s parents became concerned when the voices seemed to increase in frequency, and at the age of 7 ½ years she was evaluated by a child and adolescent psychiatrist who started her on risperidone at a dose of 0.5 mg twice daily.Nine months after beginning risperidone and 5 months prior to referral, L. began treatment with a new child and adolescent psychiatrist. At that time, the child and adolescent psychiatrist recommended changing the medication in order to prevent side effects of long-term use of antipsychotics; however, L.'s parents were hesitant to make a change at that time since she had been doing well. L. continued on the risperidone until her parents made an emergency appointment with concerns that her breasts were developing prematurely; galactorrhea was notably absent. Re-evaluation was recommended, and L. was admitted for medication stabilization and evaluation of possible adverse effects.L. had been on the risperidone for about one year at the time of referral. Total dose at the time of admission was 0.5 mg twice daily and 0.75 mg at bedtime. Parents reported at that time that L. had experienced recent symptoms of poor sleep and increased appetite. She also had poor concentration with varying energy levels throughout the day. Mother reported that L.'s mood had been irritable and grouchy; mother noted that the risperidone had previously helped to control her mood, but that effect seemed to be wearing off. At the time of admission she did not exhibit any acute symptoms of depression, mania or hypomania. L. had no history of suicidal or homicidal ideation during this time.Past Psychiatric HistoryL. was being treated currently at an outpatient psychiatry facility. She was first evaluated for psychotic symptoms and started on medication at the age of 7 ½ years. Diagnoses included psychotic disorder NOS and generalized anxiety disorder (GAD). After further assessment, the current treatment team determined that L.'s anxiety symptoms were related to her psychosis, and so the diagnosis of GAD was disregarded. Past medication failures included methylphenidate; L. was on a dose of 5 mg twice daily, but the medication was discontinued as she showed an increase in aggressive behaviors as well as sleeplessness. There was no history of prior psychiatric hospitalization.Developmental HistoryL. was in the product of a full-term, uncomplicated pregnancy with prolonged labor. According to parents most milestones were achieved at developmentally appropriate times; L. was talking at 8 months, but delayed in walking at 2 years.Educational HistoryL. …
Databáze: OpenAIRE
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