Psychomotor Agitation Following Treatment with Hydroxychloroquine
Tóm tắt
We describe the case of an elderly woman with elderly-onset rheumatoid arthritis, where the use of 4 mg/kg/day of hydroxychloroquine (HCQ) was followed by the onset of psychomotor agitation with marked physical and verbal violence towards her partner, including throwing objects at her partner. No disturbance in sleep and no anxiety, nervousness, or irritability had emerged before the onset of her psychomotor agitation. The disappearance of agitation following targeted pharmacologic intervention and HCQ interruption, its re-onset after reintroduction of the drug, and the high score (9) of Naranjo’s algorithm are surely linked to the existence of a causal relationship between HCQ and psychomotor agitation. HCQ may produce undesirable effects on the central nervous system, mainly irritability, nervousness, emotional changes, and nightmares. To the best of our knowledge, there are only a few case reports of psychosis due to HCQ. No favoring condition such as pharmacokinetic interactions or a personal and family psychiatric history was present in our patient. The neuropsychiatric manifestations we observed could be considered a bizarre-type adverse drug reaction linked to an individual’s hypersensitivity.
Tài liệu tham khảo
McKenzie AH. Dose refinements in long-term therapy of rheumatoid arthritis with antimalarials. Am J Med. 1983;75(1A):40–5.
Rynes RI. Antimalarials. In: Kelley WN, Harris ED Jr, Ruddy S, Sledge CB, editors. Textbook of rheumatology. Philadelphia: Saunders Company; 2001. p. 864–5.
Hsu WH, Chiu NY, Huang SS. Hydroxychloroquine-induced acute psychosis in a systemic lupus erythematosus female. Acta Neuropsychiatrica. 2011;23:318–9.
Drew JF. Concerning the side effects of antimalarial drugs used in the extended treatment of rheumatic diseases. Med J Aust. 1962;49:618–20.
Tubach F, Wells GA, Ravaud P, Dougados M. Minimal clinically important difference, low disease activity state, and patient acceptable symptom state: methodological issues. J Rheumatol. 2005;32(10):2025–9.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.
Folstein MF, Robins LN, Helzer JE. The Mini-Mental State Examination. Arch Gen Psychiatry. 1983;40(7):812.
Magni E, Binetti G, Bianchetti A, et al. Mini-Mental State Examination: a normative study in Italian elderly population. Eur J Neurol. 1996;3(3):198–202.
Bothwell B, Furst DE. Hydroxychloroquine. In: Day RO, Furst DE, editors. Antirheumatic therapy: actions and outcomes. Basel: Piet L.C.M. van Riel and Barry Bresnihan; 2005. p. 81–92.
McLachlan AJ, Tett SE, Cutler DJ, Day RO. Bioavaliability of hydroxychloroquine tablets in patients with rheumatoid arthritis. Br J Rheumatol. 1994;33(3):235–9.
Tett S, Cutler D, Day R. Antimalarials in rheumatic diseases. Baillieres Clin Rheumatol. 1990;4:467–89.
Munster T, Gibbs JP, Shen D, et al. Hydroxychloroquine concentration response relationships in patients with rheumatoid arthritis. Arthritis Rheum. 2002;46:1460–9.
Giacomello A. Antimalarici di sintesi derivati della 4-aminochinolina. In: D’Elia S, D’Erasmo E, Giacomello A, et al, editors. Farmacologia clinica reumatologica. Milan: Masson ed.; 1987. p. 98–9.
Tett SE, Cutler DJ, Day RO, Brown KF. Bioavailability of hydroxychloroquine tablets in healthy volunteers. Br J Clin Pharmacol. 1989;27:771–9.
Katz SJ, Russell AS. Re-evaluation of antimalarials in treating rheumatic diseases: reappreciation and insights into new mechanisms of action. Curr Eye Res. 2011;23:278–81.
Kim KA, Park JY, Lee SJ, Lim S. Cytochrome P450 2C8 and CYP3A4/5 are involved in chloroquine metabolism in human liver microsomes. Arch Pharm Res. 2003;26:631–7.
Das P, Rai A, Chopra A, Philbrick K. Psychosis likely induced by hydropxychloroquine in a patient with chronic Q fever: a case report and clinically relevant review of pharmacology. Psychosomatics. 2014;55:409–13.
Rawlins MD. Clinical pharmacology: adverse reactions to drugs. BMJ. 1981;282:974–6.
Kwak YT, Yang Y, Park SY. Chloroquine-associated psychosis mimicking very late-onset schizophrenia: case report. Geriatr Gerontol. 2015;15:1096–7.
Livezey J, Oliver T, Cantilena L. Prolonged neuropsychiatric symptoms in a military service member exposed to mefloquine. Drug Saf Case Rep. 2016;3:7.
Tran TM, Browning J, Dell ML. Psychosis with paranoid delusions after a therapeutic dose of mefloquine: a case report. Malaria J. 2006;5:74.
Good MI, Shader RI. Lethality and behavioral side effects of chloroquine. J Clin Psychopharmacol. 1982;2:40–7.
Maxwell NM, Nevin RL, Stahl S, et al. Prolonged neuropsychiatric effects following management of chloroquine intoxication with psychotropic polypharmacy. Clin Case Rep. 2015;3(6):379–87.
Ward WQ, Walter-Ryan WG, Shehi GM. Toxic psychosis: a complication of antimalarial therapy. J Am Acad Dermatol. 1985;12(5):863–5.
Gonzales-Nieto JA, Costa-Juan E. Psychiatric symptoms induced by hudroxychloroquine. Lupus. 2015;24:339–40.
Joaquim AF, Appenzeller S. Neuropsychiatric manifestations in rheumatoid arthritis. Autoimmun Rev. 2015;14(12):1116–22.