RABBIT SYNDROME INDUCED BY ATYPICAL ANTIPSYCHOTICS: A RARE EXTRAPYRMIDAL SIDE EFFECT

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Negi Naresh Babu
Kiranmai Mandava
Atif Zama
Degam Akshaya
Hajera Al Quresh
Are Anusha
Sneha Thakur
Somnath De
S. Vanita Sagar

Keywords

Rabbit Syndrome, Antipsychotics, Tardive Dyskinesia, Riserpidone, Anticholinergics.

Abstract

Rabbit syndrome (RS) characterized by rapid, fine, rhythmic movements of the perioral muscles along a vertical axis at a frequency of about 5 Hz, mimicking the chewing and puckering movements of a rabbit with no Rabbit syndrome (RS) is a rare extra pyramidal symptom (EPS) caused by a prolonged neuroleptic medication, RS is characterized by rapid, fine, and rhythmic movements with the involvement of the tongue. Patients using antipsychotics found to have a rabbit syndrome prevalence that ranges from 1.3 to 4.4%. Polypharmacy and long-term neuroleptic use are the risk factors in developing this syndrome. RS is typically thought to be caused by first-generation antipsychotics. Nonetheless, second-generation antipsychotics like Riserpidone, which have a strong serotonin blockade and a lessened dopaminergic blockade also causes RS more frequently. Differential diagnosis include tardive dyskinesia in which movements are slow and irregular which does not follow rhythmicity and involves tongue movement. Management usually involves the reduction in the dose or changing to alternative atypical antipsychotics. Anticholinergics and anti-parkinsonic medications are also helpful to treat RS.

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References

1. Nishimura K, Tsuka M, Horikawa N. Withdrawal-emergent rabbit syndrome during dose reduction of risperidone. European Neuro psycho pharmacology. 2001 Aug1;11(4):323-4.
2. Schwartz M, Hocherman S. Antipsychotic-induced rabbit syndrome: epidemiology, management and pathophysiology. CNS drugs.
3. Finkel, R., Whalen, K., Finkel, R., & Panavelli, T.A. (2015). Antipsychotic drugs.In Pharmacology. essay, Wolters Kluwer.
4. LayC, SpislaC. Rabbit syndrome and akathisia in a patient treated with risperidone. Pharmacopsychiatry. 2012 Sep;45(06):A15.
5. Katzung, B., Trevor, A., & Masters, S. (2018). Antipsychotic agents and lithium. In Basic & Clinical Pharmacology. essay, McGraw Hill Medical Publishing Division.
6. Tripathi.KD(2015). Drugs used in mental illness: Antipsychotic and Antimanic drugs. In Essentials of Medical Pharmacology. essay, Jaypee Brothers Medical Publishers (P) Ltd.
7. Tandon R. Safety and tolerability: how do newer generation “atypical” antipsychotics compare? Psychiatric Quarterly.
8. Larner AJ. Rabbit syndrome. Current Clinical Pharmacology.2007;2:212-6.
9. Nataraj J, Jabbal R. Antipsychotic-induced rabbit syndrome in a pediatric patient. The Canadian journal of hospital pharmacy. 2015 Nov;68(6):478.
10. Deleon, WynnG, SandsonNB. The pharmacokinetics of paliperidone versus risperidone. Psychosomatics. 2010 Jan 1;51(1):80-8.
11. Schwartz M, Berry A, Sharf B. Risperidone-induced rabbit syndrome. The British Journal of Psychiatry. 1998 Sep;173(3):267-8.
12. Reyad A, GirgisE, MishrikyR. Rabbit syndrome: Update on a etiology and management for pharmacists, psychiatrists and dentists.
13. Sastry AS, Tapdia MR, Pathak A, Singh VK, Chaurasia RN. Rabbit syndrome: An asymmetrical presentation. Annals of Indian Academy of Neurology. 2021 Mar;24(2):284.
14. Patil AM. Aripiprazole Associated Rabbits Syndrome: A Rare Case Report.
15. Sethi S. Rabbit syndrome-an acute complication of neuroleptic medication. Indian journal of psychiatry. 2001 Jul;43(3):279.
16. Mendhekar DN. Rabbit syndrome induced by combined lithium and risperidone. The Canadian Journal of Psychiatry. 2005 May;50(6):369.
17. Number JS. Rabbit syndrome: Case Report. Reactions.2015May;1553:138-30.
18. Catena M, Fagiolini A, Consoli G, Ducci F, Picchetti M, Marazziti D. The rabbit syndrome: state of the art. Current Clinical Pharmacology.2007 Sep 1;2(3):212-6.
19. Anderson D. Rabbit Syndrome: Correspondence. Quarterly Essay. 2002 Jan(5):836.
20. Goswami, Gangadhar BN, Chandra PS, Channava basavanna SM, Sundararajan R. A Prospective Study of the Rabbit Syndrome. Neuro psycho pharmacology.
21. Todd R, Lippmann S, Manshadi MA, Chang A. Recognition and treatment ofrabbit syndrome, an uncommon complication of neuroleptic therapies. TheAmericanjournalof psychiatry.1983 Nov 1;140(11):1519-20.
22. Lindsey PL, Mehalic J. Psychotropic Medication-Induced: Rabbit syndrome. Journal of psychosocial nursing and mental health services. 2010 Feb 1;48(2):31-6.
23. Jus K, Jus A, Gautier J, Villeneuve A, Pires P, Pineau R, Villeneuve R. Influence of certain neuroleptics on the tardive dyskinesia and on the rabbit syndrome. Viemédicaleau Canadafrançais. 1973 Sep.
24. Sethi S, Bhargava SC. Clozapine-induced rabbit syndrome. The Journal of clinical psychiatry.2003Feb 15;64(2):3037.
25. Choi j, Kwak GH, Leesa. A Case of Rabbit Syndrome. Journal of the Korean Neurological Association. 2000:113-5.
26. WadaY, Yamaguchi. The rabbit syndrome and antiparkinsonian medication in schizophrenic patients. Neuro psychobiology.

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