Reactions 1444 - 23 Mar 2013 S Aripiprazole/olanzapine Activation of mania: case report A woman in her 30s experienced activation of mania while receiving olanzapine, and later aripiprazole for schizophrenia. The woman was diagnosed with schizophrenia in her teens, and received various conventional antipsychotics, including chlorpromazine, haloperidol and thioridazine. At age 29 years she was started on fluoxetine and loxapine, which was later stopped due to sedation. Five years after that, she was initiated on olanzapine 5mg at bedtime for 4 days and 10mg thereafter [route not stated]. Two months later, she began to feel she had special God-given powers to read minds and heal the sick. She was hospitalised due to flight of ideas, pressure of activity and pressure of speech. Olanzapine was increased to 30mg, with no improvement in the mania. It was suspected that olanzapine was responsible for the mania, and the drug was withdrawn. She was restarted on loxapine and fluoxetine, and the mania abated. Three years later, she was commenced on aripiprazole 2mg daily, gradually increased to 20mg over 3 weeks [route not stated]. Within 2 weeks of attaining this dosage, she experienced increased libido, and elevated mood and the emergence of delusions of grandiosity and reference. Pressured speech and flight of ideas was evident. She was hospitalised and aripiprazole was stopped. She has since remained stable on fluoxetine, loxapine and pipotiazine with no further episodes of mania. Author comment: "It is important to recognise that in a patient with previous activation of mania by one atypical antipsychotic, there is a possibility that this can recur with a different atypical antipsychotic too". Raghunath A. Repeated activation of mania by atypical antipsychotics in a patient. BMJ Case Reports : 2012. Available from: URL: http://dx.doi.org/10.1136/ bcr-2012-007388 - Canada 803084660 1 Reactions 23 Mar 2013 No. 1444 0114-9954/10/1444-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Aripiprazole/olanzapine

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Reactions 1444 - 23 Mar 2013

SAripiprazole/olanzapine

Activation of mania: case reportA woman in her 30s experienced activation of mania while

receiving olanzapine, and later aripiprazole for schizophrenia.The woman was diagnosed with schizophrenia in her teens,

and received various conventional antipsychotics, includingchlorpromazine, haloperidol and thioridazine. At age 29 yearsshe was started on fluoxetine and loxapine, which was laterstopped due to sedation. Five years after that, she was initiatedon olanzapine 5mg at bedtime for 4 days and 10mg thereafter[route not stated]. Two months later, she began to feel she hadspecial God-given powers to read minds and heal the sick. Shewas hospitalised due to flight of ideas, pressure of activity andpressure of speech. Olanzapine was increased to 30mg, withno improvement in the mania. It was suspected thatolanzapine was responsible for the mania, and the drug waswithdrawn. She was restarted on loxapine and fluoxetine, andthe mania abated.

Three years later, she was commenced on aripiprazole 2mgdaily, gradually increased to 20mg over 3 weeks [route notstated]. Within 2 weeks of attaining this dosage, sheexperienced increased libido, and elevated mood and theemergence of delusions of grandiosity and reference.Pressured speech and flight of ideas was evident. She washospitalised and aripiprazole was stopped. She has sinceremained stable on fluoxetine, loxapine and pipotiazine withno further episodes of mania.

Author comment: "It is important to recognise that in apatient with previous activation of mania by one atypicalantipsychotic, there is a possibility that this can recur with adifferent atypical antipsychotic too".Raghunath A. Repeated activation of mania by atypical antipsychotics in a patient.BMJ Case Reports : 2012. Available from: URL: http://dx.doi.org/10.1136/bcr-2012-007388 - Canada 803084660