Allongement de l’intervalle QT secondaire aux antipsychotiques chez un jeune patient
Bibliographic record
Abstract
Resume Objectifs : Presenter un cas d’allongement de l’intervalle QT et de possibles torsades de pointes a la suite de l’ajout de risperidone au traitement d’un jeune patient qui n’avait pas de facteurs de risque pour developper ces complications cardiaques. Resume du cas : Il s’agit d’un patient de 21 ans atteint d’un trouble envahissant du comportement et de depression majeure traite avec de la fluoxetine et de l’aripiprazole. Apres le remplacement de l’aripiprazole par de la risperidone, le patient se plaint d’etourdissements et de palpitations passagers. L’electrocardiogramme revele une anomalie de l’onde T ainsi que l’allongement de l’intervalle QT corrige, qui atteint 469 ms. La risperidone est alors remplacee par l’haloperidol, et l’allongement de l’intervalle QT corrige atteint 507 ms. La valeur de l’intervalle QT corrige se normalise lors du remplacement de l’haloperidol par la perphenazine. Discussion : Le prolongement de l’intervalle QT par les antipsychotiques est une complication bien connue. Ce patient prenait egalement de la fluoxetine, un inhibiteur puissant du CYP2D6. L’augmentation des concentrations plasmatiques de risperidone serait de 4 a 10 fois superieure lorsque cet antipsychotique est combine a la fluoxetine. Il y aurait ainsi une augmentation du risque d’effets secondaires, tels que les effets extrapyramidaux, la prolongation de l’intervalle QT ainsi que les torsades de pointes avec l’association de risperidone et fluoxetine. Conclusion : Lorsqu’on entreprend l’administration d’un medicament ayant le potentiel de prolonger l’intervalle QT, il est important d’evaluer les facteurs de risque contribuant a cette complication et de les corriger. Il faut egalement porter une attention particuliere a la presence d’interactions medicamenteses. Abstract Objective: To present a case of QT interval prolongation and possible torsades de pointes with risperidone in a young patient presenting no risk factors. Case summary: This is the case of a patient age 21 with pervasive developmental disorder and major depressive disorder treated with fluoxetine and aripiprazole. After aripiprazole was replaced with risperidone, the patient complained of dizziness and occasional palpitations. The electrocardiogram revealed an abnormal T wave with a corrected QT interval prolongation of 469 ms. Risperidone was discontinued and changed to haloperidol. This resulted in a corrected QT of 507 ms which returned to baseline when haloperidol was replaced by perphenazine. Discussion: QT interval prolongation secondary to antipsychotics is a well-known complication. This patient was also taking fluoxetine, a powerful inhibitor of CYP 2D6. Plasma concentrations of risperidone are 4 to 10 times greater when it is combined with fluoxetine. There is also an increased risk of adverse effects such as extrapyramidal symptoms, QT interval prolongation, and torsades de pointes with the association of risperidone and fluoxetine. Conclusion: When administering a drug with the potential to cause QT interval prolongation, it is important to evaluate the risk factors that may contribute to this complication and to correct them. Drug interactions must also be carefully evaluated. Key words: Atypical antipsychotics, fluoxetine, interaction, QT interval, risperidone, torsades de pointes
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".