Manic Episode Associated with an Abrupt Shift from Sulpiride to Quetiapine in a Young Man with Schizophrenia

Abstract

Introduction: We report a case of manic episode associated with an abrupt shift from sulpiride to quetiapine in a young man with schizophrenia. Case report: This 20-year-old schizophrenic male had persistent psychotic despite sulpiride 2000 mg/d treatment. Extrapyramidal symptoms were noted after sulpiride was administrated for one week. Sulpiride was abruptly discontinued and replaced by quetiapine, which was titrated to 600 mg/d on the 6th day after starting quetiapine. On the 7th day after starting quetiapine, manic symptoms were noted with a Young Mania Rating Scale score of 25 and a Positive and Negative Syndrome Scale score on the positive scales of 19. Quetiapine was discontinued and replaced by haloperidol 10 mg/d two weeks after the onset of manic symptoms. Two weeks after switching to haloperidol, the manic symptoms remitted completely. There was no recurrence of manic symptoms during 21 months follow up. Discussion: Quetiapine has relatively lower potency on D2 receptors blockade compared to other atypical antipsychotics. The anti-serotoninergic effect of atypical anti- psychotics might induce dopamine secretion. Inadequate suppression D2 receptors might increase the likelihood of manic symptoms. The abrupt switch from sulpiride to quetiapine in this patient may also have resulted in a rebounding of dopaminergic activity, which might have contributed to the development of manic symptoms.