Bhardwaj Akansha, Bhardwaj Adarsh, Sirowa Ashu
Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Ophthalmology, AIMST University, Kedah, Malaysia.
Ind Psychiatry J. 2024 Jul-Dec;33(2):409-413. doi: 10.4103/ipj.ipj_134_24. Epub 2024 Dec 17.
Psychotropic medications, particularly antipsychotics, are known to elicit various adverse effects, with ocular complications being underreported yet significant. This case series presents three instances where atypical antipsychotics, namely Risperidone, Cariprazine, and Olanzapine, led to ocular dystonias and nystagmus. These adverse effects occurred at relatively low doses, highlighting the need for vigilant monitoring even with second-generation antipsychotics. Case descriptions delineate patients experiencing acute dystonic reactions and nystagmus following initiation or dose adjustment of atypical antipsychotics, leading to upward deviation of the eyes, involuntary movements, and nystagmus. Prompt recognition and management were crucial, with cessation of the offending medication resulting in symptom remission and subsequent stabilization with alternative treatments. Factors contributing to these adverse effects, such as dopamine receptor blockade and individual susceptibility, are explored, emphasizing the importance of comprehensive evaluation and open patient-physician communication. The present case series underscores the necessity of vigilant monitoring for ocular adverse effects, even with atypical antipsychotics, given their potential to induce acute dystonias and nystagmus. The presented cases advocate for heightened awareness among clinicians to promptly recognize and manage such rare complications, ensuring optimal patient care and treatment outcomes.
精神药物,尤其是抗精神病药物,已知会引发各种不良反应,其中眼部并发症虽报告不足但却很严重。本病例系列介绍了三例非典型抗精神病药物,即利培酮、卡立哌嗪和奥氮平,导致眼部肌张力障碍和眼球震颤的情况。这些不良反应在相对较低剂量时就出现了,这凸显了即使使用第二代抗精神病药物也需要进行密切监测的必要性。病例描述详细说明了患者在开始使用或调整非典型抗精神病药物剂量后出现急性肌张力障碍反应和眼球震颤,导致眼睛向上偏斜、不自主运动和眼球震颤。及时识别和处理至关重要,停用引起问题的药物可导致症状缓解,随后通过替代治疗实现病情稳定。探讨了导致这些不良反应的因素,如多巴胺受体阻断和个体易感性,强调了全面评估和医患之间开放沟通的重要性。本病例系列强调,即使使用非典型抗精神病药物,也有必要密切监测眼部不良反应,因为它们有可能诱发急性肌张力障碍和眼球震颤。所呈现的病例倡导临床医生提高认识,以便及时识别和处理此类罕见并发症,确保为患者提供最佳护理和治疗效果。