SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Poster Presentations
relief by being informed of the absence of a disease (2).
Case Presentation: A 26- year old, female patient was admitted to an outpatient psychiatric clinic with complaints of having a possible ocular
disease, which may cause blindness. Her symptoms included her irises deviating involuntarily, her eyes moving incoherently, and having a
feeling in her eyes as if they are being drawn away. A previous psychiatric admission of the patient was reported to be 3 years ago with the
complaints of dysmorphism and tremor in her hands and having a serious disorder relevant to her hands for which she was seen by several
specialists although she wasn’t convinced by their answers. Although, thereafter she was hospitalized and was treated with several mood
stabilizers and antipsychotic medications for the following three years in outpatient clinics, a full remission could not be achieved.
She was hospitalized again. Her physical and neurological examination didn’t reveal any biological anomalies. It was noticed that she was
touching her eyes constantly and her speech was focused on her bodily sensations so that she couldn’t maintain her attention on any
other topic. In the contents of her thoughts, she had somatic delusions as defined above. She was treated with pimozide, started with 2mg
and increased up to a dose of 6 mg/day gradually. Her condition was observed to improve with a decrease in intensity of her symptoms,
increased interest, improved self-care, decrease in the amount of her speech and becoming more functional.
Discussion: Because there was no increase in psychomotor activity and the content of speech was solely about the sensations in her eyes,
we did not diagnose her with an affective disorder. We arrived at the diagnosis of monosymptomatic hypochondriacal psychosis after
evaluating the cues such as the worry about having an eye disease, not being persuaded with the medical examinations and diagnosis,
lack of any other psychotic symptoms, delusions being only about bodily sensations, several admissions to non-psychiatric physicians,
and her resistance to treatment with multiple drugs. In the literature there are cases reporting surgery, which was not required, such as an
operation to treat a patient stating that he had a lumbar nerve root compression (3). In the present case the patient presented to internal
medicine and ophthalmology clinics at the beginning insisting that she needed an eye operation. In a study on 23 patients it has been
reported that these cases have responded well to pimozide (4).
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S198-9
[PP-125] Ref. No: 288
Amisulpride in the treatment of treatment resistant tic disorder: A case report
Onat Yılmaz, Mehmet Alpay Ateş, Gülşah Meral, Cengiz Başoğlu, Ayhan Algül, Servet Ebrinç, Mesut Çetin
GATA Haydarpasa Training Hospital, Department of Psychiatry, Uskudar, Istanbul, Turkey
E-mail: onatyilmaz@yahoo.com
Introduction: Tics are sudden, recurrent, involuntary motor movements or vocalizations caused by involuntary contractions of motor
or vocal muscles. Typically these disorders are characterized by early childhood onset and are more common in the male population.
Genetic, neurobiological, neurochemical and environmental factors play a role in the pathogenesis, and malfunctioning of the basal
ganglia is thought to be responsible for the disease. The presence of abnormalities in the EEG of some patients, worsening of the tics with
administration of dopamine agonists, and improvement of tics with antidopaminergic agents are some of the known biological evidence.
Amisulpride, with a pure antidopaminergic activity, and thus being used effectively in the treatment of Tourette’s syndrome, makes it a
candidate to treat other tic disorders, as well. In this report, an adult patient diagnosed with “Tic Disorder Not Otherwise Specified,” who
was previously treated with several antidepressant and antipsychotic drugs, is cured with amisulpride.
Case presentation: A 21-year-old single male patient was admitted to the hospital complaining of impairment in interpersonal relations,
difficulties in social adaptation due to the involuntary repetition of certain movements. His complaints had started at the age of nine after
his uncles were killed. Though the patient was tried on different treatment regimens, but he had no benefits. Because of his tics, he hardly
finished his primary school education and was not able to work for a long time.
In history there were no perinatal or neonatal complications and he was born by spontaneous vaginal birth. As the sixth of eleven children,
his developmental history was normal. There was no family history of any mental illness, epilepsy, alcoholism, or movement disorder.
On his admission to the unit, he was given amisulpride 200mg/day and the dosage was increased to 400mg/day in three days. He had a
score of 15 in motor tics on admission and he had a score of 3 for motor score (80% decrease) at the third week of the treatment. No side
effects were observed and he was discharged at the end of the third week. All of the signs were in remission on the follow up after two
months.
Discussion: Contrary to the antipsychotics effecting both D1 and D2 receptors in the nigrostriatal pathway, antipsychotics of the
benzamide group, which work as selective D2 receptor antagonists, are effective in the treatment of tic disorders. As the most preferred
drug in this group, amisulpride causes less extrapyramidal side effects by selectively acting on the limbic regions rather than striatal
regions. In the literature, there are case reports of amisulpride’s effective use in tic disorders.
Clinicians should keep in mind that, with less side effect risk compared to conventional antipsychotics and the benefits of its mechanism
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