Neurotoxic syndrome induced by clomipramine plus risperidone in a patient with autistic spectrum disorder: serotonin or neuroleptic malignant syndrome?

Annals of General Psychiatry

Kalliopi N. Nikolaou²  Rossetos Gournellis²  Ioannis Michopoulos²  Georgios Dervenoulas¹  Christos Christodoulou²  Athanasios Douzenis² 

[1] Second Department of Neurology, Medical School, National and Kapodistrian University of Athens, University General Hospital “Attikon”, 1 Rimini Street, Athens, GR-124 62, Greece

[2] Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, University General Hospital “Attikon”, 1 Rimini Street, Athens, GR-124 62, Greece

关键词: Autism;    Clomipramine;    Risperidone;    Serotonin syndrome;    Neuroleptic malignant syndrome;   

Others  :  1234299
DOI  :  10.1186/s12991-015-0073-z

 received in 2015-06-23, accepted in 2015-10-14,  发布年份 2015

【 摘 要 】

To the best of our knowledge, there are no case studies of serotonin syndrome (SS) in patients with autism spectrum disorder. We report the case of a 33-year-old male who presented SS under the combined use of clomipramine and risperidone. More specifically, within 2 days after clomipramine (10 mg/BID-two times a day) was added to risperidone (4 mg/OD-once a day), mirtazapine 45 mg/OD and alprazolam (0,5 mg/TID-three times a day) he began to present mental, neurological and autonomic symptoms. All his psychopathological manifestations and laboratory findings normalized after the above-mentioned drugs’ discontinuation, and the administration of supportive medical care and lorazepam 2,5 mg/TID. The diagnosis of serotonin syndrome was challenging due to the relatively low dose of clomipramine, an increase of risperidone which had taken place before clomipramine administration and clinical symptoms which could be attributed to both serotonin and neuroleptic malignant syndrome.

