quetiapine-fumarate and Purpura--Thrombocytopenic

Corticosteroids generally result in short-lasting neuropsychiatric symptoms following cessation, but the following case highlights an unusually long-lasting course of symptoms in a patient following near immediate cessation of medication, despite medication management and electroconvulsive therapy. The case presentation will be followed by a discussion of the presentation, treatment, and management of steroid-induced neuropsychiatric symptoms.. The patient was followed from symptom onset to resolution.. The patient's symptom course was unusually long and required a long course of multimodal therapy.. Corticosteroids are commonly used medications both in a wide variety of medical settings, and despite this, their neuropsychiatric effects are poorly understood. The affective and behavioral symptoms, in particular mania and psychosis, can be unpredictable and challenging to treat as in our patient, who developed a long-lasting psychotic episode on high-dose steroids despite discontinuation and treatment of nearly six months. This was despite having tolerated steroids multiple times in the past.

Topics: Adrenal Cortex Hormones; Bipolar Disorder; Dexamethasone; Dose-Response Relationship, Drug; Drug Administration Schedule; Electroconvulsive Therapy; Hospitalization; Humans; Long-Term Care; Male; Middle Aged; Prednisone; Psychoses, Substance-Induced; Purpura, Thrombocytopenic; Quetiapine Fumarate; Retreatment; Substance Withdrawal Syndrome

We aimed to contribute to the current limited literature addressing quetiapine-associated thrombocytopenia. We report the case of a young man with a first episode schizophrenia who experienced thrombocytopenic purpura following the administration of quetiapine co-prescribed with valproic acid.. HA is a 19-year-old single man who had no history of systemic or hematologic diseases and no personal psychiatric history. He presented with psychotic symptoms that have been continuously evolving since ten months. His psychiatrist put him on treatment with 400 mg/day of quetiapine and 1500 mg/day of valproic acid over a three-week titration. Twelve days later, the patient developed a sudden onset of thrombocytopenic purpura without fever, which resolved over two weeks after cessation of both drugs.. Although uncommon and reversible, thrombocytopenia induced by quetiapine can be life-threatening. Clinicians should carefully follow-up the hematological data when prescribing quetiapine. The unnecessary use of valproic acid should be avoided as a first-line treatment for young people with first-episode schizophrenia.

Topics: Adolescent; Adult; Antipsychotic Agents; Humans; Male; Purpura, Thrombocytopenic; Quetiapine Fumarate; Schizophrenia; Thrombocytopenia; Valproic Acid; Young Adult