Risperidone-Induced Neuroleptic Malignant Syndrome in Neurodegenerative Disease
Notice bibliographique
Résumé
Quetiapine-Induced HypersalivationSir: Quetiapine fumarate is a dibenzothiazepinederivative antipsychotic with combined antagonism at dopamine (D 1 , D 2 ) and serotonin type 1 and type 2 (5-HT 1A , 5-HT 2A , 5-HT 2C ) receptors.Additionally, quetiapine antagonizes α 1 -and α 2 -adrenergic and histamine H 1 receptors.Protean binding at the above receptors explains the common side effects, which include hypersomnolence, hypotension, headache, weight gain, and gastrointestinal disturbance.However, to our knowledge, there have been no case reports of quetiapine-induced hypersalivation.We report the case of a patient with schizoaffective disorder taking low-dose quetiapine who developed hypersalivation, which remitted after discontinuation of the drug.We suggest that quetiapine antagonism at the α 2 receptor contributes to the phenomenon of hypersalivation.Case report.Ms. A, a 36-year-old woman of Korean descent with a 16-year history of schizoaffective disorder, was admitted to the adult psychiatric medical care unit with a relapse of mania with psychosis.The patient's symptoms included elated mood, grandiose delusions of being a Power Ranger, disorganized behavior, and decreased need for sleep.The patient had been previously stabilized on clozapine with the only noted side effect being increased sedation.During this hospitalization, the patient refused administration of clozapine and instead was started on risperidone.Within a few days of commencement, the patient developed extrapyramidal symptoms with rigidity, dystonia, and slurring of speech, which prompted discontinuation of the risperidone.After a drug-free period of 3 days, the patient was started on quetiapine 25 mg b.i.d., and within a day, she developed increased salivation.When the dosage was increased to 50 mg b.i.d., the salivation worsened; the patient was drooling most of the day, and all of her clothing was wet.Benztropine (1 mg p.o. b.i.d.) and atropine eye drops (0.1%) sublingually did not reduce the hypersalivation.The quetiapine was stopped, and 1 day later, the hypersalivation resolved.Based on the temporal relationship between the administration and discontinuation of quetiapine and the onset and cessation of the patient's hypersalivation, it is possible that the hypersalivation was induced by the quetiapine.Hypersalivation is a common and distressing side effect seen with many psychotropic medications.However, no previous reports have associated increased salivation with the use of quetiapine.We attempt to explain the mechanism behind this event using the drug's known receptor affinities and the resultant binding effects observed in a closely related antipsychotic agent.Among the antipsychotics, clozapine is well recognized for inducing increased, voluminous salivation early in the course of treatment in up to 54% of patients. 1Clozapine is structurally similar to quetiapine and possesses a comparably broad receptor profile, which includes antagonistic activity at dopamine (D 1 , D 2 , D 3 , D 4 ) receptors, adrenergic blockade activity at the α 1 and α 2 receptors, and antagonism at serotonin 5-HT 2 receptors and histamine H 1 receptors.However, unlike quetiapine, clozapine possesses both agonistic and antagonistic properties at muscarinic receptors.Specifically, clozapine has antagonist activity at M 1 , M 2 , M 3 , and M 5 receptors, but exhibits agonist effects on the M 4 receptor.One proposed mechanism for clozapine-induced hypersalivation focuses on its antagonism of α 2 -adrenergic receptors. 2Through blockade of sympathetic stimulation, parasympathetic stimulation is left unopposed to cause high salivary flow rates.Direct parasympathetic stimulation through its agonist effects at the M 4 receptor has also been suggested to explain clozapine-induced hypersalivation. 3 Quetiapine and clozapine both share blocking affinity at α 2 -adrenergic receptors, whereas only clozapine has agonist properties at the M 4 receptor.We thus propose that α 2 -adrenergic blockade is the mechanism for quetiapineinduced hypersalivation.Further study is needed to draw definite conclusions regarding this proposed relationship.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,009 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».