Reactions 1959, p104 - 3 Jun 2023 1

Aripiprazole/levodopa S

Deterioration of delusions, hallucinations and motor symptoms: case report

A 36-year-old man developed deterioration of delusions and hallucinations during treatment with levodopa for Parkinson’s
disease and deterioration of motor symptoms during treatment with aripiprazole [routes not stated; not all dosages stated].
The man, who had a history of hypoparathyroidism, hypothyroidism, and deafness, was diagnosed with 22q11.2 deletion
syndrome, Parkinson’s disease and schizophrenia. He developed persecutory delusions and auditory hallucinations and was treated
with olanzapine. He developed akathisia, and the olanzapine dose was reduced. Later, his tremors in both upper and short-stepped
gait worsened gradually. Therefore, levodopa dose was increased, which deteriorated delusions and hallucinations.
The aripiprazole 12 mg/day was added to his regimen with partially reduced psychiatric symptoms. However, administration of
aripiprazole 18 mg/day caused deterioration of motor symptoms. Later, he was hospitalised for electroconvulsive therapy. On
admission, persistent auditory hallucinations and persecutory delusions and motor symptoms, including forward-leaning posture,
severe muscle stiffness in the limbs, impaired postural reflexes, an unsteady gait were noted. Therefore, he was treated with
trihexyphenidyl [trihexyphenidyl hydrochloride], pramipexole, levodopa/carbidopa. He received a total of eight sessions of bilateral
ECT with improvement of forward-leaning posture and muscle stiffness, gait, frequency of auditory hallucinations. Subsequently,
olanzapine dose was reduced. Further, his delusion and auditory hallucinations had almost disappeared. Tremor frequency of the
upper limbs reduced; the muscle stiffness, off time and bradykinesia improved. He was then discharged home.
Tanifuji T, et al. Successful electroconvulsive therapy for 22q11.2 deletion syndrome with Schizophrenia and Parkinson's disease. Psychiatry and Clinical Neurosciences
76: 603-604, No. 11, Nov 2022. Available from: URL: http://dx.doi.org/10.1111/pcn.13467 803785841

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