• PDF / 171,559 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 38 Downloads / 138 Views

DOWNLOAD

REPORT

---

1

S

Serotonin syndrome: case report A case report described a 24-year-old man and 28-year-old woman, who developed serotonin syndrome (SS) during treatment with venlafaxine and fluoxetine respectively [frequencies and duration of treatments to reactions onsets not stated]. Case 1: The man presented with 1-month history of mutism, staring, posturing, reduced sleep and appetite, 6-months history of low mood, anhedonia, hopelessness, helplessness, death wishes and 2-years history of academic decline and social withdrawal. As he had failed a trial of escitalopram in the past, he started receiving venlafaxine 37.5mg tablet along with lorazepam. No improvement was noted in his catatonia over the following 4 days. Further, he received six bi-frontal electroconvulsive therapies (ECTs) over 2 weeks and complete remission of catatonic and depressive symptoms was noted. On the day of the sixth-ECT, the dose of venlafaxine was increased to 300mg. On the following day, he developed confusion, over-familiarity, disorientation, agitation and disinhibition. Investigations showed the following: pulse rate 116 bpm, BP 120/80mm Hg. His pupils were mydriatic. There were bilateral postural fine tremors, with generalised hyperreflexia in all deep tendon reflexes with an ill sustained ankle clonus. He had developed SS secondary to a combination of venlafaxine and ECTs. His Hindi Mental Status Examination (HMSE) was 24/31 on the day 1 of SS. Eventually, all medications were stopped, and he was treated with cyproheptadine and quetiapine. On day 5, his HMSE score was 31 and resolution of confusion and disorientation was noted. However, a resurgence of catatonic and depressive symptoms was noted, and he again started receiving lorazepam. Eventually, his catatonic symptoms resolved. His all signs of SS except hyperreflexia and tremors improved gradually over a period of 3 weeks. Later, he received sertraline for depression. Further, quetiapine and cyproheptadine were tapered and discontinued and lorazepam was continued to prevent relapse of catatonia. Subsequently, he was discharged. Case 2: The 28-year-old woman presented with 7-month history of low mood, fatiguability, anhedonia, decreased appetite and insomnia. In the previous month, she had developed psychomotor retardation which had progressed to immobility, near mutism, and poor oral intake. She started receiving fluoxetine 20mg capsule along with lorazepam; however, no improvement in the catatonia was noted over the following 2 days. Subsequently, she started receiving bifrontal electroconvulsive therapy (ECT) thrice a week and it was administered over 2 weeks. Eventually, her catatonic symptoms resolved completely following the third ECT, and her depression remitted following the sixth ECT. She developed loose stools 2 days after the sixth ECT. Examination showed pulse of 86 bpm, BP of 120/90 mmHg, mydriasis, hyperreflexia, clonus in ankle and knee, and hypertonia in all limbs. Diagnosis of SS secondary to fluoxetine was considered. She continued the treatment with fluoxetine with c