【 授权许可】

   
2015 Nikolaou et al.

【 参考文献 】

• [1]American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 5th edition. American Psychiatric Publishing, Arlington; 2013.
• [2]Birmes P, Coppin D, Schmitt L, Lauque D: Serotonin syndrome: a brief review. CMAJ Can Med Assoc J 2003, 168(11):1439-1442.
• [3]Volpi-Abadie J, Kaye AM, Kaye AD: Serotonin syndrome. Ochsner J 2013, 13(4):533-540.
• [4]Gillman P: Neuroleptic malignant syndrome: mechanisms, interactions and causality. Mov Disord 2010, 25(12):1780-1790.
• [5]Caroff SN, Mann SC, Campbell EC, Sullivan KA, Obeso J. Neuroleptic malignant syndrome. In: Frucht SJ, Fahn S, editors. Movement disorder emergencies: diagnosis and treatment. New Jersey: Humana Press Inc; 2005. p. 41–51.
• [6]Brodkin ES, McDougle CJ, Naylor ST, Cohen DJ, Price LH: Clomipramine in adults with pervasive developmental disorders: a prospective open-label investigation. J Child Adolesc Psychopharmacol. 1997, 7(2):109-121.
• [7]Remington G, Sloman L, Konstantareas M, Parker K, Gow R: Clomipramine versus haloperidol in the treatment of autistic disorder: a double-blind, placebo-controlled, crossover study. J Clin Psychopharmacol 2001, 21(4):440-444.
• [8]Hurwitz R, Blackmore R, Hazell P, Williams K, Woolfenden S. Tricyclic antidepressants for autism spectrum disorders (ASD) in children and adolescents. Cochrane Database Syst Rev. 2012;14(3). doi:10.1002/14651858.CD008372.pub2.
• [9]McDougle CJ, Holmes J: A double-blind, placebo-controlled study of risperidone in adults with autistic disorder and other pervasive developmental disorders. Arch Gen Psychiatry 1998, 55(7):1-31.
• [10]Raheja S, Libretto SE, Singh I: Successful use of Risperidone in an adult with the pervasive developmental disorder, Asperger’s Syndrome: a case report. Br J Dev Disabil 2002, 48:61-66.
• [11]Alexander RT, Michael DM, Gangadharan SK: The use of risperidone in adults with Asperger syndrome. Int J Dev Disabil 2004, 50(99):109-115.
• [12]Barthelemy C, Bruneau N, Cottet-Eymard JM, Domenech-Jouve J, Garreau B, Lelord , et al.: Urinary free and conjugated catecholamines and metabolites in autistic children. J Autism Dev Disord 1988, 18:583-591.
• [13]McDougle CJ, Scahill L, McCracken JT, Aman MG, Tierney E, Arnold LE, et al.: Research units on paediatric psychopharmacology autism network: background and rationale for an initial controlled study of Risperidone. Child Adolesc Psychiatr Clin 2000, 9:210-224.
• [14]Neuhut R, Lindenmayer J-P, Silva R: Neuroleptic malignant syndrome in children and adolescents on atypical antipsychotic medication: a review. J Child Adolesc Psychopharmacol 2009, 19(4):415-422.
• [15]Sternbach H: The serotonin syndrome. Am J Psychiatry 1991, 148:705-713.
• [16]Radomski JW, Dursun SM, Revely MA, Kutcher SP: An exploratory approach to the serotonin syndrome; an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses 2000, 55:218-224.
• [17]Whyte IM: Neuroleptic malignant syndrome. In Medical toxicology. Edited by Dart ERC. Lippincott Williams and Wilkins, Baltimore; 2004:101-103.
• [18]Haddow AM, Harris D, Wilson M, Logie H: Clomipramine induced neuroleptic malignant syndrome and pyrexia of unknown origin. BMJ 2004, 329:1333-1335.
• [19]Levenson JL: Neuroleptic malignant syndrome. Am J Psychiatr 1985, 142:1137-1145.
• [20]Nierenberg D, Disch M, Manheimer E, Patterson J, Ross J, Silvestri G, Surnmerhill E: Facilitating prompt diagnosis and treatment of the neuroleptic malignant syndrome. Clin Pharmacol Ther 1991, 50:580-586.
• [21]Isbister GK, Buckley NA: Clomipramine and neuroleptic malignant syndrome. Literature on adverse reactions to psychotropic drugs continues to confuse. BMJ 2005, 330(7494):790-791.
• [22]Fink M: Toxic serotonin syndrome or neuroleptic malignant syndrome? Pharmacopsychiatry 1996, 29(4):159-161.
• [23]Kontaxakis VP, Havaki-kontaxaki BJ, Christodoulou NG, Paplos KG, Christodoulou GN: Olanzapine-associated neuroleptic malignant syndrome: is there an overlap with the serotonin syndrome? Ann Gener Hosp Psychiatr 2003, 2:10. BioMed Central Full Text
• [24]Steele D, Keltner NL, McGuiness TM: Are neuroleptic malignant syndrome and serotonin syndrome the same syndrome? Perspect Psychiatr Care 2011, 47(1):58-62.
• [25]ANAFRANIL (clomipramine).. http://www.novartis.com.au/pi_pdf/anf.pdf webcite
• [26]REMERON (mirtazapine).. http://www.fda.gov/ohrms/dockets/ac/04/briefing/2004-4065b1-26-tab11G-Remeron-Tabs-SLR016.pdf webcite
• [27]Cano-Muñoz JL, Montejo-Iglesias ML, Yañez-Saez RM, Gálvez-Borrero IM: Possible serotonin syndrome following the combined administration of clomipramine and alprazolam. J Clin Psychiatry 1995, 56:122.
• [28]Gillman P: The serotonin syndrome and its treatment. J Psychopharmacol 1999, 13(1):100-109.
• [29]Anderson GM, Freedman DX, Cohen DJ, Volkmar FR, Hoder EL, McPhedran P, et al.: Whole blood serotonin in autistic and normal subjects. J Child Psychol Psychiatry 1987, 28:885-900.
• [30]Varelas P, Tamer Abdelhak T: Neuroleptic malignant syndrome, malignant hyperthermia, and serotonin syndrome. [10.1007/978-1-4419-6842-5_27] webciteIn Handbook of neurocritical care Edited by Bhardwaj A, Mirski MA. 2011, 435.