Psychotic Disorder Induced by Appetite Suppressants, Phentermine or Phendimetrazine : A Case Series Study

식욕억제제 Phentermine, Phendimetrazine으로 유발된 정신병적 장애 증례군 연구

  • Kwak, Sookyoung (Department of Psychiatry, Donngguk University Ilsan Hospital) ;
  • Youn, Tak (Department of Psychiatry, Donngguk University Ilsan Hospital) ;
  • Lee, Nam Young (Department of Psychiatry, Donngguk University Ilsan Hospital) ;
  • Chung, In Won (Department of Psychiatry, Donngguk University Ilsan Hospital) ;
  • Kim, Se Hyun (Department of Psychiatry, Donngguk University Ilsan Hospital)
  • 곽숙영 (동국대학교 일산병원 정신건강의학과) ;
  • 윤탁 (동국대학교 일산병원 정신건강의학과) ;
  • 이남영 (동국대학교 일산병원 정신건강의학과) ;
  • 정인원 (동국대학교 일산병원 정신건강의학과) ;
  • 김세현 (동국대학교 일산병원 정신건강의학과)
  • Received : 2017.06.07
  • Accepted : 2017.07.07
  • Published : 2017.08.31

Abstract

Objectives A retrospective case series study was conducted to investigate the clinical characteristics of psychotic disorders induced by appetite suppressants, phentermine and phendimetrazine. Methods A retrospective electronic medical record review identified 5 admitted patients who had psychotic symptoms after taking phentermine or phendimetrazine. Clinical information was reviewed and summarized in each case. Results Hallucinations were reported in all cases, including auditory, visual, olfactory and somatic hallucinations. After discontinuation of phentermine or phendimetrazine, the symptoms rapidly improved with low dose of antipsychotics. Patients tended to have less prominent negative symptoms and higher insight into illness, and often showed depressive mood. These clinical characteristics were similar to psychosis induced by amphetamines. Two patients developed stimulant use disorder while using phentermine. Conclusions These findings call for awareness of the risks associated with use of appetite suppressants. Prescription of phentermine or phendimetrazine should be accompanied by close monitoring of mental status, and suspicion for substance/medication-induced psychotic disorder.

