 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2023, vol. 29, issue3
Subject Area: Medicine
-
DOI: 10.5272/jimab.2023293.5112
Published online: 20 September 2023
Case report
J of IMAB. 2023 Jul-Sep;29(3):5112-5115
ISOTRETINOIN INDUCED PSYCHOTIC SYMPTOMS
Tatyana Telbizova1
, Svetlin Varbanov2,
1) Department of psychiatry and medical psychology, Medical University – Varna, MHAT "St. Marina" – Varna, Bulgaria.
2) Department of health care, Sliven Affiliate, Medical University – Varna, MHAT "St. Marina" – Varna, Bulgaria.
ABSTRACT:
Isotretinoin is an effective treatment for severe and resistant forms of acne. It has proven potential for inducing dose-dependent psychiatric side effects, especially in some vulnerable groups of patients.
Objective: The aim of the present article is to report a case of a 22-year-old woman with a family history of schizophrenia who was diagnosed with acne. After unsuccessful antibiotic treatment of acne, a panic disorder accompanied by depressive symptoms manifested. Isotretinoin 20 mg/day was used as а second step of the dermatological treatment for a period of four months, along with psychotropic treatment for panic disorder – sertraline 50 mg/day and flupentixol 1,5 mg/day. When the dose of Isotretinoin was increased to 40 mg/day, paranoid delusions occurred. The manifestation of psychotic symptoms required discontinuation of all medications and initiation of antipsychotic therapy with quetiapine. The psychotic symptoms completely disappeared when the dose of quetiapine was increased to 300 mg/day.
Conclusion: The presented case emphasizes the need for increased vigilance about the manifestation of psychiatric symptoms, especially in patients with a family history, current or past medical history of mental disorder. In such cases, consultation with a psychiatrist before starting treatment with Isotretinoin is recommended in order to better clarify the benefits and the risks of the treatment. The endogenous origin of the psychosis was discussed in the differential diagnostic plan, which requires long-term monitoring of the mental state.
Keywords: Isotretinoin, acne, psychosis, psychiatric side effects,
- Download FULL TEXT /PDF 486 KB/
Please cite this article as: Telbizova T, Varbanov S. Isotretinoin induced psychotic symptoms. J of IMAB. 2023 Jul-Sep;29(3):5112-5115. [Crossref - 10.5272/jimab.2023293.5112]
Correspondence to: Tatyana Telbizova, MD, PhD, Department of psychiatry and medical psychology, Medical University of Varna, UMHAT "St. Marina", Varna; 1, Hristo Smirnenski Blvd., 9000, Varna, Bulgaria; E-mail: telbizova@gmail.com
REFERENCES:
1. Layton A. The use of Isotretinoin in acne. Dermatoendocrinol. 2009 May;1(3):162-9. [PubMed]
2. Melnik BC. Apoptosis May Explain the Pharmacological Mode of Action and Adverse Effects of Isotretinoin, Including Teratogenicity. Acta Derm Venereol. 2017 Feb 8;97(2):173-181. [PubMed]
3. Draghici CC, Miulescu RG, Petca RC, Petca A, Dumitrascu MC, Sandru F. Teratogenic effect of Isotretinoin in both fertile females and males (Review). Exp Ther Med. 2021 May;21(5):534. [PubMed]
4. Ludot M, Mouchabac S, Ferreri F. Inter-relationships between isotretinoin treatment and psychiatric disorders: Depression, bipolar disorder, anxiety, psychosis and suicide risks. World J Psychiatry. 2015 Jun 22;5(2):222-7. [PubMed]
5. Testa A, Giannuzzi R, Sollazzo F, Petrongolo L, Bernardini L, Dain S. Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases. Eur Rev Med Pharmacol Sci. 2013 Feb;17 Suppl 1:65-85. [PubMed]
6. Bremner JD. Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed. J Affect Disord Rep. 2021 Dec;6:100230. [PubMed]
7. Haybaeck J, Postruznik M, Miller CL, Dulay JR, Llenos IC, Weis S. Increased expression of retinoic acid-induced gene 1 in the dorsolateral prefrontal cortex in schizophrenia, bipolar disorder, and major depression. Neuropsychiatr Dis Treat. 2015 Feb 4;11:279-89. [PubMed]
8. Rao PK, Bhat RM, Nandakishore B, Dandakeri S, Martis J, Kamath GH. Safety and efficacy of low-dose Isotretinoin in the treatment of moderate to severe acne vulgaris. Indian J Dermatol. 2014 May;59(3):316. [Crossref]
9. Truitt JM, Reichenberg JS, Sharghi KG, Sampson SM, Roenigk RK, Magid M. Isotretinoin: the ups are just as troubling as the downs. G Ital Dermatol Venereol. 2018 Aug;153(4):535-539. [PubMed]
10. Goodfield MJ, Cox NH, Bowser A, McMillan JC, Millard LG, Simpson NB, et al. Advice on the safe introduction and continued use of Isotretinoin in acne in the U.K. 2010. Br J Dermatol. 2010 Jun;162(6):1172-9. [PubMed]
11. Ghorpade GS, Kadam KS, Amey AY, Unnithan VB. Cross-sectional study of perceived stress, self-esteem, body image disturbance and suicidal ideation in patients of acne vulgaris. Int J Res Dermatol. 2020 Nov-Dec;6(6):769-775. [Crossref]
12. Samuels DV, Rosenthal R, Lin R, Chaudhari S, Natsuaki MN. Acne vulgaris and risk of depression and anxiety: A meta-analytic review. J Am Acad Dermatol. 2020 Aug;83(2):532-541. [PubMed]
13. Ahmed F, Husain A, Begum M, Alam MN, Ibrahim MA. Psychiatric morbidity among the patients with acne Vulgaris in a tertiary care Hospital. Bangladesh J Med Sci. 2019; 18(4):773-778. [Crossref]
14. Arnaudova-Zhekova MD. Pathophysiological, clinical diagnostic and therapeutic aspects of delirium. University Publishing House of Medical University - Varna; 2017. [in Bulgarian].
15. Segmiller FM, Rüther T, Linhardt A, Dehning S, Möller HJ, Zetzsche T. Psychosis during treatment with Isotretinoin. Ther Adv Psychopharmacol. 2013 Aug;3(4):244-5. [PubMed]
16. Elhusein B, Elkhaled W, Khoodoruth MAS, Kumar R, Al Abdulla M. Isotretinoin-induced psychotic episode in a 17-year-old adolescent male. SAGE Open Med Case Rep. 2020 Jun 20;8:2050313X20931342. [PubMed]
17. Jensen KV, Abba-Aji A. Isotretinoin-Induced Delusional Disorder, Somatic Subtype. Case Rep Dermatol Med. 2020 Jul 25;2020:8853167. [PubMed]
18. Kontaxakis VP, Ferentinos PP, Havaki-Kontaxaki BJ. Papadimitriou GN. Genetic vulnerability and isotretinoin-induced psychiatric adverse events. World J Biol Psychiatry. 2010 Mar;11(2):158-9. [PubMed]
19. Goodman AB. Three independent lines of evidence suggest retinoids as causal to schizophrenia. Proc Natl Acad Sci U S A. 1998 Jun 23;95(13):7240-4. [PubMed]
20. Zaimov K. [Psychopathology. Lecture course for psychology students.] [in Bulgarian] Science and art, Sofia. 1971; 103-126.
Received: 07 February 2023
Published online: 20 September 2023