Acute psychotic disorder associated with immunosuppressive agent use after renal transplantation: a case report

Abstract

Kidney transplantation is the best treatment option for end-stage renal disease in appropriate patients. Immunosuppressant agents given in this duration can cause many psychiatric disorders. In this paper, we present a young kidney transplant patient with psychosis constituted delusions about his transplanted kidney after 4 years later from transplantation. He had refused to take his immunosuppressant pills because of psychotic process. In this paper, we wanted to discuss the psychiatric risks of immunosuppressant agents and importance of the psychiatric treatment in this aspect. ARTICLE HISTORY

Acute schizophrenia-like psychotic disorder associated with immunosuppressive agent use three years after renal transplantation: a case report

“…Int J Sci Rep. 2018 July;4 (7):192-195 International Journal of Scientific Reports | July 2018 | Vol 4 | Issue 7 Page 194 disorders in high plasma levels of the calcineurin inhibitors. 15 The patient presented had no family or personal history of mental disorder prior to and even over three years after the surgery but she developed psychosis following elevated plasma level of tacrolimus. Similar reports are in the literature.…”

“…The mechanisms of these psychiatric adverse effects are extremely complex, unpredictable, and usually severe. 15 Calcineurin inhibitors have regulatory effects on both dopaminergic and the N-methyl-D-aspartate receptor (also known as the NMDA receptor or NMDAR) systems. Glutamate/NMDA excitatory system inhibition caused by tacrolimus as well as its central serotonergic effects could explain the drug-induced psychosis.…”

“…A Turkish report had it that a 26 year old man developed psychotic features four years after he had kidney transplant. 15 It does appear that the toxic effect could be shortly after transplant or much longer, especially with increased plasma level of the drug. Whichever time it occurs, the experience in the case presented here shows that dose reduction, and preferably total substitution where possible leads to complete recovery from the psychiatric sequel.…”

Heart transplantation in the era of COVID-19 pandemic: delirium, post-transplant depression, and visitor restrictions; the role of liaison and inpatient psychosomatic treatment—a case report

“…The neurotoxic effect of tacrolimus may be related to up-regulation of endothelin receptors, damage of the blood-brain barrier, and neuromodulatory systems. 2,18 In cases of liver transplant recipients with acute psychotic disorder, in less than 24 h after suspension of tacrolimus, all symptoms disappeared in both patients, making a causal relationship with tacrolimus likely. 2 In transplant recipients, the use of corticosteroids may be a risk for the development of APD, and up to 14% of transplant recipients using corticosteroids manifest psychotic symptoms.…”

Klinikinis Atvejis: Paciento, Sergančio Šizofrenija Ir Turinčio Transplantuotą Inkstą, Gydymo Ypatumai

“…Po inksto transplantacijos skirtas imunosupresinis gydymas. Žinoma, jog imuninę sistemą slopinantys vaistai gali sukelti psichikos sutrikimus, tokius kaip psichozė, depresija, nerimo ir elgesio sutrikimai [15]. Svarbu stebėti pacientų būklę ir, kai reikia, mažinti imunosupresantų dozes, skirti tipinius ar atipinius antipsichotinius vaistus, atsiradus psichozės simptomų.…”