Abstract
[Author Affiliation]Ezgi Ince. 1 Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.Pinar Algedik. 2 Department of Child and Adolescent Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.Ezgi Sen Demirdogen. 2 Department of Child and Adolescent Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.Murat Emul. 1 Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.Turkay Demir. 2 Department of Child and Adolescent Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.Address correspondence to: Ezgi Ince, MD, Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey, E-mail: drezgiince@gmail.comTo The Editor:Risperidone is widely accepted as being beneficial in childhood psychiatric disorders with disruptive behavioral symptoms, even with comorbid attention-deficit/hyperactivity disorder (Sabuncuoglu 2007). In addition, risperidone in combination with a psychostimulant is reported to be effective and safe without any increment in unwanted effects in children with a subaverage intelligence quotient (IQ) who have disruptive behavioral and/or attention problems (Aman et al. 2004).Two types of dyskinesia are described, according to the duration of onset after the first introduction of methylphenidate (MPH) treatment in children. Dyskinesic symptoms that occur after several weeks (Lipkin et al. 1994) or acute symptoms that occur within hours (Senecky et al. 2002) after MPH administration may subside completely in the same day after cessation of MPH (Balazs et al. 2007). Waugh (2013) proposed that dyskinesia is related with MPH add-on treatment in children with behavioral problems who were under chronic antipsychotic or valproate treatment (Waugh 2013). In addition, switching from an antipsychotic drug to MPH is also attributed as a cause of dyskinesia in several case reports (Hollis and Thompson 2007; Sabuncuoglu 2007).Here, we report an acute development of dyskinesia after the first introduction of MPH in a boy with risperidone withdrawal who was under valproate treatment.Case ReportA 6-year-old boy who was born at the 38th week of gestation by normal spontaneous vaginal delivery, showed delayed development in expressive language, whereas development of motors skills was in the normal range. He was living with his parents and a younger brother. None of whom had delayed speech or movement disorders.When he was 5 years old, he was referred by his pediatrician to a child and adolescent psychiatry outpatient clinic because of speech delay. His parents stated that he displayed difficulty in attention, and exhibited behavioral problems such as hitting his parents, and kicking and punching the walls. During examination, he was able to use ∼25 words and to respond to simple commands, but had limited eye contact and motor tics in his hands. He was sent to a pediatric neurology department because of his blank stare, brief upward rotation of the eyes, and unresponsiveness for a few seconds. His awakening electroencephalogram (EEG) was normal and his sleeping EEG revealed widespread irregular slow wave paroxysms with short intervals in both hemispheres. He was diagnosed with epilepsy, and treatment with valproate 100 mg twice a day was initiated.Only language skills and social understanding were below average on psychological testing by the Brunet-Lezine R Scale. His Autism Diagnostic Interview-Revised scores were not high, and a hearing test was rated as normal. Diagnosis of expressive language disorder was offered according to Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (American Psychiatric Association 2013). After 6 months of speech therapy and frequent interviews with parents and child, the boy's speech-related symptoms were improved, he could make eye contact, and he had better social skills; however, his behavioral problems remained. …
Published Version
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