Abstract
Methyphenidate is used in treating patients with depression, narcolepsy, traumatic brain injury, cancer pains and HIV related cognitive impairment as well as treatment of Attention Deficit Hyperacivity Disorder(ADHD) in adults and children. It is known that usage of psychostimulants in high dosages may exacerbate manic and psychotic symptoms. This is a case presenting with manic symptoms after long acting methylphenidate is added to venlafaxine treatment for depression. 25 year old male, brought with complaints of increased religious activity, saying God is making him do things, increase of appetite, being talkative, greeting cemetaries and decreased sleep. In psychiatric assessment, his psychomotor activity was high, speech was pressured, had auditory hallucinations; had delusions of referance, grandieur and control, had no insight. He had been on venlafaxine treatment for depression for the last three months, 225mg/day for the last two. Methylphenidate 36mg/day was added to treatment 2 months before. His presenting symptoms started after it was increased to 54mg/day. Our diagnosis was manic episode (with psychotic features). One of the potential adverse effects of methylphenidate is exacerbation of manic symptoms. ADHD and Bipolar Disorder comorbidity may reach to 40%. However, our case did not have a comorbid ADHD. We associated manic symptoms with use of methylphenidate since the sypmtoms have started at the fourth month of venlafaxine treatment and after the increase of dosages of methylphenidate dosage.
Keywords
References
- Challman TD, Lipsky JJ. Methylphenidate: it’s pharmacology and uses. Mayo Clin Proc. 2000;75:711–721.
- Morton WA, Stockton GG. Methylphenidate Abuse and Psychiatric Side Effect. Prim Care Companion J ClinPsychiatry. 2000;2:1591
- Biederman J. Attention-deficit/hyperactivity disorder: a life-span perspective. J Clin Psychiatry. 1998;59(suppl 7):4–16.
- Snyder SH. Amphetamine psychosis: a “model” schizophrenia mediated by catecholamines. Am J Psychiatry. 1973; 130:61–7. Bell DS. The experimental reproduction of amphetamine psychosis. Arch Gen Psychiatry. 1973; 29:35–40.
- Lahti T, Leppämäki S, Tani P, Partonen T. Actigraphic recording of manic symptoms induced by methylphenidate. Case Rep Med. 2009;2009:286430.
- Ross RG. Psychotic and manic-like symptoms during stimulant treatment of attention deficit hyperactivity disorder. Am J Psychiatry. 2006;163:1149-52.
- Chakraborty K, Grover S. Methylphenidate-induced manialikesymptoms. Indian J Pharmacol. 2011;43:80-1.
- Chen G, Masana MI, Manji HK. Lithium regulates PKC-mediated intracellular cross-talk and gene expression in the CNS in vivo. Bipolar Disord. 2000;2:217-36.
Abstract
Metilfenidat depresyon, narkolepsi, travmatik beyin hasarı, kanser ağrısı, HIV ile ilişkili bilişsel yıkımın yanısıra çocuklarda ve yetişkinlerde dikkat eksikliği ve hiperaktivite bozukluğunda (DEHAB) kullanılmaktadır. Yüksek dozlarda psikostimulan kullanımının manik ve psikotik belirtileri arttırdığı bilinmektedir. Bu vaka sunumunda depresyon tanısı nedeniyle venlafaksin kullanmaktayken tedavisine uzun salınımlı metilfenidat eklenmesi ile manik belirti geliştiren olguyu sunmayı amaçladık. Olgumuz 25 yaşında erkek hasta dini aktivite artışı, Tanrının ona bir şey yaptırdığını söylemesi, iştah artışı, çok konuşma, mezarlıkla selamlaşmak gibi davranışlar sergileme ve uykuda azalma şikayetleri ile yakınları tarafından getirildi. Yapılan psikiyatrik değerlendirmede psikomotor aktivitesi artmış, konuşması basınçlı, işitsel hallüsinasyonu mevcut, grandiyöz, referans ve kontrol edilme hezeyanları mevcuttu ve içgörüsü yoktu. Olgumuz son üç aydır depresif yakınması nedeniyle venlafaksin tedavisi almaktaydı ve son iki aydır da 225 mg/gün kullanmaktaydı. Metilfenidat 36 mg/gün tedavisi de son iki aydır mevcut tedavisine eklenmişti. Hastamızın belirtileri metilfenidat tedavisi 54 mg/gün dozuna arttırılınca ortaya çıktı. Bizim olgumuza koyduğumuz teşhis psikotik özellikli manik hecmeydi. Metilfenidatın potansiyel olumsuz etkilerinden biri manik belirtilerin alevlenmesidir. DEHAB ve ikiuçlu mizaç bozukluğu birlikteliği %40’lara kadar ulaşabilmektedir. Fakat bizim olgumuzda DEHAB ekhastalığı yoktu. Biz metilfenidat kullanımı ile manik hecme birlikteliğini; belirtilerin gelişiminin venlafaksin kullanımının dördüncü ayında ve özellikle de metilfenidat dozununun arttırılmasından sonra dramatik biçimde ortaya çıkması ile ilişkilendirdik.
Keywords
References
- Challman TD, Lipsky JJ. Methylphenidate: it’s pharmacology and uses. Mayo Clin Proc. 2000;75:711–721.
- Morton WA, Stockton GG. Methylphenidate Abuse and Psychiatric Side Effect. Prim Care Companion J ClinPsychiatry. 2000;2:1591
- Biederman J. Attention-deficit/hyperactivity disorder: a life-span perspective. J Clin Psychiatry. 1998;59(suppl 7):4–16.
- Snyder SH. Amphetamine psychosis: a “model” schizophrenia mediated by catecholamines. Am J Psychiatry. 1973; 130:61–7. Bell DS. The experimental reproduction of amphetamine psychosis. Arch Gen Psychiatry. 1973; 29:35–40.
- Lahti T, Leppämäki S, Tani P, Partonen T. Actigraphic recording of manic symptoms induced by methylphenidate. Case Rep Med. 2009;2009:286430.
- Ross RG. Psychotic and manic-like symptoms during stimulant treatment of attention deficit hyperactivity disorder. Am J Psychiatry. 2006;163:1149-52.
- Chakraborty K, Grover S. Methylphenidate-induced manialikesymptoms. Indian J Pharmacol. 2011;43:80-1.
- Chen G, Masana MI, Manji HK. Lithium regulates PKC-mediated intracellular cross-talk and gene expression in the CNS in vivo. Bipolar Disord. 2000;2:217-36.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | April 1, 2013 |
| Published in Issue | Year 2013 Volume: 3 Issue: 4 |