LETTERS

Letters to the Editor Aripiprazole-Induced Acute Hiccups: A Case Report Hiccups are repeated, involuntary spasmodic contractions of the diaphragm and inspiratory muscles followed by sudden closure of the glottis.1 Multiple causes including lesions or infections of the central nervous system, gastric distension or gastroesophageal reflux, drugs, and irritation of the phrenic or vagus nerves have been described in the etiology of hiccups.2 Hiccups are defined as acute if the episode lasts for minutes to hours, persistent if the episode lasts for more than 48 hours, and intractable if the hiccups last for more than 1 month.3 Here we report a patient with acute hiccups induced by aripiprazole. To the Editor:

CASE REPORT “Mr. G,” a 62-year-old married man who had a normal birth and developmental history was hospitalized several times because of severe depression over the last 20 years. In his last admission to the outpatient unit, he had depressive symptoms unresponsive to 150 mg/day venlafaxine, 30 mg/day mirtazapine, and 10 mg/day olanzapine, and he was hospitalized to the inpatient unit. After admission, olanzapine was discontinued, and after 5 days, aripiprazole 5 mg/day was initiated. Within 2–3 hours of taking aripiprazole, the patient started having hiccups continually. The patient was examined by a neurologist and an internist. Physical examinations were normal, and blood, biochemistry, and thyroid function test results were unremarkable. Thorax and cranial CT scans and abdominal radiography demonstrated no significant findings. The hiccups were considered a probable drug reaction, so the next scheduled dose was held. Around 30 hours after the last dose, the hiccups stopped. After obtaining informed consent, aripiprazole 5 mg/day was administered again, and the hiccups were observed for only a very brief period (around 5 minutes/day). In the following 5 days, the hiccups appeared irregularly during the day, lasting for a few minutes. On day 6, the hiccups disappeared, and in his follow-up, the hiccups did not recur for a month. DISCUSSION Although the exact mechanism of hiccups remains undefined, both hypo- and hyperdopaminergic states and seratonergic modulation seem to be important in the development of hiccups.4 The central mechanism of action of aripiprazole is believed to be the stabilization of dopamine and serotonin e60

neuro.psychiatryonline.org

systems through actions mainly at the D2, 5-HT1A, and 5-HT2A receptors, which may be critical in the etiopathogenesis of hiccups.5 There are three case reports of aripiprazole-induced hiccups in the literature.4,6,7 In two of the cases reported, the patients had brain injuries and one patient had hyponatremia.4,6,7 In our patient, there was no history of predisposing risk factors such as brain injury or hyponatremia.8 In contrast to the previous reports, in our patient, the hiccups persisted a shorter time (30 hours), and when we rechallenged with aripiprazole, the hiccups were observed for a brief period and then resolved spontaneously in 5 days. This may be related to having no concomitant medical condition. In this case, we would like to point out that benign hiccups associated with aripiprazole can resolve spontaneously without treatment and especially in the lack of predisposing factors, one should not be immediately discouraged to continue aripiprazole.

REFERENCES 1. Krakauer EL, Zhu AX, Bounds BC, et al: Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 6-2005. A 58-year-old man with esophageal cancer and nausea, vomiting, and intractable hiccups. N Engl J Med 2005; 352:817–825 2. Launois S, Bizec JL, Whitelaw WA, et al: Hiccup in adults: an overview. Eur Respir J 1993; 6:563–575 3. Moretto EN, Wee B, Wiffen PJ, et al: Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013; 1:CD008768 4. Ray P, Zia Ul Haq M, Nizamie SH: Aripiprazole-induced hiccups: a case report. Gen Hosp Psychiatry 2009; 31:382–384 5. Naber D, Lambert M: Aripiprazole: a new atypical antipsychotic with a different pharmacological mechanism. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:1213–1219 6. Behere RV, Venkatasubramanian G, Naveen MN, et al: Aripiprazoleinduced hyponatremia: a case report. J Clin Psychiatry 2007; 68: 640–641 7. Yeh YW: Persistent hiccups associated with switching from risperidone to aripiprazole in a schizophrenic patient with cerebral palsy. Clin Neuropharmacol 2011; 34:135–136 8. Cheng YM, Lin WA, Yang HN: Risperidone-induced hiccups in a youth with Down syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:641–642 Ays¸e Sakalli Kani Tuba Öcek Cana Aksoy-Poyraz, M.D. Senol Turan Alaattin Duran Dept. of Psychiatry, Cerrahpas¸a Medical School, Istanbul, Turkey (ASK, TÖ, ST, AD); and Dept. of Psychiatry, Konya Beyhekim State Hospital, Konya, Turkey (CA-P) Correspondence: Cana Aksoy-Poyraz, M.D.; e-mail: [email protected] J Neuropsychiatry Clin Neurosci 2015; 27:e60; doi: 10.1176/appi.neuropsych. 13100307

J Neuropsychiatry Clin Neurosci 27:1, Winter 2015

Aripiprazole-induced acute hiccups: a case report.

Aripiprazole-induced acute hiccups: a case report. - PDF Download Free
409KB Sizes 0 Downloads 11 Views