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To the editor: In his case report, Chen [1] described a rare condition where a 37-year-old schizophrenic patient developed hypomania after ziprasidone treatment. We present another case of ziprasidone-associated hypomania in a schizophrenic patient. This additional information may enlighten us further with respect to the pattern of possible side effects associated with ziprasidone treatment in patients with schizophrenia and affective disorder. Our 17-year-old female patient had a threemonth history of restricted affect, psychomotor retardation, delusions of persecution and reference, commentary auditory hallucinations, and negative symptoms leading to social withdrawal. Her prominent psychotic symptoms and also retrospectively considering the whole course post treatment confirm the diagnosis of schizophrenia. She had been treated with sulpiride and ziprasidone, each for about one week, however, drug compliance is doubtful. Olanzapine and risperidone were subsequently used successively under our supervision during her hospitalization. Her psychotic symptoms remained unresponsive to these two second-generation antipsychotics. Ziprasidone 40 mg/d was then added to the treatment regimen while the risperidone was tapered. The initial ziprasidone dosage was then increased to 80 mg/d. Her auditory hallucinations and persecutory delusions were resolved within approximately two weeks. However, hypomanic symptoms-like elated mood, pressured speech and sexual disinhibition, appeared within one week. These mood symptoms were resolved on cessation of the ziprasidone and commencement of zotepine and valproate (Figure 1). [2] After more than two years of follow up, no more mood disturbances had been diagnosed and the patient was more active, although occupational capacity remained poor. Based on the above evidence, it appears reasonable to suggest that the presented case is another example of ziprasidone-associated hypomania in a Taiwanese schizophrenic patient. In comparison with the two other reports of ziprasidone- associated mania/hypomania in schizophrenia [3,4], our case involved the lowest dose of ziprasidone before the occurrence of mania/hypomania (80 mg/d vs. 160 mg/d in the other three cases). In bipolar disorder, however, mania/hypomania may be triggered at dosages as low as 40 mg/d [5]. With reference to these four cases, we make the following observations: 1. There is a risk of mania/hypomania in both schizophrenia and bipolar disorder patients treated with ziprasidone. This exaggerated mood may occur in both sexes and from adolescence to middle age. 2. Ziprasidone associated mania/hypomania generally occurs within days of drug commencement, and resolves soon after discontinuation. 3. Apart from warning us of the potential for this side effect, this phenomenon may also shed new light on treating depression and negative symptoms in schizophrenia through further elaboration of the mechanism of action of ziprasidone and related safety considerations.