Effect of the addition of aripiprazole on hyperprolactinemia associated with risperidone long-acting injection.

We sought to assess the effect of the addition of a fixed dose of 5 mg daily of aripiprazole on hyperprolactinemia induced by risperidone long-acting injectable (RLAI) treatment in patients with chronic psychoses and the adverse events related to the addition of aripiprazole and its impact on the disease. This is an open uncontrolled clinical trial with 13 patients with a severe mental disorder (schizophrenia and other unspecified psychoses) treated with RLAI and with increased serum prolactin levels. Subjects received the addition of a fixed dose of 5 mg daily of aripiprazole for 3 months. The main efficacy outcome was the change in serum prolactin levels after 3 months of treatment. Twelve of the 13 patients showed a decrease in serum prolactin levels (81 ± 46 µg/L at baseline vs 42 ± 21 µg/L at month 1, P < 0.001, 52% mean reduction). In 2 patients, prolactin levels reverted normality. In 8 patients who continued treatment for 2 more months, the decrease in prolactin levels was maintained. Symptoms associated with hyperprolactinemia improved, and no worsening of the Clinical Global Impression Scale scores was observed. The adverse effects due to the addition of aripiprazole were mild and transient. The addition of aripiprazole 5 mg daily to RLAI was associated with a significant decrease in hyperprolactinemia levels and no major additional toxicity in patients with chronic psychosis.

Un caso de manía orgánica, diagnóstico diferencial / A case of organic mania, differential diagnosis

Presentamos el caso de una paciente de 74 años con antecedentes de síndrome depresivo que ingresa en el servicio de psiquiatría por un cuadro maníaco en principio relacionado con un hipotiroidismo severo al dejar de tomar levotiroxina. Unos meses después la paciente ingresó en el servicio de medicina interna por disnea, artritis, úlceras bucales así como hipocomplementemia y elevación de ANA. Revisando la historia clínica de la paciente observamos que antes del brote maníaco la paciente tenía datos clínicos que indicaban actividad lúpica. Es importante identificar los síntomas neuropsiquiátricos en una paciente con lupus, ya que pueden ser la manifestación de inicio de la enfermedad en contraposición a un trastorno afectivo primario. Existen muy pocos casos descritos de psicosis secundaria a un hipotiroidismo aunque la relación entre los trastornos tiroideos y el lupus eritematoso sistémico no es tan rara (AU)

We present a case of a 74 year-old woman with a history of depression who was admitted to the psychiatric department due to having a maniacal clinical picture associated with a severe hypothyroidism on stopping taking levothyroxine. A few months later the patient was admitted to the internal medicine department because of dyspnea, arthritis, mouth ulcers and a low complement and increased ANA. Reviewing the history of the patient before the outbreak we observed that the patient had a clinical history showing lupus activity. It is important to identify neuropsychiatric symptoms in a patient with lupus, as they could be the initial onset of the illness as opposed to a primary affective disorder. There are very few cases of psychosis secondary to hypothyroidism, although the relationship between thyroid disorders and systemic lupus erythematosus is not so rare (AU)