0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters to the Editor   |    
Response to Khandaker et al. Letter
Lily N.L. Ho, M.B.CH.B.
Am J Psychiatry 2010;167:1130-1130. doi:10.1176/appi.ajp.2010.10030429r
View Author and Article Information
Hong Kong, China

accepted for publication in April 2010.

The author's disclosures accompany the original letter.

Accepted April , 2010.

Copyright © American Psychiatric Association

To the Editor: Dr. Khandaker et al. mention that the development of manic symptoms in the patient, which occurred after oseltamivir use, may have been a red herring in the causation. This would be difficult to conclude, since she experienced only mild upper respiratory symptoms and fever for 1 day and the fever subsided before the start of oseltamivir and onset of manic symptoms. However, she and her parents could note that there was a marked change in her personality, with elated mood, after taking oseltamivir. A previous case series showed that neuropsychiatric adverse events after oseltamivir use may start on the first day of treatment (1). The close temporal relationship between the onset of manic symptoms and the use of oseltamivir in our patient, with relatively mild upper respiratory symptoms and fever that subsided before the onset of mania, suggests that oseltamivir-induced mania was a more likely diagnosis.

Regarding the genetic difference, it has been suggested that a nonsynonymous single nucleotide polymorphism in human cytosolic sialidase is more prevalent in Asian populations. This polymorphism affects the activity of sialidase, which may cause neuropsychiatric adverse events in patients receiving oseltamivir (2). This may account for the observation that the majority of cases were reported in Japan.

Both oseltamivir and influenza have been reported to be associated with the development of neuropsychiatric events (35). Moreover, fatal neuropsychiatric adverse reactions after oseltamivir use have been reported (1). The aim of our case report was to encourage vigilant monitoring of the mental state of patients after using oseltamivir until we have a better understanding about the properties of this drug.

Hama  R:  Fatal neuropsychiatric adverse reactions to oseltamivir: Case series and overview of causal relationships.  Int J Risk Safety Med 2008; 20:5—36
 
Li  C-Y;  Yu  Q;  Ye  Z-Q;  Sun  Y;  He  Q;  Li  X-M;  Zhang  W;  Luo  J;  Gu  X;  Zheng  X;  Wei  L:  A nonsynonymous SNP in human cytosolic sialidase in a small Asian population results in reduced enzyme activity: potential link with severe adverse reactions to oseltamivir.  Cell Res 2007; 17:357—362
[CrossRef] | [PubMed]
 
 Roche Laboratories: Tamiflu prescribing information. http://www.gene.com/gene/products/information/tamiflu/pdf/pi.pdf
 
Hara  K;  Tanabe  T;  Nakao  R;  Kasahara  T;  Okamoto  N;  Okasora  K;  Morimoto  T;  Kashiwagi  M;  Tamai  H:  Clinical characteristics of children with abnormal behaviors associated with influenza infection.  J Jpn Pediatr Soc 2007; 111:38—44
 
Tsz-Yin  So;  Nagappan  S:  Oseltamivir and neuropsychiatric behaviors in children: case report.  J Paediatr Sci 2009; 1:e6
 
References Container
+

References

Hama  R:  Fatal neuropsychiatric adverse reactions to oseltamivir: Case series and overview of causal relationships.  Int J Risk Safety Med 2008; 20:5—36
 
Li  C-Y;  Yu  Q;  Ye  Z-Q;  Sun  Y;  He  Q;  Li  X-M;  Zhang  W;  Luo  J;  Gu  X;  Zheng  X;  Wei  L:  A nonsynonymous SNP in human cytosolic sialidase in a small Asian population results in reduced enzyme activity: potential link with severe adverse reactions to oseltamivir.  Cell Res 2007; 17:357—362
[CrossRef] | [PubMed]
 
 Roche Laboratories: Tamiflu prescribing information. http://www.gene.com/gene/products/information/tamiflu/pdf/pi.pdf
 
Hara  K;  Tanabe  T;  Nakao  R;  Kasahara  T;  Okamoto  N;  Okasora  K;  Morimoto  T;  Kashiwagi  M;  Tamai  H:  Clinical characteristics of children with abnormal behaviors associated with influenza infection.  J Jpn Pediatr Soc 2007; 111:38—44
 
Tsz-Yin  So;  Nagappan  S:  Oseltamivir and neuropsychiatric behaviors in children: case report.  J Paediatr Sci 2009; 1:e6
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 52.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 51.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 19.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 1.  >
Topic Collections
Psychiatric News
APA Guidelines