Two cases of mild serotonin toxicity via 5-hydroxytryptamine 1A receptor stimulation
An 81-year-old woman who experienced persecutory delusions with mild dementia, was treated with neuroleptics (). She was admitted to a psychiatric unit, owing to increased hostility and aggression related to her delusions. The results of brain imaging tests revealed mild brain atrophy in the frontotemporal and hippocampal regions with no cerebrovascular lesions. After successful treatment of her paranoid state, the patient developed depressive symptoms, which were treated with 10 mg/day of paroxetine. The final neuroleptic dose was 8 mg/day of perospirone that had been administered for 3 weeks. Fourteen hours after the addition of paroxetine to the patient’s ongoing perospirone treatment, she exhibited tachycardia, finger tremors, prominent anxiety and agitation, and hyperactive knee jerks. The symptoms continued for days (ie, for as long as perospirone and paroxetine were coadministered), and they disappeared 3 days after the discontinuation of both drugs.