Multiple drugs
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Various toxicities: 6 case reports In a study of 39 patients, 6 patients (2 females and 4 males) including 5 patients aged 7–28 years [not all ages stated] were described, who developed psychosis, increased or worsened aggression, hyperactivity, obsessive-compulsive disorder (OCD)-like behaviours, anxiety, agitation, irritability or self injurious behaviour during treatment with aripiprazole, buspirone, clonazepam, gabapentin, guanfacine, levetiracetam, oxcarbazepine, sertraline, trihexyphenidyl, valproic-acid or verapamil [routes, dosages, durations of treatments to reactions onsets not stated; not all outcomes stated]. A 12-year-boy had a history of attention deficit/hyperactivity disorder (ADHD), OCD, epilepsy, autism spectrum disorder (ASD), intellectual disability (ID) and anxiety. At the beginning of 12 years age, he experienced 2 episodes of psychosis after 2 separate trihexyphenidyl treatment, which he had been receiving for alternating hemiplegia of childhood (AHC) related dystonic episodes. These psychotic episodes manifested as auditory hallucinations, delusions, severe paranoia and thoughts of self-harm. On an occasion, he climbed into a running washing machine in an attempt to drown himself. He hit his bus driver when he felt his demands were not met and also pursued his home-health nurse with a knife. In both psychotic episodes, his psychotic symptoms resolved after stopping trihexyphenidyl, but depressed mood and aggression had persisted. He exhibited treatment ineffectiveness to risperidone, haloperidol and propranolol for aggression and methylphenidate for ADHD. He received levetiracetam and valproic acid for seizure control. However, they increased aggression and hyperactivity. He also received diphenhydramine for AHC-related dystonia, but it increased hyperactivity. He was on fluoxetine and guanfacine for several years, but did not get longterm benefits. At the time of this report, he was managed with behavioural therapy and had an improvement in behaviour and mood. Psychosis did not recur after stopping trihexyphenidyl. A 28-year-old man had a history of ADHD, ID, epilepsy, anxiety and AHC (diagnosed at the age of 15 months). He had a longstanding history of aggressive episodes. He received sertraline and aripiprazole for management of aggression, anxiety and depression. However, these treatments worsened OCD-like behaviours and anxiety. He received levetiracetam and oxcarbazepine for seizure control, and high dose buspirone and guanfacine for behavioural control. But, due to these treatments his aggression worsened. At the time of this report, he was on lorazepam and gabapentin, but severe behavioural problems persisted. A 27-year-old man, had a history of Y768H gene-positive AHC, ADHD, ID, epilepsy, anxiety and depression. He received sertraline, citalopram and aripiprazole for many years with no long-term benefits. The risperidone treatment was also ineffective. He had been receiving treatment with gabapentin and clonazepam for AHC-related paroxysmal symptoms. However, these treat
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