Rebound Catatonia Associated With Injectable Paliperidone.

Paliperidone is an atypical antipsychotic medication commonly used to treat schizophrenia, schizoaffective disorder, and bipolar disorder. It is a metabolite of risperidone and has a similar mechanism of action, primarily blocking dopamine 2 receptors (D2 receptors) in the brain. Paliperidone has various adverse effects, including extrapyramidal symptoms, weight gain, and metabolic disturbances. Catatonia is rare but severe side effects can occur in the context of an underlying psychiatric, neurologic, or general medical condition. Paradoxically, antipsychotics for treating schizophrenia or bipolar spectrum disorders can precipitate or worsen catatonic symptoms. The report suggests that 17-19% of all cases diagnosed as catatonia due to other medical conditions are medication-induced. Catatonia is a neuropsychiatric syndrome that presents as a cluster of psychomotor signs and symptoms resulting in movement and behavior aberrations. Various symptoms, including mutism, stupor, rigidity, and abnormal movements, characterize catatonia. Catatonia is a potentially life-threatening condition requiring prompt recognition and management. Here, we present a case of a patient with catatonia associated with long-acting injectable paliperidone intramuscular therapy in a patient with schizophrenia.

Extrapyramidal Symptoms in a Bipolar 1 Patient Following Re-initiation of Lithium: A Case Report.

A Chinese American female presents with extrapyramidal symptoms following re-initiation of lithium carbonate as part of her treatment plan following a recent manic episode. She developed neurological symptoms including stiffness in the upper extremities and restlessness shortly after the medication was initiated. The patient has a history of bipolar disorder for which she has been treated with lithium carbonate among other mood stabilizers, but the patient was not compliant with medications. Though rare in presentation, this case report aims to highlight the importance for clinicians to recognize the possibility of extrapyramidal symptoms developing in patients taking lithium regardless of the duration of the lithium therapy.