Demet AYKUT SAĞLAM, Evrim ÖZKORUMAK, AHMET TİRYAKİ

Mania Induced by Aripiprazole Use: a Case

Bipolar depresyon tedavisinde olanzapin, ketiyapin, aripiprazol gibi bazı antipsikotik ilacların etkili oldukları gösterilmiş olup, atipik antipsikotiklerle tedavi sırasında mani ve depresyon dönemlerinin indüksiyonu da bir risk olarak tanımlanmıştır. Literatürde aripiprazol'ün antidepresan etkinliği olması ile birlikte manik kaymaya da yol açabileceği bildirilmiştir. Bu yazıda 30mg/dl dozundaki aripiprazol tedavisi ile manik kayma görülen bir olgu tartışılmıştır. 35 yaşında, kadın hasta, 12 yıldır bipolar afektif bozukluk-I (BAB-I) tanısıyla takip edilmekte olup son 14 aydır paliperidon 9mg/gün ve lityum 1200mg/gün tedavisi almaktadır. Son 3 haftadır 'güçsüzlük, hayattan keyif almama, sürekli yatma isteği sonrasında gelişen günahkar olduğunu, suçlu olduğunu, kötülük göreceğini düşünme, insanlardan şüphelenme, kendine büyü yapıldığını dile getirme' şeklinde yakınmaları ile yakını refakatinde polikliniğe başvurmuştur. Hasta, BAB- I 'psikotik özellikli depresif nöbet' tanısı ile kliniğe yatırılarak takip altına alınmıştır. Mevcut tedavisine aripiprazol 30mg/gün eklenmiştir. Aripiprazol eklendikten sonraki 15 gün içinde hastanın dışa vuran davranışlarında artma, anlamsız gülümsemeler, uyku ihtiyacında azalma, büyüklük sanrıları şeklinde yakınmaları ortaya çıkmıştır. Mani belirtilerinin aripiprazol ile indüklenmiş olacağı düşünülerek aripiprazol dozu 10mg/gün'e düşürülmüştür, sonraki 2 hafta içinde hastanın gece uykuları düzelmiş, sanrıları azalarak kaybolmuştur.

Aripiprazol kullanımı ile ortaya çıkan mani: Olgu Sunumu

Olanzapine, quetiapine and aripiprazole have been shown to be effective treatments for bipolar depression. However, induction of manic and depressive episodes with atypical antipsychotic treatments have also been described as risk. Current literature described antidepressant effects of Aripiprazole with the risk of manic shift. In this report, a case who developed manic episode with the treatment of 30mg/day of the aripiprazole will be discussed. A 35-year-old, woman, who had 12 years history of bipolar affective disorder-I (BAD-I) for 12 years, and taking paliperidone 9mg/day and lithium 1200mg/day for the last 14 months. She was admitted to outpatient clinic by her parents with complaints of fatigue, loss of pleasure and increased sleep. She was suspicious, had thoughts of getting harm form others and being a sinner, and suspecting that someone put a spell on her. She was admitted to inpatient service with the diagnosis of BAD-I depressive episode with psychotic features. Aripiprazole 30mg/day was added to current treatment regime. Consequently, increase in targeted activities, inappropriate affect, decreased need for sleep, and grandiose delusions were observed. The symptoms of mania were considered to be induced by aripiprazole, and its dose was decreased to 10mg/day. Following the dose reduction, sleepiness and her delusions were improved within the consecutive 2 weeks.

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