Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
권호 표지
DOI QR코드

DOI QR Code

Phentermine and Phendimetrazine-Induced Psychotic Disorder and Bipolar Disorder: A Case Series

Phentermine 및 Phendimetrazine으로 유발된 정신병적 장애 및 양극성 장애 증례군 연구

  • Kim, Soo Young (Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Tae-Suk (Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Dai-Jin (Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Chae, Jeong-Ho (Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Chang Uk (Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Joo, Soo Hyun (Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 김수영 (가톨릭대학교 의과대학 서울성모병원 정신건강의학교실) ;
  • 김태석 (가톨릭대학교 의과대학 서울성모병원 정신건강의학교실) ;
  • 김대진 (가톨릭대학교 의과대학 서울성모병원 정신건강의학교실) ;
  • 채정호 (가톨릭대학교 의과대학 서울성모병원 정신건강의학교실) ;
  • 이창욱 (가톨릭대학교 의과대학 서울성모병원 정신건강의학교실) ;
  • 주수현 (가톨릭대학교 의과대학 서울성모병원 정신건강의학교실)
  • Received : 2022.02.27
  • Accepted : 2022.04.05
  • Published : 2022.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives Recently, weight loss has emerged as a national concern in South Korea, and this has resulted in an increase in the frequency of use of central nervous system (CNS)-stimulating appetite suppressants. This study aimed to collect cases of psychotic disorders and bipolar disorders triggered by phentermine and phendimetrazine and explore the clinical features and courses. Methods In this retrospective study, we analyzed the electronic medical records of patients and selected eight patients who developed psychotic symptoms and manic symptoms for the first time after taking phentermine and phendimetrazine. All cases were reviewed, and their clinical features and course were summarized. Results All eight patients developed psychotic symptoms, and one had accompanying manic symptoms. The final diagnosis was appetite-suppressant-induced psychotic disorder in four patients, schizophrenia in three, and appetite-suppressant-induced bipolar disorder in one. In addition, three patients were diagnosed as having substance-use disorder. The key psychotic symptoms of these patients were hallucinations and paranoia. Conclusions These case findings suggest that phentermine and phendimetrazine can cause psychotic disorder, bipolar disorder, or substance use disorder and that medical professionals and the public should practice caution when prescribing and using these drugs.

