Blonanserin-induced Mood Alteration in Schizophrenia and Schizoaffective Disorder: Two Cases
A 25-year-old male with schizophrenia developed a hypomanic episode 1 week after the initiation of blonanserin at 8 mg/day. He was first diagnosed with schizophrenia in 2003 at the age of 16 years with symptoms of auditory hallucination and delusions of reference and persecution and has been on various antipsychotic medications for 9 years. The patient did not achieve symptomatic remission, and his course was characterized by intermittent worsening and softening of the referential delusion that others were talking behind his back. He has been on a stable regimen of olanzapine 5-20 mg (final dose 10 mg), aripiprazole 15 mg, clonazepam 0.5 mg, and benztropine 1 mg since 2010. In February 2011, he experienced increased appetite and weight gain; thus, fluoxetine (20 mg) was added to his regimen for 7 months until September 2011 with no mood change.\nIn March 2012, the patient's ideas of reference began to increase and in May, he complained that his neighbors said bad things about him and that the rumors had spread throughout the community. Following this exacerbation, blonanserin 8 mg/day was added to his regimen. Ten days later, the intensity of his delusions decreased, but he developed new symptoms indicative of a hypomanic episode, such as euphoria, elated mood, grandiosity, and hyperactivity. The patient expressed his plan to become a psychiatrist and he wrote poems for several hours per day with the intention of becoming a professional poet. He had a score of 19 on the Young Mania Rating Scale (YMRS). One week later blonanserin was withdrawn and the episode ended 4 weeks after discontinuation (YMRS score: 4).