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Differential sensitivities to risperidone and olanzapine in a human immunodeficiency virus patient
J M Meyer1, J Marsh, G Simpson
1USC Department of Psychiatry, Los Angeles County-USC Medical Center 90033, USA.
Background:
Neuroleptic sensitivity presents a considerable problem for the treatment of psychosis in the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV)-positive patient population. As yet, there are few data on the response of these patients to newer atypical antipsychotic medications.
Methods:
We present the detailed medication history of a 33-year-old man with AIDS, who had a prior history of extrapyramidal symptoms (EPS) with both typical antipsychotics and risperidone, and was treated with olanzapine for major depression with psychotic features.
Results:
The patient developed akathisia in a dose-dependent manner at dosages between 10 and 15 mg daily of olanzapine, but no EPS. Akathisia responded to dose reduction and use of beta-adrenergic blockade.
Conclusions:
The AIDS patient may exhibit sensitivity even to newer atypical antipsychotics. The lack of EPS and response to a beta-blocker underscore the different mechanisms causing akathisia and EPS.