Keywords

References

  1. World Health Organization. The Asia-Pacific Perspective: Redefining Obesity and Is Treatment. Sydney: Health Communications Australia;2000.
  2. Korea Disease Control and Prevention Agency. Korea Health Statistics 2019: Korea National Health and Nutrition Examination Survey (KNHANES VIII-1). Cheongju: Korea Disease Control and Prevention Agency;2020.
  3. Kosis.kr [homepage on the Internet]. Korea: Ministry of Food and Drug Safety [updated 2021 July 23; cited 2022 Feb 18]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=145&tblId=DT_145013_044&conn_path=I2.
  4. Seo MH, Kim YH, Han K, Jung JH, Park YG, Lee SS, et al. Prevalence of obesity and incidence of obesity-related comorbidities in Koreans based on National Health Insurance Service health checkup data 2006-2015. J Obes Metab Syndr 2018;27:46-52. https://doi.org/10.7570/jomes.2018.27.1.46
  5. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean Society for the study of obesity guideline for the management of obesity in Korea. J Obes Metab Syndr 2019;28:40-45. https://doi.org/10.7570/jomes.2019.28.1.40
  6. Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. The science of obesity management: an endocrine society scientific statement. Endocr Rev 2018;39:79-132. https://doi.org/10.1210/er.2017-00253
  7. Jo SJ, Lee HK, Park BJ, Kang HC, Lee SY, Jo JB. A rapid systematic review on adverse effects of psychostimulant appetite suppressants: focusing on dependence and psychosis. J Korean Academy of Addiction Psychiatry 2021;25:45-57. https://doi.org/10.37122/kaap.2021.25.2.45
  8. Rothman RB, Baumann MH. Appetite suppressants, cardiac valve disease and combination pharmacotherapy. Am J Ther 2009;16:354-364. https://doi.org/10.1097/MJT.0b013e31817fde95
  9. Kim KK. Mechanisms of action and clinical applications of antiobesity drugs currently available in Korea. J Korean Med Assoc 2019;62:588-597. https://doi.org/10.5124/jkma.2019.62.11.588
  10. Bramness JG, Gundersen OH, Guterstam J, Rognli EB, Konstenius M, Loberg EM, et al. Amphetamine-induced psychosis--a separate diagnostic entity or primary psychosis triggered in the vulnerable? BMC Psychiatry 2012;12:221.
  11. Rubin RT. Acute psychotic reaction following ingestion of phentermine. Am J Psychiatry 1964;120:1124-1125. https://doi.org/10.1176/ajp.120.11.1124
  12. Homola J, Hieber R. Combination of venlafaxine and phentermine/topiramate induced psychosis: a case report. Ment Health Clin 2018;8:95-99. https://doi.org/10.9740/mhc.2018.03.095
  13. Alexander J, Cheng YH, Choudhary J, Dinesh A. Phentermine (Duromine) precipitated psychosis. Aust N Z J Psychiatry 2011;45:684-685.
  14. Lee SH, Liu CY, Yang YY. Schizophreniform-like psychotic disorder induced by phentermine: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1998;61:44-47.
  15. Cleare AJ. Phentermine, psychosis, and family history. J Clin Psychopharmacol 1996;16:470-471. https://doi.org/10.1097/00004714-199612000-00020
  16. Devan GS. Phentermine and psychosis. Br J Psychiatry 1990;156:442-443. https://doi.org/10.1192/bjp.156.3.442
  17. Hoffman BF. Diet pill psychosis: follow-up after 6 years. Can Med Assoc J 1983;129:1077-1078.
  18. Hoffman BF. Diet pill psychosis. Can Med Assoc J 1977;116:351-355.
  19. Raison CL, Klein HM. Psychotic mania associated with fenfluramine and phentermine use. Am J Psychiatry 1997;154:711.
  20. Bagri S, Reddy G. Delirium with manic symptoms induced by diet pills. J Clin Psychiatry 1998;59:83.
  21. Zimmer JE, Gregory RJ. Bipolar depression associated with fenfluramine and phentermine. J Clin Psychiatry 1998;59:383-384. https://doi.org/10.4088/JCP.v59n0707e
  22. Kim SH, Ahn DH, Yoo TH. A case of organic hallucinous following phendimetrazine(Fringar@) abuse. J Korean Neuropsychiatr Assoc 1992;31:1119-1122.
  23. Lee JM, Lee KU, Jhoo JH, Park JI. Two cases of psychotic disorder following phendimetrazine use. Korean J Psychopharmacol 2010;21:95-98.
  24. Yun JA, Park WR, Yu JC, Choi KS. A case of phendimetrazine induced-psychotic disorder and dependence. J Korean Neuropsychiatr Assoc 2013;52:402-405. https://doi.org/10.4306/jknpa.2013.52.5.402
  25. Kwak SY, Youn TY, Lee NY, Chung IW, Kim SH. Psychotic disorder induced by appetite suppressants, phentermine or phendimetrazine: a case series study. Korean J Biol Psychiatry 2017;24:134-141.
  26. Jo HS, Wang SM, Kim JJ. Recurrent psychosis after phentermine administration in a young female: a case report. Clin Psychopharmacol Neurosci 2019;17:130-133. https://doi.org/10.9758/cpn.2019.17.1.130
  27. Starzer MSK, Nordentoft M, Hjorthoj C. Rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. Am J Psychiatry 2018;175:343-350. https://doi.org/10.1176/appi.ajp.2017.17020223
  28. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Philadelphia: Lippincott Williams & Wilkins;2015.
  29. Baumann MH, Ayestas MA, Dersch CM, Brockington A, Rice KC, Rothman RB. Effects of phentermine and fenfluramine on extracellular dopamine and serotonin in rat nucleus accumbens: therapeutic implications. Synapse 2000;36:102-113. https://doi.org/10.1002/(SICI)1098-2396(200005)36:2<102::AID-SYN3>3.0.CO;2-#
  30. Solis E Jr, Suyama JA, Lazenka MF, DeFelice LJ, Negus SS, Blough BE, et al. Dissociable effects of the prodrug phendimetrazine and its metabolite phenmetrazine at dopamine transporters. Sci Rep 2016;6:31385.
  31. An H, Sohn H, Chung S. Phentermine, sibutramine and affective disorders. Clin Psychopharmacol Neurosci 2013;11:7-12. https://doi.org/10.9758/cpn.2013.11.1.7
  32. Niemi-Pynttari JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry 2013;74:e94-e99. https://doi.org/10.4088/JCP.12m07822
  33. Chen WL, Hsieh CH, Chang HT, Hung CC, Chan CH. The epidemiology and progression time from transient to permanent psychiatric disorders of substance-induced psychosis in Taiwan. Addict Behav 2015;47:1-4. https://doi.org/10.1016/j.addbeh.2015.02.013