Antipsychotics
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Neuroleptic hypersensitivity: 2 case reports In a case report, two men aged 74 years (case 1) and 69 years (case 2) were described, who developed neuroleptic sensitivity manifesting as aggravation of extrapyramidal syndrome, severe confusion, swallowing difficulties, visual hallucinations, sleep disorders, orthostatic hypotension, dysuria, dyspraxia, reduced facial expression, gait disorder, dyskinesia, repeated falls, irritability, suicidal thoughts or pareidolia during treatment with olanzapine, along with clomipramine or sertraline for obsessive compulsive disorder (OCD) [routes, frequencies and durations of treatment to reactions onset not stated; not all ADR outcomes stated]. Case 1: The man, who had developed OCD symptoms at the age of 60 years, consulted a psychiatrist at the age of 62 years. He received treatment with unspecified SSRI for 9 years. At the age of 71, he showed various extrapyramidal symptoms including dysphonia, bradykinesia and occasional falls due to mild ataxia. In August 2016 at the age of 74 years, he experienced depression with delusional symptoms focused on the intestinal transit and was admitted to the psychiatry department. During hospital admission, cognitive impairments including memory and attention difficulties were noted. He received clomipramine 150mg followed by addition of olanzapine 7.5mg five days later. Following treatment, his condition deteriorated with aggravation of extrapyramidal syndrome, severe confusion, swallowing difficulties, visual hallucinations, sleep disorders, orthostatic hypotension, dysuria and dyspraxia. Neuroleptic hypersensitivity was suspected. Olanzapine and clomipramine were discontinued, resulting in improvement of tempero-spatial orientation confirming neuroleptic hypersensitivity. Improvement of psychiatric symptoms was noted. Eventually, he was diagnosed with concurrent dementia with lewy bodies (DLB) and received treatment with rivastigmine. Two years after his discharge, he required hospitalisation with acute pneumonia and died. Case 2: The man, who had dysphagia obsessions with constant feeling that his saliva was "too thick and difficult to swallow", presented to psychiatry department at the age of 65 years. He had various concurrent conditions. He had initially received various unspecified SSRIs, but due to poor adherence no benefit was noted. On admission, a diagnosis of depressive disorder with delusional symptoms was made from the symptoms and past history. He started receiving paroxetine, which led to improvement of depression without affecting his compulsions. At the age of 69 years, he returned to psychiatry unit with reappearance of depressive symptoms and additional phobias. On admission, he started receiving sertraline 200mg daily followed by initiation of olanzapine 10mg daily. After the initiation of therapy, he developed extrapyramidal syndrome, reduced facial expression, gait disorder, dyskinesia, repeated falls, irritability, suicidal thoughts and pareidolia (visual hallucinations of human heads) suggestive of severe sens
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