Abstract Background Dengue is a common mosquito-borne viral infection worldwide. Manic episode due to dengue encephalopathy is a rare complication of this infection. Patients with brain lesion may be more susceptible to developing extrapyramidal symptoms (EPS) from antipsychotics. Here, we present the first reported case of the use of alpha-2 adrenergic receptor (α2AR) agonists, clonidine and tizanidine, in bipolar disorder due to encephalopathy. Case summary A 23-year-old Thai man diagnosed with bipolar disorder due to dengue encephalopathy had persistent manic symptoms for 7 months. He failed to respond to sodium valproate 1,500 mg/day and quetiapine 800 mg/day, and had antipsychotic-induced EPS from haloperidol, risperidone, and quetiapine. After adjunct α2AR agonists (clonidine 0.9 mg/day, and then switch to tizanidine 12 mg/day due to drowsiness) to sodium valproate (1,500 mg/day) and quetiapine (800 mg/day), EPS disappeared, and manic symptoms were in remission after 1 year of follow-up. Conclusion Clonidine and tizanidine may provide substantial efficacy and safety when used as an adjunctive treatment for manic episode due to encephalopathy. In addition, clonidine and tizanidine may decrease antipsychotic-induced EPS, and this may result in a better tolerability of medications.

中文翻译：

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可乐定和替扎尼定用于治疗登革热脑病引起的双相情感障碍：病例报告

摘要背景登革热是世界范围内常见的蚊媒病毒感染。登革热脑病引起的躁狂发作是这种感染的罕见并发症。脑部病变患者可能更容易因抗精神病药而出现锥体外系症状 (EPS)。在这里，我们介绍了首例使用 α-2 肾上腺素能受体 (α2AR) 激动剂、可乐定和替扎尼定治疗脑病引起的双相情感障碍的病例。病例摘要 一名 23 岁的泰国男子因登革热脑病被诊断患有双相情感障碍，其躁狂症状持续 7 个月。他对 1,500 毫克/天的丙戊酸钠和 800 毫克/天的喹硫平没有反应，并且有抗精神病药诱导的氟哌啶醇、利培酮和喹硫平的 EPS。辅助 α2AR 激动剂（可乐定 0.9 mg/天，后因困倦改用替扎尼定 12 mg/天）至丙戊酸钠（1,500 mg/天）和喹硫平（800 mg/天），EPS 消失，1 年后躁狂症状缓解。结论 可乐定和替扎尼定作为脑病所致躁狂发作的辅助治疗可提供显着的疗效和安全性。此外，可乐定和替扎尼定可能会降低抗精神病药引起的 EPS，这可能会导致更好的药物耐受性。