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Original Research Expression of Depressive Symptoms in a Nonclinical Brazilian Adolescent Sample
Clarice Gorenstein, PhD, Laura Andrade, MD, PhD, Elaine Zanolo, Rinaldo Artes, PhD
(PDF)

Posttraumatic Stress Disorder and General Psychopathology in Children and Adolescents Following a Wildfire Disaster
Brett M McDermott, MBBS, Cert Child Psych, FRANZCP, Erica M Lee, BA, Dip Psych, Marianne Judd, BSc Psych, MEd, Peter Gibbon, PhD
(PDF)

Individual Change in Methylphenidate Use in a National Sample of Children Aged 2 to 11 Years
Elisa Romano, PhD, Raymond H Baillargeon, PhD, Isabel Fortier, PhD, Hong-Xing Wu, MSc4, Philippe Robaey, MD, Mark Zoccolillo, MD, Richard E Tremblay, PhD
(PDF)

An Introduction to Economic Evaluation: What’s in a Name?
Jeffrey S Hoch, MA, PhD, Carolyn S Dewa, MPH, PhD
(PDF)

Recherche Originale *Méthadone et Syndrome d’Apnées du Sommeil
Philippe Durst, MD, Jérôme Palazzolo, MD, PhD, Jean-Pierre Peyrelong, MD, Michel Berger, MD, Michel Chalabreysse, MD, Michel Billiard, PhD, André Vialle, MD
(PDF)

Review Paper
Using Metaanalysis to Evaluate Evidence: Practical Tips and Traps
Raymond W Lam, MD, FRCPC, Sidney H Kennedy, MD, FRCPC
(PDF)

Brief Communication
Experimental Affective Symptoms in Panic Disorder Patients
Thea Overbeek, MD, PhD, Koen Schruers, MD, PhD, Ine Docters van Leeuwen, BSc, Tineke Klaassen, MD, PhD, Eric Griez, MA, MD, PhD
(PDF)

Book Reviews
(PDF)

The Treatment of Drinking
Problems: A Guide for the Helping Professions.
Review by
Nady el-Guebaly, MD, FRCPC

Bipolar Disorder: A Clinician’s Guide to Biological Treatments.
Review by
Review by: Rakesh Jain MD, MPH
Shailesh Jain, MD, MPH


Handbook of Female Psychopharmacology
Review by
Laura Calhoun, FRCPC

Sleep and Dreaming: Scientific Advances and Reconsiderations.
Review by
Alan Douglass, MD

Cognitive-Behavioral Treatment of Obesity. A Clinician’s Guide.
Review by
Hany Bissada, MD, FRCPC

Cognitive Therapy of Personality Disorders. Second Edition.
Review by
W John Livesley

Letters to the Editor
(PDF)

Hemorrhages During Escitalopram–Venlafaxine– Mirtazapine Combination Treatment of Depression

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

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

Lithium-Associated Anencephaly

Aripiprazole-Induced Seizure

Prevalence of Bipolar Disorder and Major Depression Among Patients Seen in Primary and Secondary Care in Finland

The Need for More Community Nursing for Adults With Intellectual Disabilities and Mental Health Problems

Improvement in Tardive Dyskinesia With Aripiprazole Use

Letters to the Editor

Aripiprazole-Induced Seizure

Dear Editor:

Antipsychotics, both typical and atypical, have been known to lower seizure threshold. Aripiprazole is a novel atypical antipsychotic that is a partial agonist at dopamine D₂ and serotonin_1A (5-HT_1A) receptors and has antagonist activity at the 5-HT₂ receptor. The risk of seizures with aripirazole is reported to be 0.1% (1), the lowest among atypical agents. Our literature search revealed no report of seizure induction with aripiprazole.

Case Report

Mr A, aged 31 years, was brought to the emergency department after a motor vehicle accident. He had lost control of his vehicle, which landed in a ditch. He carried a diagnosis of delusional disorder and major depression; aripiprazole 15 mg daily had recently been added to sertraline 150 mg daily that he had been taking for the past 2 years. Both the patient and his family suspected that a seizure had caused the accident, since they were perplexed by the circumstances of the crash. The patient denied that he had attempted suicide. Mr A was restarted on aripiprazole while he was in the intensive care unit. About 3 weeks later, he had a witnessed partial complex seizure on the ward. There was no evidence of any medical cause for the seizure. His laboratory tests were within normal limits, except for a serum magnesium level of 1.7 mg/dL (the lower normal being 1.8 mg/dL). He was started on levetiracetam, and his aripiprazole was later discontinued, because it was considered to be the offending agent. The patient was subsequently transferred to the rehabilitation unit, where he stayed seizure-free. He was discharged home after an adequate recovery.

Discussion

Seizure induction from antipsychotic drugs is not a new phenomenon. Several risk factors are known, including a personal or family history of epilepsy, head trauma, and concomitant use of another drug known to lower seizure threshold (2). Since experience with aripiprazole is limited at this time, the risk of lowering of seizure threshold with this drug may actually be higher than reported in the premarketing studies. Our patient possibly had 2 separate seizures, one of which was the witnessed event that occured when the medication was reinitiated, making the likelihood high that aripiprazole was the offender. Medical causes were ruled out, and there were no other implicated medications.

For optimum outcomes, high vigilence is needed to promptly identify the cause of seizures in patients taking psychotropic medications. The relevence of seizure secondary to aripiprazole needs further elucidation.

References

1. Abilify ® (aripiprazole) tablets [product information]. New York: Bristol-Myers Squibb Company/Otsuka America Pharmaceutical Inc; March 2004.

2. Hedges D, Jeppson K, Whitehead P. Antipsychotic medication and seizures: a review. Drugs Today (Barc) 2003;39:551–7.

Asif R Malik, MD
Saj Ravasia, MD, CCFP, FRCPC, DABPN
Fargo, North Dakota