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Related Experiment Videos

Primidone-induced catatonic schizophrenia.

A Sher, J M Andersen, S C Bhatia

    Drug Intelligence & Clinical Pharmacy
    |July 1, 1983
    PubMed
    Summary

    High primidone levels can cause severe psychiatric symptoms, including hallucinations and catatonic schizophrenia, in patients with intellectual disabilities. Reducing the dosage led to symptom resolution and normalization of serum levels.

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    Area of Science:

    • Neuroscience
    • Psychiatry
    • Clinical Pharmacology

    Background:

    • Primidone is an anticonvulsant medication used to treat epilepsy and essential tremor.
    • Long-term use of primidone can lead to accumulation and toxicity, particularly in patients with impaired drug metabolism.
    • Intellectual disability may affect drug pharmacokinetics and increase the risk of adverse events.

    Observation:

    • A 19-year-old female with severe intellectual disability, treated with primidone for 7 years, presented with visual and auditory hallucinations.
    • The patient subsequently developed symptoms consistent with catatonic schizophrenia.
    • Primidone serum levels were significantly elevated, exceeding the normal therapeutic range.

    Findings:

    • Elevated primidone serum levels were identified as the likely cause of the patient's psychiatric symptoms.
    • A reduction in primidone dosage resulted in the subsidence of hallucinations and catatonic features.
    • Normalization of primidone serum levels correlated with clinical improvement.

    Implications:

    • This case highlights the importance of therapeutic drug monitoring for primidone, especially in vulnerable populations.
    • Clinicians should consider drug toxicity in patients with intellectual disabilities presenting with new-onset psychiatric symptoms.
    • Careful dose titration and regular monitoring are crucial to prevent adverse effects of primidone.

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