Neuropsychotherapeutics

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A female patient [age at onset not stated] developed suicidal ideation during treatment with risperidone, clonazepam, quetiapine and sertraline during pregnancy. Additionally, postpartum, her 5-day-old son developed recurrent seizures, respiratory distress, choroid plexus haemorrhage, germinal matrix haemorrhage, undescended testis, hydronephrosis, atrial septal defect, patent ductus arteriosus and mild tricuspid regurgitation following in utero exposure to risperidone, clonazepam, quetiapine and sertraline. He also developed generalised rashes, redness, and maculopapular lesions during treatment with phenytoin for recurrent seizures [routes, dosages and duration of treatment to reaction onset not stated].

The female patient (mother) had a history of schizophrenia, major depression and anxiety disorder. Her regular medications included risperidone, clonazepam, quetiapine and sertraline. She had delusions of being infected with COVID-19, during COVID-19 quarantine period, which caused her attempt suicide during last month of her gestation, when she was near delivery. The suicidal ideation was also caused due to antipsychotic and antidepressant therapy. She underwent unspecified medical intervention and survived. Thereafter, she visited her gynaecologist for pregnancy follow-up and decided to terminate the pregnancy. She delivered a boy with a birth weight of 3300g. At the age of 5 days, the neonate presented with frequent apnoea, seizures, apparent meconium aspiration, increased blood ammonia and lactate. He was referred from the birth center to the NICU. The boy started receiving phenobarbital for treatment of seizures. Further investigations demonstrated elevated direct bilirubin and arterial blood gas, which was probably due to neonatal icterus and apnoea respectively. The sonography revealed undescended testis and unilateral hydronephrosis. The echocardiography revealed atrial septal defect, patent ductus arteriosus and mild tricuspid regurgitation. The MRI showed confirmed temporoparietal lesions probably due to asphyxia. He started receiving phenytoin for his seizure. Had meconium aspiration and apnoea. His seizures were controlled with phenytoin. However, he developed generalised rash, redness and maculopapular lesions. Therefore, phenytoin was discontinued and he started receiving levetiracetam. For dermatological side-effects, he was treated with hydrocortisone and eucerin. Consequently, his rashes subsided. Eventually, he was discharged from the hospital after 2 weeks. He was scheduled for referral at neurology, nephrology, and cardiac clinics for treating his defects and follow-up. After five months of follow-up, the only sequel left was mild paresthesia of the left upper limb.