Psychiatry and Clinical Psychopharmacology

Psychopharmacology Severe extrapyramidal symptoms associated with the use of aripiprazole

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S231-S231
Read: 530 Published: 17 March 2021

Aripiprazole, an atypical antipsychotic, is a partial agonist of D2 and 5-HT1A receptor while antagonizing 5-HT2A receptors. Previous studies indicate that the rate of extrapyramidal symptoms caused by aripiprazole is very close to that of placebo. However, there are studies and case reports in the literature that do show aripiprazole-induced extrapyramidal symptoms. In this presented case, while using 10 mg / day of aripiprazole, severe extrapyramidal symptoms appeared and they disappeared after discontinuation of the drug. A 63-year-old female patient who came to our clinic with depressive complaints, suicidal thoughts, and delusions of reference and persecution. Upon hospitalization, escitalopram and risperidone were started, and escitalopram dose was increased to 20 mg/day, while risperidone was increased to 2 mg/day. Since the patient had complained about sleeping too much, aripiprazole was substituted with risperidone, and a dose of 10 mg/day was titrated. Due to decreasing complaints, the patient was discharged after 4 weeks and outpatient follow-ups were performed. Under physician’s supervision following discharge, bradimimia, bradykinesia, pervasive rigidity, and a resting tremor dominated in the right side were observed and a diagnosis of drug-induced Parkinsonism was made. Considering this to be an aripiprazole-induced extrapyramidal side effect, aripiprazole was reduced and then completely stopped, while biperiden was started at 4 mg/day. At follow-up two weeks later, symptoms of parkinsonism had almost entirely regressed. Extrapyramidal symptoms are side effects that make it difficult to carry on daily activities. Parkinsonism is an acute extrapyramidal symptom that often occurs within the first 1 month following the initiation of treatment. In our case, it appeared in the third week of treatment. Due to her advanced age, gender, and the diagnosis of psychotic depression, the patient had many risk factors for developing severe extrapyramidal symptoms. While using aripiprazole, especially in the treatment of patients at high risk, it should be considered that extrapyramidal symptoms might occur. If these symptoms are observed, a differential diagnosis of drug-induced parkinsonism should be made.

EISSN 2475-0581