Antipsychotic Induced Bruxism Treated with Clozapine
2009; American Psychiatric Association Publishing; Volume: 21; Issue: 1 Linguagem: Inglês
10.1176/jnp.2009.21.1.105
ISSN1545-7222
AutoresD.N. Mendhekar, Chittaranjan Andrade,
Tópico(s)Psychosomatic Disorders and Their Treatments
ResumoBack to table of contents Previous article Next article LETTERFull AccessAntipsychotic Induced Bruxism Treated with ClozapineDattatrya Namdeorao Mendhekar D.P.M., M.D.,Chittaranjan Andrade M.D.,Dattatrya Namdeorao Mendhekar D.P.M., M.D.,Chittaranjan Andrade M.D.,Published Online:1 Jan 2009AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A variety of movement disorders, including bruxism, are known to occur with antipsychotic drugs. In few cases, movements do not disappear even several years after the withdrawal of causative agents, thus leading to permanent disability. We report a case of a patient with schizophrenia who developed chronic bruxism after exposure to multiple antipsychotics. A trial of clozapine resulted in complete remission. Case Report Mr. A, a 56-year-old man, was suffering from schizophrenia with frequent relapse and remission for the last 14 years. His symptoms were characterized by suspicious and withdrawn behavior, poor personal care, muttering, and inappropriate affect. Psychopharmacological treatment started 6 months after the onset of illness and he was exposed to optimum dosages of various antipsychotic drugs, such as chlorpromazine and trifluoperazine. At the end of 8 years of antipsychotic therapy, when he was taking tablet trifluoperazine (15 mg) and trihexiphenydil (4 mg), he developed bruxism of mixed typed—both grinding and clenching. The teeth movements were so obvious that others could hear them easily. These involuntary movements were observed only while he was awake. They were regular and rhythmic and would disappear while eating and speaking. Since he was in remission he was not given any antipsychotic drugs for the next 6 years and did not consult a psychiatrist, but he continued to exhibit bruxism. There were no reports of dental abnormalities. Use of the Naranjo Adverse Drug Reactions Probability Scale indicated a highly probable relationship between the bruxism and long-term exposure of neuroleptic therapy in this case. 1 Subsequently he developed paranoid symptoms and was started on a regimen of clozapine (25 mg). This was increased to 150 mg per day over a period of 6 weeks with proper hematological monitoring. With clozapine, his paranoid symptoms and bruxism were controlled. At the end of 16 weeks of treatment with clozapine, the bruxism disappeared, and he was stabilized on the same dose of clozapine without recurrence of bruxism. Discussion A previous study reported a higher percentage of bruxism and signs of temporomandibular disorders among psychiatric cases. 2 Our case strongly suggests a neuroleptic-induced phenomenon because of the chronic exposure to antipsychotic drugs prior to the occurrence of bruxism and complete disappearance with clozapine. Eight earlier cases of antidopaminergic related bruxism have been reported, but even multiple drug trials have failed to provide confirmation. 3 A subsequent report suggested involvement of adrenergic, serotonergic, and dopaminergic systems in the pathogenesis of bruxism, as the side effects were relieved after propanolol was added to ongoing antipsychotic treatment. 4 Although there are rare reports of tardive dystonia induced by typical antipsychotics, clozapine, in contrast, has been reported to ameliorate tardive dystonia. 5 To our knowledge, clozapine has not been tried in neuroleptic-induced bruxism. Positive response to clozapine, as reported in an earlier study of neuroleptic induced tardive dystonia, chronic duration, and dystonic pattern of teeth movements, further support our finding that bruxism is a focal tardive dystonia. Clozapine may be the first drug of choice in such cases even though there are few reports of tardive dystonia associated with clozapine. Neuropsychiatry and Headache Clinic, Pratap Nagar Metro, Delhi, IndiaDepartment of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengalooru, IndiaReferences1 . Naranjo CA, Busto U, Sellers EM, et al: A method for estimating the probability of adverse drug reaction. Clin Pharmacol Ther 1981; 30:239–245Google Scholar2 . Winocur E, Hermesh, H, Litter D, et al: Signs of bruxism and temporomandibular disorders among psychiatric patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103:60–63Google Scholar3 . Micheli F, Fernandez M, Gatto M, et al: Bruxism secondary to chronic antidopaminergic drug exposure. Clin Neuropharmacol 1993; 16:315–323Google Scholar4 . Amir I, Hermesh H, Gavish A: Bruxism secondary to antipsychotic drug exposure: a positive response to propanolol. Clin Neuropharmacol 1997; 20:86–89Google Scholar5 . Skidmore F, Reich SG: Tardive dystonia. Curr Treat Option Neurol 2005; 7:2005Google Scholar FiguresReferencesCited byDetailsCited byMedications and addictive substances potentially inducing or attenuating sleep bruxism and/or awake bruxism10 August 2020 | Journal of Oral Rehabilitation, Vol. 48, No. 3World Journal of Clinical Cases, Vol. 7, No. 4Fluoxetine-Induced Sleep Bruxism Rapidly Treated With Once-Nightly Dosing of Buspirone in a 6-Year-Old GirlClinical Neuropharmacology, Vol. 41, No. 5Current Treatment Options in Neurology, Vol. 18, No. 2Journal of Child and Adolescent Psychopharmacology, Vol. 26, No. 8Management of sleep bruxism in adults: a qualitative systematic literature review11 June 2015 | Journal of Oral Rehabilitation, Vol. 42, No. 11Bruxism and oral parafunctional hyperactivity in social phobia outpatients19 September 2014 | Journal of Oral Rehabilitation, Vol. 42, No. 2Bruxisme induit par les psychotropes : mise au pointAnnales Médico-psychologiques, revue psychiatrique, Vol. 170, No. 3Duloxetine-Induced Nocturnal Bruxism Resolved by BuspironeClinical Neuropharmacology, Vol. 34, No. 4Clinical Schizophrenia & Related Psychoses, Vol. 5, No. 3 Volume 21Issue 1 Winter, 2009Pages 105-106 Metrics PDF download History Published online 1 January 2009 Published in print 1 January 2009
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