Reversible Toxic Psychosis After Cephalexin

Bm, Saker; Aw, Musk; Ef, Haywood; Pe, Hurst

doi:10.5694/j.1326-5377.1973.tb110518.x

Cited by 24 publications

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“…Thirty years after the first reported case of cephalexininduced psychosis [1], we report a similar event in a woman with no comorbid chronic disease. Cephalexin remains a commonly used antibiotic, with indications as documented in infection treatment guidelines [2].…”

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confidence: 81%

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Cephalosporin-Induced Psychosis

Ca¹,

Gedamu²

2003

Aust N Z J Psychiatry

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We report a case of a DSM-IV manic episode developing in a patient with schizophrenia, presumably related to the addition of quetiapine.A 21-year-old man with DSM-IV paranoid schizophrenia presented with a 1 year history of auditory hallucinations, paranoid delusions, disorganized speech, irritability and anxiety. At first visit, he was receiving haloperidol (4.5 mg/day). History and review of the clinical record were negative for mania. Family history was negative for psychopathology.The patient was started on quetiapine to control treatment-unresponsive symptoms at an initial dose of 100 mg/day up to 300 mg/day in 2 weeks, before bedtime. During titration, the haloperidol regimen was maintained. Over 3 weeks his symptoms substantially worsened, and he demonstrated in addition euphoria, disorganized and bizarre behaviour, sexual disinhibition with frequent public masturbation, frequent laughter, psychomotor agitation, distractibility and reduced need for sleep. Quetiapine was discontinued and treatment with haloperidol (9 mg/day), chlorpromazine (300 mg/ day), and clonazepam (9 mg/day) was started. Since symptoms persisted, clozapine was introduced at the starting dose of 50 mg/day, followed by 600 mg/day valproate 2 days later. Progressive improvement in the clinical picture was observed within 10 days, with reduced agitation, sexual disinhibition, bizarre behaviour, hallucinations and formal thought disorder, improved sleep, and return to euthymia. One month after admission, the patient was discharged with the following medication: haloperidol (7 mg/day); clozapine (400 mg/ day); valproate (600 mg/day); and clonazepam (9 mg/day). Six months later, he is free from manic symptoms; however, auditory hallucinations persist, although they are less frequent.Quetiapine is an atypical antipsychotic with structural similarities with clozapine. Specifically, quetiapine is a dibenzothiazepine derivative with modest D 2 receptor affinity and serotonin 5-HT 2A receptor affinity, along with considerable histamine receptor and α 2 -adrenoceptor blockade [1]. At low doses (up to 300 mg/day) it shows a consistently higher degree of occupancy of 5-HT 2A receptors than D 2 receptors; the degree of occupancy of both receptors is dose-dependent [2]. Slow quetiapine titration in this patient may have caused mania, due to prevalent 5-HT 2A receptor blockade. Olanzapine and risperidone might similarly induce mania [3]. Thus far only two cases of possible quetiapine-induced hypomania have been reported [4,5].

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confidence: 81%

“…It seems probable this woman experienced an acute reversible psychosis after cephalexin. Since the first report [1] there have been two similar reports with other cephalosporins [3,4]. Four cases of psychotic events have been reported to ADRAC after treatment with cephalexin (pers.…”

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confidence: 92%