Keywords

References

  1. Bray GA. Drug insight: appetite suppressants. Nat Clin Pract Gastroenterol Hepatol 2005;2:89-95. https://doi.org/10.1038/ncpgasthep0092
  2. Rothman RB, Baumann MH, Dersch CM, Romero DV, Rice KC, Carroll FI, et al. Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin. Synapse 2001;39:32-41. https://doi.org/10.1002/1098-2396(20010101)39:1<32::AID-SYN5>3.0.CO;2-3
  3. Rothman RB, Baumann MH. Therapeutic potential of monoamine transporter substrates. Curr Top Med Chem 2006;6:1845-1859. https://doi.org/10.2174/156802606778249766
  4. Kang JG, Park CY. Anti-obesity drugs: a review about their effects and safety. Diabetes Metab J 2012;36:13-25. https://doi.org/10.4093/dmj.2012.36.1.13
  5. Rueda-Clausen CF, Padwal RS, Sharma AM. New pharmacological approaches for obesity management. Nat Rev Endocrinol 2013;9: 467-478. https://doi.org/10.1038/nrendo.2013.113
  6. Kim MK. Behavioral intervention and anti-obesity drug therapy. Korean J Med 2013;84:624-628. https://doi.org/10.3904/kjm.2013.84.5.624
  7. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult bodymass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016;387:1377-1396. https://doi.org/10.1016/S0140-6736(16)30054-X
  8. INCB.org [homepage on the Internet]. Vienna: International Narcotics Control Board Online Resources, Inc.;c1995-2017[updated 2015 Mar; cited 2017 Mar 8]. Available from: http://www.incb.org/documents/Psychotropics/technical-publications/2015/Technical_PSY_2015_ENG.pdf.
  9. Boileau I, Dagher A, Leyton M, Gunn RN, Baker GB, Diksic M, et al. Modeling sensitization to stimulants in humans: an [11C]raclopride/positron emission tomography study in healthy men. Arch Gen Psychiatry 2006;63:1386-1395.
  10. Bramness JG, Gundersen OH, Guterstam J, Rognli EB, Konstenius M, Loberg EM, et al. Amphetamine-induced psychosis--a separate diagnostic entity or primary psychosis triggered in the vulnerable? BMC Psychiatry 2012;12:221. https://doi.org/10.1186/1471-244X-12-221
  11. McKetin R, Lubman DI, Baker AL, Dawe S, Ali RL. Dose-related psychotic symptoms in chronic methamphetamine users: evidence from a prospective longitudinal study. JAMA Psychiatry 2013;70: 319-324. https://doi.org/10.1001/jamapsychiatry.2013.283
  12. Rubin RT. Acute psychotic reaction following ingestion of phentermine. Am J Psychiatry 1964;120:1124-1125. https://doi.org/10.1176/ajp.120.11.1124
  13. Alexander J, Cheng YH, Choudhary J, Dinesh A. Phentermine (Duromine) precipitated psychosis. Aust N Z J Psychiatry 2011;45:684- 685.
  14. Devan GS. Phentermine and psychosis. Br J Psychiatry 1990;156: 442-443. https://doi.org/10.1192/bjp.156.3.442
  15. Raison CL, Klein HM. Psychotic mania associated with fenfluramine and phentermine use. Am J Psychiatry 1997;154:711.
  16. Glatt MM. Psychosis and addiction to phenmetrazine. The Lancet 1959;274:348-349.
  17. Lee JM, Lee KU, Jhoo JH, Park JI. Two cases of psychotic disorder following phendimetrazine use. Korean J Psychopharmacol 2010; 21:95-98.
  18. Yun JA, Park WR, Yu JC, Choi KS. A case of Phendimetrazine induced-psychotic disorder and dependence.J Korean Neuropsychiatr Assoc 2013;52:402-405. https://doi.org/10.4306/jknpa.2013.52.5.402
  19. Kim KK, Cho HJ, Kang HC, Youn BB, Lee KR. Effects on weight reduction and safety of short-term phentermine administration in Korean obese people. Yonsei Med J 2006;47:614-625. https://doi.org/10.3349/ymj.2006.47.5.614
  20. Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000;356:1255-1259. https://doi.org/10.1016/S0140-6736(00)02799-9
  21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5TM). 5th edition. Arlington, VA: American Psychiatric Association;2013. p.110-111.
  22. Robinson DG, Schooler NR, John M, Correll CU, Marcy P, Addington J, et al. Prescription practices in the treatment of first-episode schizophrenia spectrum disorders: data from the national RAISEETP study. Am J Psychiatry 2015;172:237-248. https://doi.org/10.1176/appi.ajp.2014.13101355
  23. Wang LJ, Lin SK, Chen YC, Huang MC, Chen TT, Ree SC, et al. Differences in clinical features of methamphetamine users with persistent psychosis and patients with schizophrenia. Psychopathology 2016;49:108-115. https://doi.org/10.1159/000445065
  24. Fraser S, Hides L, Philips L, Proctor D, Lubman DI. Differentiating first episode substance induced and primary psychotic disorders with concurrent substance use in young people. Schizophr Res 2012;136: 110-115. https://doi.org/10.1016/j.schres.2012.01.022
  25. Volkow ND, Wang GJ, Fowler JS, Tomasi D, Telang F. Addiction: beyond dopamine reward circuitry. Proc Natl Acad Sci U S A 2011; 108:15037-15042. https://doi.org/10.1073/pnas.1010654108
  26. Wise RA. Roles for nigrostriatal--not just mesocorticolimbic--dopamine in reward and addiction. Trends Neurosci 2009;32:517-524. https://doi.org/10.1016/j.tins.2009.06.004
  27. Rowley HL, Butler SA, Prow MR, Dykes SG, Aspley S, Kilpatrick IC, et al. Comparison of the effects of sibutramine and other weightmodifying drugs on extracellular dopamine in the nucleus accumbens of freely moving rats. Synapse 2000;38:167-176. https://doi.org/10.1002/1098-2396(200011)38:2<167::AID-SYN8>3.0.CO;2-W
  28. Volkow ND, Chang L, Wang GJ, Fowler JS, Ding YS, Sedler M, et al. Low level of brain dopamine D2 receptors in methamphetamine abusers: association with metabolism in the orbitofrontal cortex. Focus 2003;1:150-157. https://doi.org/10.1176/foc.1.2.150
  29. Volkow ND, Fowler JS. Addiction, a disease of compulsion and drive: involvement of the orbitofrontal cortex. Cereb Cortex 2000;10:318-325. https://doi.org/10.1093/cercor/10.3.318
  30. Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction 2009;104:1085-1099. https://doi.org/10.1111/j.1360-0443.2009.02564.x
  31. Barr AM, Panenka WJ, MacEwan GW, Thornton AE, Lang DJ, Honer WG, et al. The need for speed: an update on methamphetamine addiction. J Psychiatry Neurosci 2006;31:301-313.
  32. Hill SK, Reilly JL, Harris MS, Rosen C, Marvin RW, Deleon O, et al. A comparison of neuropsychological dysfunction in first-episode psychosis patients with unipolar depression, bipolar disorder, and schizophrenia. Schizophr Res 2009;113:167-175. https://doi.org/10.1016/j.schres.2009.04.020
  33. Baethge C, Baldessarini RJ, Freudenthal K, Streeruwitz A, Bauer M, Bschor T. Hallucinations in bipolar disorder: characteristics and comparison to unipolar depression and schizophrenia. Bipolar Disord 2005;7:136-145. https://doi.org/10.1111/j.1399-5618.2004.00175.x