A case of schizophrenia with a rare course after severe akathisia while using long-acting injectable antipsychotics: Paliperidone palmitate

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  • 持効性注射薬:paliperidone palmitate使用中に重症アカシジアを併発したのち稀有な経過を辿った統合失調症の一例

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Abstract

A 50- year- old female patient, diagnosed with schizophrenia, was firstly admitted for the treatment of psychiatric symptoms including hallucinations, delusions, and agitation. Since she frequently denied and refused oral treatments, a long- acting injectable antipsychotic drug was started after no significant adverse side- effects of similar oral treatment had been confirmed.While taking the series of injections, the symptoms of akathisia appeared and gradually became worse. The akathisia did not resolve even after all antipsychotic drugs were discontinued and the patient began to present with complaints of suicidal ideation. The results of the interviews revealed that the patient had been drinking her own urine for a long period of time. The increased and persisted blood drug concentration due to reabsorption of drugs from drinking urine seemed to trigger akathisia. While the patient had been hospitalized for the treatments of schizophrenia and akathisia, herpes simplex encephalitis occurred and she was soon transferred to another general hospital. Although herpes simplex encephalitis became less severe, anti-NMDA receptor encephalitis occurred. After the rehabilitation ended, the patient was readmitted to our hospital. The patient still suffered from severe sequelae of encephalitis and oral tendency, a major symptom of Klüver- Bucy syndrome. This case showed the need to pay attention to strange behaviors such as drinking urine in psychiatric treatment.

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