Ziprasidone in the treatment of delayed carbon monoxide encephalopathy

• Published in: Progress in neuro-psychopharmacology & biological psychiatry Vol. 30; no. 4; pp. 755 - 757
• Main Authors: Hu, Ming-Chuan, Shiah, I-Shin, Yeh, Chin-Bin, Chen, Hsing-Kang, Chen, Chih-Kang
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.06.2006; Elsevier
• Subjects: Antipsychotic Agents - therapeutic use; Biological and medical sciences; Brain Diseases - drug therapy; Carbon Monoxide Poisoning - drug therapy; Chemical and industrial products toxicology. Toxic occupational diseases; CO intoxication; Encephalopathy; Female; Gas, fumes; Humans; Medical sciences; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Piperazines - therapeutic use; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Psychosis; Thiazoles - therapeutic use; Toxicology; Ziprasidone; MRI; Ziprasidone; EEG; CO; electroencephalogram; TD; Psychosis; HBO; PD; GCS; Encephalopathy; COHb; CO intoxication; Nervous system diseases; Toxic gas; Neuroleptic; Psychotropic; 5-HT2 Serotonine receptor; Cerebral disorder; D2 Dopamine receptor; Treatment; Central nervous system disease; Poisoning; Antagonist; Piperazine derivatives; Carbon monoxide
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2006.01.019

Delayed carbon monoxide (CO) encephalopathy is a serious complication of acute CO poisoning. We present a case of successful treatment of ziprasidone, a newer atypical antipsychotic, in delayed CO encephalopathy. A 52-year-old depressed woman suffered acute CO intoxication after an attempt of suicide by burning charcoal. She was initially treated with hyperbaric oxygen (HBO) therapy for the acute intoxication. One week later, the patient developed neuropsychiatric symptoms including parkinsonism, tardive dyskinesia (TD), cognitive deterioration, urinary incontinence, gait disturbance, mutism, disorientation to time, place and person, and disorganized as well as disturbing behavior. During her psychiatric hospitalization, the patient had been treated with daily HBO therapy, bromocriptine (2.5 mg/day), the conventional antipsychotic sulpiride (600 mg/day), and atypical antipsychotics such as risperidone (5 mg/day) and quetiapine (400 mg/day). However, her delayed neuropsychiatric sequelae of CO intoxication persisted despite of these treatments. It was until she had been treated with ziprasidone (80 mg/day) for 10 days that her mental condition was improved. With ziprasidone therapy, the patient obtained substantial improvement in her neuropsychiatric symptoms, cognitive function, and daily activities. Our case indicates that ziprasidone can be used effectively in the treatment of delayed CO encephalopathy.