A 19-year-old Taiwanese man had a 1-year history of
schizophrenia, paranoid type, and
cerebral palsy. His only medication was a 12-week course of
risperidone 6 mg orally daily. His positive symptoms of
auditory hallucinations and paranoid delusions improved markedly, but negative symptoms of inattention, avolition, and
anhedonia continued. His motor disability and
athetosis of the hand related to
cerebral palsy also worsened during
risperidone therapy. After a discussion with the patient's guardian, conversion of
antipsychotic therapy from
risperidone to
amisulpride was commenced. On days 1-8 of the conversion,
amisulpride 400 mg was given orally daily. The daily
risperidone dose on days 1, 2, and 3 was 6, 4, and 2 mg, respectively;
risperidone was discontinued after day 3. On day 4, the patient exhibited a euphoric mood, with persistent laughing, expansive self-esteem, extreme talkativeness, flight of ideas, distractibility, and
psychomotor agitation. On day 8, the
amisulpride dosage was increased to 800 mg orally daily and his manic symptoms worsened. On day 17,
amisulpride was withheld and
risperidone 4 mg daily was resumed. The manic symptoms subsided within three days after the cessation of
amisulpride. The patient was maintained on
risperidone 4 mg daily for six months without any further hypomanic or manic symptoms.
CONCLUSION: