ABSTRACT
Risperidone is an atypical antipsychotic agent used primarily to treat schizophrenia. It is a dopamine antagonist with antiserotonergic, antihistaminergic and antiadrenergic properties. Antipsychotic discontinuation symptoms have been described in the literature following abrupt or rapid reduction in the dose. This unusual case demonstrates that sudden withdrawal of even a modest dose of risperidone may cause significant discontinuation symptoms in susceptible individuals. Hence, there is a need for caution while taking a patient off antipsychotic medications in view of the vulnerable subgroup.
ABSTRACT
Background: Although the term "zycloiden psychosen" was first used by Karl Kleist in 1926 to group together disorders, which had presented with sudden onset, brief episodic course, polymorphous psychotic symptoms and good inter-episode recovery, its origin can be traced back to 1880s. Despite its existence in the community, for so long, the diagnosis of cycloid psychosis is only seldom made, making it a unique disorder. Hence, there seems to be lack of awareness of this rare entity even among the psychiatrists. Case description: A middle-aged woman with abrupt onset of recurrent brief episodes of psychotic symptoms, and complete inter-episode recovery, was admitted with history of alleged consumption of poison in a state of confusion. During psychotic episodes, motility disturbances were predominant. The current episode lasted for about two weeks. Discussion: This case doesn't satisfy the criteria for schizophrenia or affective illness. Although ICD-10 describes 'acute polymorphic psychotic disorder' (F23.0, F23.1) it requires the presence of typical schizophrenic symptoms for its diagnosis and is usually not recurrent. The closest this case resembles is cycloid psychosis, meeting three of four Perris criteria. Conclusion: The diagnosis of such unusual cases of psychosis predicts the prognosis and helps in assessment and management of future episodes.