Antipsychotics
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Lack of efficacy and various toxicities: case report A 14-year-old boy exhibited lack of efficacy during treatment with amisulpride, clozapine, haloperidol, pimozide, quetiapine and ziprasidone for Gilles de la Tourette syndrome (TS). Additionally, he developed increased sleep time, difficulty in concentration, fatigue, restlessness, sedation, polydipsia, polyuria and total weight increase during treatment with risperidone or clozapine for TS [routes and times to reactions onsets not stated; not all outcomes stated]. At the age of 14 years, the boy, who presented to a clinic with involuntary body movements and vocal tics, was diagnosed with TS. He had comorbidity of major depressive disorder. The Yale Global Tic Severity Scale (Y-GTSS) score was 85. Therefore, he started receiving haloperidol 1 mg/day, which was increased by 1 mg weekly up to 6 mg/day. Due to lack of effect, the dose of haloperidol was increased by 2 mg weekly up to 15 mg/day for a period of 1 month. However, he showed no response, and haloperidol was therefore stopped. He started receiving risperidone 1 mg/day, which was increased weekly by 1 mg up to 4 mg/day. However, risperidone was discontinued due to no clinical improvement. Then, he started receiving pimozide 0.5 mg/day, which was increased by 0.5mg every 3 days until a dose of 6 mg/day. However, there was no reduction in severity of the symptoms, which led to discontinuation of pimozide. He started receiving quetiapine 25 mg/day, and the dose of quetiapine was increased by 25 mg every 3 days up to 200 mg/day, after which it was increased by 50 mg/day until 600 mg/day. However, he showed no improvement, and quetiapine was stopped. Then, he started receiving amisulpride [amylsurpirid] 100 mg/day, which was titrated up to 800 mg/day, without any response. Subsequently, he dropped school, and stopped the treatments. He started using marijuana and alcohol from time to time, and he reported that the tics were reduced for several hours, and he felt better. After 2 years of treatment-free period, he presented to a clinic with an increase in the count of motor and vocal tics, in the frequency and severity to a degree to hinder own daily activities. He had been misusing marijuana once per week. Due to the tics, he experienced difficulties to leave the house, drink, eat and put clothes on without having assistance. At the age of 19 years of age, he started receiving ziprasidone 20 mg/day, which was increased by 20mg every 5 days up to 120 mg/day for 2 weeks. However, ziprasidone had no beneficial effect, and therefore stopped. Then, he started receiving clozapine 12.5 mg/day, which was titrated up to 150 mg/day. However, he developed sedation secondary to clozapine, and clozapine had no efficacy on symptom severity. Therefore, clozapine was stopped. He started receiving haloperidol 2.5 mg/day, which was increased up to 20 mg/day for a period of 3 weeks. However, haloperidol was discontinued due to lack of response. He started receiving risperidone 1 mg/day, which was increased up to 4 mg/day, and
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