Oculogyric Crisis Due to Low-Dose Olanzapine: A Case Report

Erden, Semih; Ferahkaya, Hurşit

doi:10.1097/wnf.0000000000000475

Cited by 4 publications

(1 citation statement)

References 14 publications

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“…Atypical antipsychotics like olanzapine are less commonly reported to cause OGC as compared to typical antipsychotics like haloperidol, perphenazine which is in contradiction to our case 14 . Erden Ferahkaya 15 suggests that while atypical antipsychotics are indeed safer than typical antipsychotics in relation to extrapyramidal adverse effects, they are potential to cause dystonic features like OGC.…”

Section: Discussionmentioning

confidence: 99%

Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: a case report

Yogi,

Bhusal,

Limbu

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: Oculogyric crisis (OGC), marked by upward eye deviation, is rare and linked to diverse causes, including drugs and neurological conditions. This study details a 16-year-old male’s OGC onset after olanzapine treatment for an initial mania episode, highlighting the need to recognize this potential side effect. Case presentation: A 16-year-old male with nonpsychotic mania was treated with olanzapine and sodium valproate. On day 30, he developed OCG due to olanzapine, managed with medication. After discharge, similar ocular symptoms emerged. Gradual olanzapine tapering alongside anticholinergic administration led to symptom relief. The Young Mania Rating Scale score decreased; psychoeducation was provided to the patient and family. Discussion: This study presents an exceptional case of olanzapine-induced OGC, a rare dystonic eye movement reaction. The patient’s presentation matched OGC criteria, confirmed by a high Adverse Drug Reaction Probability Scale score. Unusually, symptoms appeared 30 days postolanzapine initiation. A thorough assessment ruled out alternative causes. Mechanisms, possibly related to dopamine-choline balance and receptor sensitivity, remain uncertain. Despite atypical antipsychotics’ lower risk, olanzapine’s moderate D2 receptor binding led to this unusual response. Management involved dose reduction and anticholinergic therapy. Conclusion: This case report highlights the rare occurrence of olanzapine-induced OCG in a patient with nonpsychotic mania. Effective management requires proper history taking, examination, regular follow-up, monitoring, and appropriate medication use. The case demonstrates the need for caution when increasing olanzapine dose in manic patients with untreated mental illness and a history of neurological symptoms.

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Section: Discussionmentioning

confidence: 99%

Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: a case report

Yogi,

Bhusal,

Limbu

et al. 2023

Annals of Medicine &Amp; Surgery

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Olanzapine

2021

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Oculogyric crisis: case reportA 15-year-old boy developed oculogyric crisis while receiving olanzapine for attention-deficit/hyperactivity disorder. The boy, who had a history of mild mental retardation, epilepsy and attention-deficit/hyperactivity disorder was admitted in an outpatient clinic with symptoms of mobility and anger attacks. When he became angry, he had behavioral issues like banging on doors and throwing items, and his mobility was increased. Previously, he received haloperidol, aripiprazole, risperidone, quetiapine and amisulpride. But the treatment did not benefit him and he also developed aripiprazole and haloperidol attributed neck stiffness. He also received methylphenidate and atomoxetine for the attention-deficit/hyperactivity disorder. However, he did not benefit from the treatment. During the presentation, he was receiving valproic acid for epilepsy. He started receiving olanzapine 2.5 mg/d [route not stated]. Three days later, the olanzapine dose was increased to 2.5mg twice a day. Slight improvement was noted from the day 01 of the treatment. Four days following the start of the treatment, he developed involuntary upward looking and an inability to look down and forward. Pupils were slid up, only their sclera was visible and the pupils were disappeared completely. He was admitted in an emergency department with the symptoms. No abnormality was detected in blood tests and brain imaging. He was suspected to have olanzapine related oculogyric crisis. He had a score of 5 on Naranjo adverse drug reaction probability scale.The boy immediately discontinued the olanzapine treatment and he started receiving biperiden. His symptom of eyes crossing upward completely resolved and then did not recur.

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Characteristics of eye disorders induced by atypical antipsychotics: a real-world study from 2016 to 2022 based on Food and Drug Administration Adverse Event Reporting System

Mu,

Chen

2024

Front. Psychiatry

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BackgroundCommon atypical antipsychotics include risperidone, paliperidone, olanzapine, lurasidone, quetiapine, clozapine, aripiprazole, ziprasidone, asenapine, brexpiprazole, and cariprazine. Previous studies on ocular adverse reactions of antipsychotics were mainly focused on typical antipsychotics. Systematic research on atypical antipsychotics remains limited.ObjectiveThis study aimed to evaluate the potential risks of different atypical antipsychotics causing ocular side effects by mining the Food and Drug Administration Adverse Event Reporting System (FAERS) database.MethodsExtract reports from the FAERS from the first quarter of 2016 to the fourth quarter of 2022 were obtained. Data mining of eye disorders associated with atypical antipsychotics was carried out using The Reporting Odds Ratio (ROR) method and The Medicines and Healthcare Products Regulatory Agency (MHRA) method to determine positive signals.ResultsFAERS reports for 9913783 cases were included in these 28 quarters. 64 defined ocular adverse events were classified into 10 categories according to High-Level Group Terms (HLGT).ConclusionsThere were differences in the types and severity of ocular-related adverse events associated with atypical antipsychotics. Ocular neuromuscular-related adverse events were found among all 11 atypical antipsychotics. Olanzapine had the highest signal intensity in oculogyric crisis. Aripiprazole had the highest signal strength in blepharospasm. Cariprazine was associated with cataract-related ocular adverse reactions. In terms of the types of adverse events, our study found that aripiprazole was associated with 28 types of ocular adverse events, followed by quetiapine. Clozapine was only associated with two types of ocular adverse events.

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Oculogyric Crisis Due to Low-Dose Olanzapine: A Case Report

Abstract: Supplemental digital content is available in the text.

Cited by 4 publications

References 14 publications

Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: a case report

Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: a case report

Olanzapine

Characteristics of eye disorders induced by atypical antipsychotics: a real-world study from 2016 to 2022 based on Food and Drug Administration Adverse Event Reporting System

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