Risperidone Induced Bradycardia and Syncope in A Case with Volatile Substance Abuse

Antipsikotik ilaçlarla tedavi edilen hastalarda kardiyak arrest, ventriküler aritmi ve ani ölüm gerçekleşebileceğini bildiren çalışmalar mevcuttur. Yine uçucu madde kötüye kullanımında da kardiyak aritmiler ve ani ölüm ortaya çıkabilir. Bu yazıda, uçucu madde kötüye kullanımı olan ve risperidon ile tedaviye başlanılmasını takiben bradikardi ve senkop ortaya çıkan bir olgu sunulmuştur. İki ay boyunca hemen her gün yapıştırıcı madde koklayan 15 yaş 8 aylık erkek hasta sıkıntı, bunaltı, kendi kendine konuşma yakınmaları ile getirilmişti. Son dönemlerde sosyal olarak kendini izole etmekteymiş. Ruhsal Bozuklukların Tanısal ve Sayımsal El Kitabı (DSM-IV)'e göre 'uçucu madde kötüye kullanımı' ve 'psikotik özellikleri olan majör depresif bozukluk' tanıları konularak, risperidon 1,5 mg/gün tedavisi başlandı. Bir hafta sonraki kontrolünde göğüs ağrısı ve sık sık bayılma atakları ortaya çıktı. Çekilen EKG'sinde (Elektrokardiyogram) sinüzal bradikardi mevcuttu. Risperidonun kesilmesinin ardından senkop atakları ortadan kalktı, EKG'si normale döndü.Uçucu madde kullanan bireylerde antipsikotik kullanımı gerektiğinde kardiyak yan etkiler göz önünde bulundurulmalıdır. Uçucu madde kullanımı olan hastada daha önce kardiyak yan etkileri bildirilen antipsikotik başlanması durumunda, özellikle erken dönemde EKG takibi yaptırılması gerekli olabilir

Uçucu madde kötüye kullanımı olan bir olguda risperidon ile indüklenen bradikardi ve senkop

Risperidone induced bradycardia and syncope in a case with volatile substance abuse There are studies reporting that cardiac arrest, ventricular arrhythmia and sudden death might be seen in patients treated with antipsychotic drugs. Besides, cardiac arrhythmia and sudden death may be observed in volatile substance abuse. We report a patient with volatile substance abuse, who had bradycardia and syncope arised with the initiation of risperidone treatment. The patient was male, aged 15 years and 8 months, had started to snuff adhesive almost daily for the last two months. He was referred with complaints of uneasiness, anxiety, andtalking to himself. He had isolated himself socially at recent times. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), diagnosis of “volatile substance abuse” and “major depressive disorder with psychotic characteristics” was established and 1.5 mg/day risperidone treatment was initiated. At the follow-up visit one week later, chest pain and frequent syncope attacks were observed. Sinusal bradycardia was detected in his ECG (Electrocardiogram). Upon discontinuation of risperidone, syncope attacks disappeared and ECG became normal.When antipsychotic use is required in a person abusing volatile substances, cardiac adverse effects must be taken into consideration. In the presence of any previous antipsychotic use with cardiac adverse effects in patients abusing volatile substance, follow-ups with ECG may be necessary, especially at the early phase of antipsychotic treatment

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