27th National Clinical Education Symposium Presentation Abstracts
28 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-1
Rabbit Syndrome with Lurasidone in a Patient with Recurrent Catatonia
İldeniz Tolga Uzun1, Eren Yıldızhan1, Aslı Aytulun1, Mustafa Nuray Namlı1
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1. Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, 3rd Psychiatry Department
DOI: 10.5080/kes27.abs120 Page 146
OBJECTIVE:Rabbit syndrome is a movement disorder characterized by involuntary, fine, rhythmic, perioral extrapyramidal movements associated with use of neuroleptics. It is more commonly observed in middle-aged and elderly patients, as well as in women. This case aims to present rabbit syndrome in a female patient with recurrent catatonia who was started on lurasidone due to depressive symptoms. CASE (The patient consent must be provided and specified with appropriate terms.):A 68-year-old female patient presented to our clinic with complaints of anxiety, anhedonia, mutism, and refusal to eat or drink following a knee prothesis surgery. She had experienced similar symptoms after a cholecystectomy surgery in 2018. The patient was admitted to our service with the diagnosis of bipolar disorder; depressive episode with catatonic features. She scored 20 on the Bush-Francis Catatonia Rating Scale. Since oral diazepam treatment was ineffective, 11 sessions of electroconvulsive therapy administered, and the catatonic symptoms improved. Initial medications were olanzapine 10 mg/day and escitalopram 20 mg/day, however, as her depressive symptoms continued, olanzapine and escitalopram were discontinued, and lurasidone 80 mg/day was initiated. Five days after initiating lurasidone, rhythmic tremor-like movement were observed in the perioral muscles and the mandible, consistent with rabbit syndrome. Symptoms resolved four days after discontinuing lurasidone. The abnormal involuntary movement scale score decreased from 18 to 0. Her outpatient treatment was finalized as ketiapin 300 mg/day and duloxetine 60 mg/day. (Written informed consent was obtained for the publication of case). DISCUSSION:In the literature, there is also another case of rabbit syndrome associated with lurasidone (Reichenberg et al. 2017). While rabbit syndrome is often a late-onset side effect of antipsychotics, its appearance on the 5th day is noteworthy. Our case highlights that lurasidone can also cause extrapyramidal side effects (EPS), requiring caution, especially in patients with a prior history of EPS or catatonia.