Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia

Ryohei Takada, Kazuhiko Yamamuro, Toshifumi Kishimoto Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan Purpose: Antipsychotic drug treatment can potentially lead to adverse events such as extrapyramidal symptoms (EPSs). If these events persist, they lower pati...

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Autores principales:	Takada R, Yamamuro K, Kishimoto T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	schizophrenia long-lasting injectable dopamine levodopa Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/3dd5227f4d394b3296849b6a920e0940
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spelling	oai:doaj.org-article:3dd5227f4d394b3296849b6a920e09402021-12-02T02:15:59ZLong-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia1178-2021https://doaj.org/article/3dd5227f4d394b3296849b6a920e09402018-10-01T00:00:00Zhttps://www.dovepress.com/long-lasting-extrapyramidal-symptoms-after-multiple-injections-of-pali-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Ryohei Takada, Kazuhiko Yamamuro, Toshifumi Kishimoto Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan Purpose: Antipsychotic drug treatment can potentially lead to adverse events such as extrapyramidal symptoms (EPSs). If these events persist, they lower patient quality of life. The purpose of this report is to present our experience with such a case, as an example to encourage further study.Patients and methods: The patient was a 64-year-old male who had been diagnosed with schizophrenia that had been treated with oral antipsychotics for over 40 years. Due to lack of compliance, he was treated with the long-acting injectable antipsychotic, paliperidone palmitate, but developed persistent EPSs after 6 months. He was subsequently treated and monitored in our inpatient facility.Results: Antipsychotic treatment was stopped. After 6 weeks, the patient’s psychosis had worsened, but his EPSs remained unchanged. Levodopa treatment was then started (up to 400 mg/d), which improved his EPSs, so he was restarted on oral antipsychotic therapy (aripiprazole, 6–18 mg/d). His psychotic symptoms improved over 2 months. The improvements in both psychosis and EPSs remained stable. Dopamine transporter scans revealed moderate dopamine transporter loss in the striatum, and computed tomography revealed no sign of brain abnormalities, suggesting that the patient was susceptible to dopamine reductions.Conclusion: Paliperidone palmitate can induce EPSs, even if injected only a few times. Although the characteristics of the drug are potential causes, the patient’s predisposition to dopamine perturbations can also influence the outcome. Therefore, adequate awareness is required before injection. Keywords: schizophrenia, long-lasting injectable, dopamine, levodopaTakada RYamamuro KKishimoto TDove Medical Pressarticleschizophrenialong-lasting injectabledopaminelevodopaNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 14, Pp 2541-2544 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	schizophrenia long-lasting injectable dopamine levodopa Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	schizophrenia long-lasting injectable dopamine levodopa Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Takada R Yamamuro K Kishimoto T Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
description	Ryohei Takada, Kazuhiko Yamamuro, Toshifumi Kishimoto Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan Purpose: Antipsychotic drug treatment can potentially lead to adverse events such as extrapyramidal symptoms (EPSs). If these events persist, they lower patient quality of life. The purpose of this report is to present our experience with such a case, as an example to encourage further study.Patients and methods: The patient was a 64-year-old male who had been diagnosed with schizophrenia that had been treated with oral antipsychotics for over 40 years. Due to lack of compliance, he was treated with the long-acting injectable antipsychotic, paliperidone palmitate, but developed persistent EPSs after 6 months. He was subsequently treated and monitored in our inpatient facility.Results: Antipsychotic treatment was stopped. After 6 weeks, the patient’s psychosis had worsened, but his EPSs remained unchanged. Levodopa treatment was then started (up to 400 mg/d), which improved his EPSs, so he was restarted on oral antipsychotic therapy (aripiprazole, 6–18 mg/d). His psychotic symptoms improved over 2 months. The improvements in both psychosis and EPSs remained stable. Dopamine transporter scans revealed moderate dopamine transporter loss in the striatum, and computed tomography revealed no sign of brain abnormalities, suggesting that the patient was susceptible to dopamine reductions.Conclusion: Paliperidone palmitate can induce EPSs, even if injected only a few times. Although the characteristics of the drug are potential causes, the patient’s predisposition to dopamine perturbations can also influence the outcome. Therefore, adequate awareness is required before injection. Keywords: schizophrenia, long-lasting injectable, dopamine, levodopa
format	article
author	Takada R Yamamuro K Kishimoto T
author_facet	Takada R Yamamuro K Kishimoto T
author_sort	Takada R
title	Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_short	Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_full	Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_fullStr	Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_full_unstemmed	Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
title_sort	long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/3dd5227f4d394b3296849b6a920e0940
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Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia

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