Elsevier

General Hospital Psychiatry

Volume 34, Issue 5, September–October 2012, Pages 578.e5-578.e6
General Hospital Psychiatry

Case Report
Oral-paliperidone-induced tardive dyskinesia: a case report

https://doi.org/10.1016/j.genhosppsych.2011.11.001Get rights and content

Abstract

Objectives

Tardive dyskinesia (TD) is generally considered the most severe extrapyramidal sequelae of antipsychotic treatments.

Method

Case report.

Results

We present a 20-year-old woman with previous treatment of risperidone 6–7 mg daily for approximately 4 years. She developed TD 2 years later after switching to paliperidone 9 mg daily. To the best of our knowledge, she is the first case report of having direct paliperidone-induced TD. Immediate treatments including paliperidone dose reduction to 6 mg daily, clonazepam 1.5 mg daily and trihexyphenidyl 2 mg daily were performed for 1 month, and her symptoms were relieved eventually after switching to clozapine 75 mg daily.

Conclusion

Although second-generation antipsychotics such as paliperidone are considered to have a lowered risk of developing TD, this case could bring awareness to clinicians of the possibility of TD with the use of any antipsychotics.

Introduction

Tardive dyskinesia (TD) is generally considered the most severe extrapyramidal sequelae of antipsychotic treatment, and it is usually associated with greater premorbid impairment, longer duration of antipsychotic treatment at higher dosages, older age, female gender, concurrent affective disorders and greater severity of the psychotic disorder [1], [2]. It is characterized by involuntary movements, which usually involve the oral and facial region, but all parts of the body can be involved. The pathophysiology of TD remains unclear, and no definite treatments exist. Dopamine receptor hypersensitivity, GABA dysregulation and oxidative-stress-induced neurotoxicity may be implicated mechanisms for developing TD [3].

Current evidence supports a lower TD risk for second-generation antipsychotics (SGAs) than for first-generation antipsychotics (FGAs) [4]. Paliperidone extended release, the major active metabolite of the atypical antipsychotic risperidone, was a newly introduced second-generation antipsychotic agent in 2005 that has proven effects over both positive symptoms and negative symptoms of schizophrenia [5], [6]. However, TD could still be developed among patients under long-term paliperidone treatment.

Section snippets

Case report

Miss A is a 20-year-old single woman with a fair developmental history. At 14 years old, psychotic symptoms were first noted with persistent commanding auditory hallucinations, strong guilty delusions and severe psychotic behaviors such as self-talking and even wandering naked on the streets. Schizophrenia was diagnosed, and risperidone 2 mg daily was initially prescribed. One year later, even worse psychotic symptoms developed, along with manic symptoms of hyperactivity, hypersexuality and

Discussion

Tardive dyskinesia may be caused by both FGAs and SGAs, with a 1-year risk of 5.5% and 3.9% and a prevalence of 32.4% and 13.1%, respectively [7]. In past studies, only one patient was reported to have TD during paliperidone use; however, the 54-year-old woman suffered from TD symptoms before paliperidone use began [8]. Another 64-year-old woman who suffered from paliperidone-associated rabbit syndrome was also reported [9]. To our best knowledge, Miss A, with no past history of movement

References (15)

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