Benefical Effects of Sigma-1 Agonist Fluvoxamine for Tardive Dyskinesia and Tardive Akathisia in Patients with Schizophrenia: Report of Three Cases
Ms B, a 43-year-old woman, had been diagnosed with schizophrenia for 22 years. She had been treated with conventional antipsychotics as haloperidol, zuclopenthixol, chlorpromazine for almost 12 years. For the last 10 years, she had been treated with various atypical antipsychotics such as olanzapine, aripiprazole, ziprasidone. She has be given quetiapine 800 mg/day and biperiden 4 mg/day for last two years. She had been also diagnosed as tardive dyskinesia for almost 10 years and her treatment was switched to atypical antipsychotics from typical antipsychotics for last 10 years. The results of brain magnetic resonance imaging (MRI), encephalography (EEG), blood chemistry, a complete blood count, and thyroid function tests were all normal. On psychiatric and physical examination, fatigue, difficulty concentrating and choreic movements on fingers of bilateral upper limbs were noted. Ms A was diagnosed with schizophrenia, residual type and medication induced movement disorder (tardive dyskinesia) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Ms A scored 6 on the Abnormal Involuntary Movement Scale (AIMS). Fluvoxamine 100 mg/day was added to her treatment. At the fourth week, the dyskinesia had improved gradually based on scores of 2 on the AIMS.