Drs. O'Neill and Stephenson are practicing psychiatrists at Leeds and York Partnership NHS Foundation Trust, UK.
Psychopharmacol Bull. 2022 Feb 25;52(1):61-67.
We present the case of a young gentleman with diagnoses of bipolar affective disorder, high body mass index, and obstructive sleep apnoea. He was commenced on zuclopenthixol due to an inadequate response to quetiapine, but this swiftly led to marked physical health deterioration including shortness of breath, back pain, tachycardia, tachypnoea, and hypoxia. He was urgently transferred to hospital where he required intubation and intensive care admission. AFTER excluding other causes, it was felt that commencing zuclopenthixol had induced laryngo-pharyngeal dystonia leading to upper airway compromise and severely impaired respiratory function. He progressively recovered after zuclopenthixol was stopped, and he was transferred back to the psychiatric hospital after eight days. THIS case highlights the potential challenges in diagnosing this rare but potentially fatal reaction to antipsychotics. We review the available literature on other cases including a potential interaction between typical antipsychotics and serotonin-specific reuptake inhibitors. Psychiatrists and emergency physicians should be aware of this condition and be alert in considering the administration of anticholinergics, which could be a simple yet life-saving intervention.
我们报告了一例年轻男性患者，他被诊断患有双相情感障碍、高身体质量指数和阻塞性睡眠呼吸暂停。由于对喹硫平反应不佳，他开始使用氯氮平，但这迅速导致明显的身体健康恶化，包括呼吸急促、背痛、心动过速、呼吸急促和缺氧。他被紧急转院到医院，需要进行插管和重症监护。排除其他原因后，认为开始使用氯氮平引起了咽-喉肌张力障碍，导致上呼吸道狭窄和严重呼吸功能受损。停用氯氮平后，他逐渐恢复，八天后转回精神病院。这个病例强调了诊断这种罕见但可能致命的抗精神病药物反应的潜在挑战。我们回顾了其他病例的可用文献，包括典型抗精神病药物和 5-羟色胺特异性再摄取抑制剂之间的潜在相互作用。精神科医生和急诊医生应该意识到这种情况，并警惕考虑使用抗胆碱能药物，这可能是一种简单但救生的干预措施。
