Comments on Graves' hyperthyroidism-induced psychosis treated with aripiprazole: a case report
| Autor: | Iqbal Ahmed, Russ S. Muramatsu |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Pediatrics
medicine.medical_specialty Psychosis medicine.drug_class Population Atypical antipsychotic Torsades de pointes Context (language use) Quinolones Piperazines Psychiatric history medicine Humans Pharmacology (medical) Medical history education Psychiatry education.field_of_study business.industry medicine.disease Graves Disease Psychotic Disorders Aripiprazole Female business medicine.drug Antipsychotic Agents |
| Zdroj: | Journal of pharmacy practice. 26(5) |
| ISSN: | 1531-1937 |
| Popis: | Macedo et al described the first ever case in which the atypical antipsychotic aripiprazole was used successfully to treat Graves’ hyperthyroidism-induced psychosis in a patient with atrial fibrillation. We have experienced similar success using aripiprazole in a patient with atrial fibrillation and an elevated QTc of 509 ms. Aripiprazole was chosen in our case due to its reported lack of association with QTc prolongation and torsade de pointes. Here we briefly describe the case of a 45-year-old SamoanJapanese male with a medical history of polycystic kidney and liver disease and a psychiatric history of depression but not psychosis or substance abuse who was initially admitted to the medical ward with acute onset of newly disorganized behavior and speech and paranoid delusions in the context of untreated hyperthyroidism secondary to Graves’ Disease (antithryoglobulin and antithyroperoxidase positive, thyroid-stimulating hormone [TSH] 6.99 ng/dL, free T3 18.40 pg/mL). On hospital day number 4, he became increasingly agitated and paranoid and aripiprazole was restarted while treatment continued with methimazole 20 mg twice daily, atenolol 50 mg daily, and digoxin 0.125 mg daily. Again his disorganized behavior and speech resolved over the next 4 days, with improvement in his delusional beliefs and no report of adverse effects. At the time of this report, he was scheduled for future thyroid ablation with plan for ongoing outpatient psychiatric treatment. Final discharge diagnosis was psychotic disorder secondary to Graves’ hyperthyroidism. This case demonstrates that Macedo et al’s findings are replicable and supports the purported use of aripiprazole to treat Graves’ hyperthyroidism-induced psychosis, especially in patients with associated cardiac abnormalities including prolonged QTc. Caution, however, should still be taken when using aripiprazole in this population as the package insert does report QTc prolongation in 1 or more patients who overdosed on aripiprazole either alone or in combination with other substances, and a recent case report describes QTc prolongation and torsades de pointes occurring in an intensive care unit patient after administration of low doses. Our case suggests that lower doses may be as effective as higher doses, thus potentially lowering the risk of side effects, and that longer duration of treatment may be indicated as relapse of psychotic symptoms can possibly occur. Unfortunately, medication nonadherence, also reported in Macedo et al’s case, appears to be a major barrier to prolonged treatment. Patient education and close monitoring provided by health care professionals such as physicians and pharmacists could go a long way to increase the chances of successful treatment. |
| Databáze: | OpenAIRE |
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