Metoclopramide-induced rapid-onset psychosis in a child with methylphenidate use: a case report

Metoclopramide, a dopamine antagonist employed for its antiemetic effects, can precipitate neuropsychiatric adverse effects, including extrapyramidal symptoms and, in a few instances, acute psychosis. Although there have been reports of metoclopramide-induced psychosis in elderly individuals, there is no documentation of such incidents in children as far as we are aware.

This case report describes an 11-year-old girl with a history of mild intellectual disability and attention deficit hyperactivity disorder, managed with 10 mg of methylphenidate daily. She presented to the emergency department with acute gastrointestinal symptoms and was administered two tablets of metoclopramide alongside her regular dose of methylphenidate. Subsequently, she developed psychotic symptoms, disorganized behavior, and agitation. An extensive medical evaluation ruled out other organic pathologies, leading to a diagnosis of rapid-onset psychosis induced by metoclopramide. The psychotic episode, which lasted approximately two weeks, resolved with low-dose antipsychotic treatment.

Children, especially those with neurodevelopmental disorders, are more susceptible to a wide range of side effects. Therefore, this report highlights the necessity for careful pharmacological management. Additionally, this case represents a significant contribution to the scientific literature by being the first to document metoclopramide-induced acute psychosis in children to the best of our knowledge.