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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0357

Antipsychotic treatment selection in a young patient with psychosis and comorbid acute lymphoblastic leukemia: a case report

CASE REPORT; ANTIPSYCHOTIC TREATMENT SELECTION IN A YOUNG PATIENT WITH PSYCHOSIS COMORBID WITH ACUTE LYMPHOBLASTIC LEUKAEMIA

In a 21-year-old patient with psychosis in the context of acute lymphoblastic leukemia and severe neutropenia, switching from amisulpride to lurasidone improved psychotic and mood symptoms without adversely affecting the white blood cell count.

The aim is to discuss, through a case report, the challenges of antipsychotic selection in patients with psychosis and comorbid leukemia due to the risk of neutropenia. This is a single case report: a 21-year-old male patient with a family history of schizophrenia was assessed in the psychiatric emergency department for hostility, visual and auditory (command) hallucinations, paranoid delusions, and suicide risk, and reported recent marked weight loss and fatigue. Leukopenia detected on laboratory testing was interpreted by hematologists as a sign of a concurrent viral infection; the patient received inpatient care for three months, underwent trials of various antipsychotics, and was discharged on amisulpride 300 mg/day with adjunctive lorazepam. Two weeks later, he was diagnosed with B-cell acute lymphoblastic leukemia (B-ALL), and an intensive chemotherapy protocol was initiated; negativism, loss of motivation, depressive symptoms, and severe neutropenia subsequently developed. The consultation-liaison psychiatrist switched amisulpride to lurasidone; the patient responded well, his mood improved, his psychotic symptoms resolved, and he achieved clinical stability on lurasidone 74 mg daily with adjunctive lorazepam while his white blood cell count remained stable. The figure in the poster shows that the incidence of antipsychotic-induced neutropenia/agranulocytosis (per 1,000 exposed patients, with 95% confidence intervals) is highest with clozapine, followed by perazine. The authors present lurasidone as a potential antipsychotic of choice in a young patient with psychosis and comorbid ALL and report that it controlled psychotic and mood symptoms without causing additional neutropenia.

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