Serotonin Syndrome in a Schizophrenia Patient Post-hemi Colectomy

Tan TY, AB Abdul Kadir


This article describes a case of Serotonin syndrome (SS), which developed in a patient with treatment resistant schizophrenia post-hemi colectomy. Patient was a 38-year-old, male with treatment resistant schizophrenia who developed septic shock secondary to ischemic sigmoid volvulus, complicated with nosocomial pneumonia and surgical site infection post-operation. Antipsychotics (haloperidol and amisulpiride) was reinitiated a week postoperation when his medical condition was stabilized as patient began to show symptoms of psychosis. Haloperidol was later switched to olanzapine as he was still agitated and disturbed. Fluvoxamine 50mg was added as he displayed hair-pulling behavior. Clopixol accuphase and parental sedation with midazolam and phenergen was given as adjunctive management for agitation. Several days after, he became more restless. Central nervous system examination revealed rigidity, tremors, hyperreflexia and clonus. Discontinuation of fluvoxamine and amisulpiride with reduction of olanzapine to 20mg ON resulted in full neurologic recovery within the first 24 hours. It was not well understood how this patient developed serotonin syndrome despite him on low dose of fluvoxamine. Clinicians should be aware of risk of serotonin syndrome when adding serotonergic agents to antipsychotics especially in patients’ post-hemi colectomy.

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Fluvoxamine; Atypical antipsychotics; Schizophrenia; Serotonin Syndrome; Post-hemi Colectomy

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