Blonanserin-induced Mood Alteration in Schizophrenia and Schizoaffective Disorder: Two Cases
A 38-year-old male developed a manic episode after the initiation of blonanserin treatment. He first visited our outpatient department in May 2012 with complaints of persecutory and referential delusions that had developed 2 weeks earlier. He claimed that his colleagues at work bullied him and had hatched a plot to get him fired. His family reported that he accused his brother of being a spy from the company and called his father a North Korean spy. Furthermore, he showed bizarre behaviors such as wandering and picking up garbage. Schizophreniform disorder was suspected, and he was initially administered blonanserin 6 mg, alprazolam 0.375 mg, and benztropine 2 mg/day. Shortly after receiving the medication, he displayed a slightly argumentative attitude and increased activity, but his behavior was considered to be within the normal range. Two weeks later, at a dose of 8-mg blonanserin, the patient reported that his persecutory and referential delusions were no longer valid, and he displayed a slight euphoria and increased psychomotor activity that met the criteria for a hypomanic episode.\nTwo weeks later, at 16 mg/day blonanserin, the patient showed full-blown manic symptoms including talkativeness, hyperactivity, irritable and expansive mood, and flight of idea. He was considered for hospitalization but refused. He scored 27 on the YMRS. Valproate 500 mg/day was added to his regimen, and the dose of blonanserin was reduced to 12 mg/day. His manic episode continued for 2 additional weeks; however, when blonanserin was discontinued his manic symptoms disappeared within 2 weeks (YMRS score: 2).