Reactions 1704, p50 - 2 Jun 2018
In a case series, a 13-year-old girl was described who
experienced sleepiness (falling asleep early) and fatigue
following treatment with aripiprazole and a 6.5-year-old girl
was described who developed anxiety, agitation and
aggression following treatment with aripiprazole and
risperidone [routes and durations of treatments to reactions
onsets not stated, not all dosages and outcomes stated].
Patient A: The 13-year-old girl, who had Pitt-Hopkins
syndrome (PTHS), presented due to increased agitation,
anxieties and behavioural changes. She started receiving
aripiprazole 0.5 mg/day. Two weeks later, the dose was
increased to 0.5mg twice daily. However, she started falling
asleep early and also developed fatigue, hence, the dose was
reduced to 0.4mg twice daily. A year later, her condition of
falling asleep early still persisted.
Patient B: The 6.5-year-old girl presented for sleeping
problems, hyperactive behaviour, shouting and aggression.
She started receiving risperidone, which was later increased to
0.25mg twice daily. Subsequently, she developed anxiety
attacks in the form of fear. Consequently, a few weeks later,
the dose was reduced to 0.1mg in morning and 0.15mg at
night, which led to resolution of her fear. A few months later,
the dose was gradually increased to 0.25mg twice daily.
Consequently, she experienced paradoxical effect of anxiety
attacks. A few weeks later, the dose was lowered to 0.25mg in
morning and 0.2mg at night. At the age of eight years, a slow
switch over to aripiprazole 1 mg/day was done wherein
risperidone was continued at a low dose. Two and a half weeks
later, a dose adjustment was done with risperidone (0.1mg in
morning and 0.2mg at night) and aripiprazole 0.5mg twice
daily. A month and half later, aripiprazole dose was increased
to 1mg in morning and 0.5mg at night. At this increased dose,
she developed temper tantrums and her agitation increased.
Two months later, her risperidone dose was adjusted to 0.1mg
in morning and 0.2mg at night, while the aripiprazole dose was
adjusted to 0.6mg in morning and 0.5mg at night. Two weeks
later, aripiprazole dose was increased to 0.7mg in morning and
0.5mg at night. A year and a half later, her shouting increased
and she developed aggression. Hence, aripiprazole dose was
reduced to 0.4mg twice daily and risperidone to 0.1mg twice
daily, resulting in favourable behavioural effects.
Author comment: "The risk of adverse effects, such as
weight gain, drooling, somnolence, headaches, increased
prolactin, and extrapyramidal symptoms, is real." "A mutation
in the TCF4 gene could affect the dopamine system in
children with PTHS, possibly leading to hypersensitivity to
small dose changes of atypical antipsychotics."
Lambrechts S, et al. Low-Dose Aripiprazole and Risperidone for Treating Problem
Behavior in Children with Pitt-Hopkins Syndrome. Journal of Clinical
Psychopharmacology 38: 260-261, No. 3, Jun 2018. Available from: URL: http://
doi.org/10.1097/JCP.0000000000000871 - Belgium
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved