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Guest Editorial
Palliative Care: An Opportunity for Mental Health Professionals
Harvey Max Chochinov
(PDF)

In Review
Structured Interview Assessment of Symptoms and Concerns in Palliative Care
Keith G Wilson, Ian D Graham, Raymond A Viola, Susan Chater, Barbara J de Faye, Lynda A Weaver, Julie A Lachance
(PDF)

Palliative Care for Families: Remembering the Hidden Patients
Linda J Kristjanson, Samar Aoun
(PDF)

Psychotherapeutic Interventions at the End of Life: A Focus on Meaning and Spirituality
William Breitbart, Christopher Gibson, Shannon R Poppito, Amy Berg
(PDF)

Review Paper
Prevalence Studies of Substance-Related Disorders: A Systematic Review of the Literature
Julian M Somers, Elliot M Goldner, Paul Waraich, Lorena Hsu
(PDF)

Original Research
Stress and Psychological Impact on SARS Patients During the Outbreak
Siew E Chua, Vinci Cheung, Grainne M McAlonan, Charlton Cheung, Josephine WS Wong, Erik PT Cheung, Marco TY Chan, Teresa KW Wong, Khai M Choy, Chung M Chu, Peter WH Lee, Kenneth WT Tsang
(PDF)

Brief Communication
Psychological Effects of the SARS Outbreak in Hong Kong on High-Risk Health Care Workers
Siew E Chua, Vinci Cheung, Charlton Cheung, Grainne M McAlonan, Josephine WS Wong, Erik PT Cheung, Marco TY Chan, Michael MC Wong, Siu W Tang, Khai M Choy, Meng K Wong, Chung M Chu, Kenneth WT Tsang
(PDF)

Schizophrenia: The Quest for a Minimum Sense of Identity to Ward Off Delusional Disorder
Marie-Christine Noël-Jorand, Max Reinert, Sébastien Giudicelli, Daniel Dassa
(PDF)

Diabetes, Tardive Dyskinesia, Parkinsonism, and Akathisia in Schizophrenia: A Retrospective Study Applying 1998 Diabetes Health Care Guidelines to Antipsychotic Use
Emmanuelle Lévy, Howard C Margolese, Lawrence Annable, Guy Chouinard
(PDF)

The Psychosocial Effects of Being Quarantined Following Exposure to SARS: A Qualitative Study of Toronto Health Care Workers
Emma Robertson, Karen Hershenfield, Sherry Lynn Grace, Donna Eileen Stewart
(PDF)

Hard Times and Good Friends: Negative Life Events and Social Support in Patients With Seasonal and Nonseasonal Depression
Erin E Michalak, Edwin M Tam, Chinnapalli V Manjunath, Lakshmi N Yatham, Anthony J Levitt, Robert D Levitan, Raymond W Lam
(PDF)

Letters to the Editor
(PDF)

Combined Transcranial Magnetic Stimulation and Right Unilateral Electroconvulsive Therapy in Patients With Treatment-Refractory Depression

Re: Treatment Noncompliance With Orally Disintegrating Olanzapine Tablets

Reply: Treatment Noncompliance With Orally Disintegrating Olanzapine Tablets

Quetiapine in the Management of Psychosis Secondary to Huntington's Disease: A Case Report

Ziprasidone-Induced Lupus Erythematosus

Lorazepam-Induced Prolongation of the QT Interval in a Patient With Schizoaffective Disorder and Complete AV Block

Letters to the Editor

Ziprasidone-Induced Lupus Erythematosus

Dear Editor:

Ziprasidone is a novel atypical antipsychotic medication that presumably exerts its antipsychotic effects through antagonism of 5-HT_2A and D₂ receptors (1). Drug-induced lupus erythematosus (DILE) has been documented to occur with the administration of several medications (2). To our knowledge, there have been no reported cases of DILE associated with ziprasidone. Here, we report a case of DILE in an individual receiving ziprasidone.

Mrs K, aged 64 years, was admitted to the hospital for markedly elevated blood pressure with subsequent development of nonoliguric renal insufficiency. Upon admission, it was noted that a rash had been present for 2 to 3 weeks. The rash, described as erythematous plaques not involving the nose, was found bilaterally over the cheeks, forearms, scalp, chest, and back. The patient denied other symptoms associated with lupus erythematosus, including polyarthralgia, pleurisy, sun sensitivity, Raynaud’s phenomenon, and extremity paresthesias. There was no evidence of connective tissue disease in her past medical history. Her psychiatric history was remarkable for depression with psychosis, for which she received ziprasidone 20 mg daily for approximately 5.5 months.

Rheumatology and dermatology consults were obtained. Both consultants felt that she was likely suffering a reaction to the ziprasidone, rather than a connective tissue disease. Serum autoantibodies, rheumatoid factor, erythrocyte sedimentation rate (sed rate), and punch biopsy were obtained to evaluate the rash. Results of serum tests showed a slightly elevated sed rate at 45 mm/Hr and a positive result for SS-A/Ro autoantibodies at 162.7. Other serum autoantibodies used as markers for drug- induced lupus were negative. Results of the punch biopsy were consistent with a drug-induced rash caused by type 3 or 4 hypersensitivity reaction. A literature search on the other medications currently taken by the patient did not reveal an association with drug-induced lupus. Administration of ziprasidone was discontinued, and Mrs K was switched to risperidone at 1 mg daily. She was seen by the consulting dermatologist 4 days after the initial consultation. The dermatologist noted that her rash had improved over the intervening 4 days. Discontinuation of the ziprasidone in conjunction with rapid improvement of signs and symptoms is consistent with the diagnosis of DILE. To our knowledge, this is the first reported case of DILE owing to ziprasidone; thus, it is likely an uncommon phenomenon. Perhaps as our experience with ziprasidone expands, the relevance of DILE as a side effect will be further elucidated.

References

1. Ziprasidone hydrochloride. Am J Health Syst Pharm. 2002;59(1);28–9.

2. Wickers WA, Campbell NR, Martin L. Acute severe adverse clozapine reaction resembling systemic lupus erythematosus. Postgrad Med J 1994;70:940–1.

Eric Swensen, MD
Sajid Ravasia, MD, CCFP, FRCPC, DABPN
Fargo, North Dakota