Portal de Periódicos da CAPES

Leukopenia Associated With Addition of Paroxetine to Clozapine

1998; Physicians Postgraduate Press, Inc.; Volume: 59; Issue: 1 Linguagem: Inglês

10.4088/jcp.v59n0107d

1555-2101

Tony P. George, Linda Innamorato, Michael J. Sernyak, Ross J. Baldessarini, Franca Centorrino,

Parkinson's Disease and Spinal Disorders

Risperidone-Induced Tardive DyskinesiaSir: I present a case of risperidone-induced tardive dyskinesia that is unusual because the patient had never been treated with the typical antipsychotics and the dose of risperidone was only 1 mg/day.During his withdrawal, symptoms fluctuated in an inverse relationship with the increase and decrease of risperidone dose.Case report.Mr. A, a 50-year-old divorced white man, has been receiving psychiatric treatment for 16 years.He suffers from recurrent major depression and was hospitalized twice in the past 5 years with suicidal ideation.In addition to various antidepressants, he was tried for short periods of time on lithium, carbamazepine, and divalproex sodium with no discernible benefit.In the spring of 1996, after unsuccessful trials of paroxetine and nefazodone, he was started on fluvoxamine 50 mg/day and risperidone 0.5 mg h.s.A month later, risperidone was increased to 1 mg h.s., and fluvoxamine was slowly increased to 200 mg/day.In the fall of 1996, because Mr. A was no better, fluvoxamine was tapered off, and he was given fluoxetine 40 mg/day with which he was treated successfully a few years earlier.Risperidone 1 mg/day was continued.In late November 1996, he showed blinking of the eyes, parkinsonian tremor of the hands, and some tongue-rolling movements.Risperidone was stopped and fluoxetine reduced to 20 mg/day.Gradually, the abnormal movements worsened, and a month later the blinking was so frequent and constant that he was not able to read, watch television, or drive his car.His respiration became labored and deep with occasional high-pitched vocal sounds during expiration.He was restarted on risperidone 0.5 mg h.s., and a month later clorazepate 15 mg/day in divided dosage was added.His symptoms improved minimally, but he developed suicidal impulses and was rehospitalized for 8 days in January 1997.His symptoms were suppressed with increased dosage of risperidone 2 mg/day and fluoxetine 40 mg/day.Another attempt was then made to withdraw risperidone.Blepharospasm and labored breathing returned.He also started to make cluck-