Psychosis Induced by Varenicline in a Patient With No Psychiatric History
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Tarih
2017
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info:eu-repo/semantics/closedAccess
Özet
Psychosis Induced by Varenicline in a Patient With No Psychiatric History
Taha Can Tuman, MD
To the Editor: Varenicline is an agent that attenuates the need for nicotine by exerting partial agonist effects on nicotinic receptors.1 It has been linked to the emergence of psychiatric symptoms in patients with psychiatric disorder.2-4
Case report. Mr A was a 23-year-old man who developed a psychotic episode after using varenicline even though he had no personal or familial history of psychiatric disease. In the last month, he started to be suspicious of people and think that his friends would harm him. Consequently, he was unable to leave his house. He thought that poisonous gas was being fed into the house, so he kept the windows open at all times. He also suspected that people were thinking bad thoughts about him, and they made fun of him. He felt irritated. He reported that he used varenicline 2 mg/d for the last 2 months for smoking cessation, and his symptoms appeared 20 days after starting treatment. A mental status examination showed him to be oriented to place and time and anxious in mood, with impaired abstract thinking and persecutory and reference delusions in thought content. Attention and concentration were poor, and his perception of insight and reality were weak. The patient was diagnosed with DSM-5 psychosis induced by varenicline; risperidone 4 mg/d was started. His Positive and Negative Syndrome Scale5 (PANSS) score was 101. At follow-up 2 weeks later, Mr A had achieved partial insight and his delusions regressed. At the next visit, his mood was euthymic. Delusions continued to regress, and he gained full insight. His PANSS score was 48, and his risperidone dose was gradually decreased and finally stopped.
Previously, varenicline has been shown to exacerbate psychosis in patients who have a history of psychiatric disease.2-4 Forcen et al6 reported that varenicline accelerated psychosis in a patient who had no record of psychiatric history, but later the patient was diagnosed with paranoid personality disorder. In Mr A, however, no cluster A personality disorder was detected after recovery of psychosis. Development of psychosis after initiation of varenicline for nicotine addiction in the patient presented here, a person who had no history of psychiatric disorder, is unusual. Varenicline stimulates the mesolimbic dopamine system and results in dopamine release.7 Increased dopamine may also trigger psychosis,7 as it did in Mr A. Therefore, clinicians are cautioned to be careful even when varenicline is prescribed for patients who have no history of psychiatric disorder.
Açıklama
Anahtar Kelimeler
Psychiatric History
Kaynak
The primary care companion for CNS disorders
WoS Q Değeri
Scopus Q Değeri
Q3
Cilt
19
Sayı
4
