Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorder
Antipsychotic plasma levels have been extensively used in the assessment of poor treatment response, lack of adherence and adverse events in delusional disorder. It has not been used as an indicator of metabolizer status, to determine whether a delusional disorder patient is a poor, intermediate, o...
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| Format: | Article |
| Language: | English |
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Instituto Psiquiatría Psicodex SL
2021-08-01
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| Series: | Psicosomática y Psiquiatría |
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| Online Access: | https://raco.cat/index.php/PsicosomPsiquiatr/article/view/391188 |
| _version_ | 1797793190534709248 |
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| author | A Guàrdia A González-Rodríguez A Álvarez M Betriu M.V. Seeman J.A. Monreal D Palao J Labad |
| author_facet | A Guàrdia A González-Rodríguez A Álvarez M Betriu M.V. Seeman J.A. Monreal D Palao J Labad |
| author_sort | A Guàrdia |
| collection | DOAJ |
| description |
Antipsychotic plasma levels have been extensively used in the assessment of poor treatment response, lack of adherence and adverse events in delusional disorder. It has not been used as an indicator of metabolizer status, to determine whether a delusional disorder patient is a poor, intermediate, or ultra-rapid metabolizer of antipsychotics. Pharmacogenetic probes are, of course, the right method for the latter task, but they are not readily available for clinical use. We report the case of a 46-year-old woman with delusional disorder who developed unexpected adverse effects to treatment with relatively low dose risperidone and poor symptomatic response. Blood level monitoring indicated high levels of risperidone and a high concentration-to-dose ratio, which suggested accumulation of unmetabolized risperidone. Paradoxically, extrapyramidal side effects increased when, after reducing the risperidone dose, 5 mg/day of aripiprazole was added. Consequently, the patient was switched to olanzapine 5 mg/day. Sertraline 150 mg/day was later added for comorbid depression. A complete symptomatic response was achieved. Although other factors may well have been at play, this sequence of events suggests that the patient was a slow metabolizer of CYP2D6, which metabolizes both risperidone and aripiprazole. With pharmacogenetic assessment not available, therapeutic drug monitoring helped clinicians decide on appropriate management.
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| first_indexed | 2024-03-13T02:43:43Z |
| format | Article |
| id | doaj.art-b8974b59db2d4722b0209d693e15ebec |
| institution | Directory Open Access Journal |
| issn | 2565-0564 |
| language | English |
| last_indexed | 2024-03-13T02:43:43Z |
| publishDate | 2021-08-01 |
| publisher | Instituto Psiquiatría Psicodex SL |
| record_format | Article |
| series | Psicosomática y Psiquiatría |
| spelling | doaj.art-b8974b59db2d4722b0209d693e15ebec2023-06-28T20:02:50ZengInstituto Psiquiatría Psicodex SLPsicosomática y Psiquiatría2565-05642021-08-011410.34810/PsicosomPsiquiatrnum1404Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorderA GuàrdiaA González-RodríguezA ÁlvarezM BetriuM.V. SeemanJ.A. MonrealD PalaoJ Labad Antipsychotic plasma levels have been extensively used in the assessment of poor treatment response, lack of adherence and adverse events in delusional disorder. It has not been used as an indicator of metabolizer status, to determine whether a delusional disorder patient is a poor, intermediate, or ultra-rapid metabolizer of antipsychotics. Pharmacogenetic probes are, of course, the right method for the latter task, but they are not readily available for clinical use. We report the case of a 46-year-old woman with delusional disorder who developed unexpected adverse effects to treatment with relatively low dose risperidone and poor symptomatic response. Blood level monitoring indicated high levels of risperidone and a high concentration-to-dose ratio, which suggested accumulation of unmetabolized risperidone. Paradoxically, extrapyramidal side effects increased when, after reducing the risperidone dose, 5 mg/day of aripiprazole was added. Consequently, the patient was switched to olanzapine 5 mg/day. Sertraline 150 mg/day was later added for comorbid depression. A complete symptomatic response was achieved. Although other factors may well have been at play, this sequence of events suggests that the patient was a slow metabolizer of CYP2D6, which metabolizes both risperidone and aripiprazole. With pharmacogenetic assessment not available, therapeutic drug monitoring helped clinicians decide on appropriate management. https://raco.cat/index.php/PsicosomPsiquiatr/article/view/391188Delusional disorderPlasma levelsTherapeutic drug monitoringCYP450 |
| spellingShingle | A Guàrdia A González-Rodríguez A Álvarez M Betriu M.V. Seeman J.A. Monreal D Palao J Labad Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorder Psicosomática y Psiquiatría Delusional disorder Plasma levels Therapeutic drug monitoring CYP450 |
| title | Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorder |
| title_full | Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorder |
| title_fullStr | Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorder |
| title_full_unstemmed | Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorder |
| title_short | Therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable: case report of delusional disorder |
| title_sort | therapeutic drug monitoring is useful when pharmacogenetic assessment is unavailable case report of delusional disorder |
| topic | Delusional disorder Plasma levels Therapeutic drug monitoring CYP450 |
| url | https://raco.cat/index.php/PsicosomPsiquiatr/article/view/391188 |
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