Risperidone Induced Bradycardia and Syncope in A Case with Volatile Substance Abuse

There are studies reporting that cardiac arrest, ventricular arrhythmia and sudden death might be seen in patients treated with antipsychotic drugs. Besides, cardiac arrhythmia and sudden death may be observed in volatile substance abuse. We report a patient with volatile substance abuse, who had bradycardia and syncope arised with the initiation of risperidone treatment. The patient was male, aged 15 years and 8 months, had started to snuff adhesive almost daily for the last two months. He was referred with complaints of uneasiness, anxiety, andtalking to himself. He had isolated himself socially at recent times. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), diagnosis of "volatile substance abuse" and "major depressive disorder with psychotic characteristics" was established and 1.5 mg/day risperidone treatment was initiated. At the follow-up visit one week later, chest pain and frequent syncope attacks were observed. Sinusal bradycardia was detected in his ECG (Electrocardiogram). Upon discontinuation of risperidone, syncope attacks disappeared and ECG became normal. When antipsychotic use is required in a person abusing volatile substances, cardiac adverse effects must be taken into consideration. In the presence of any previous antipsychotic use with cardiac adverse effects in patients abusing volatile substance, follow-ups with ECG may be necessary, especially at the early phase of antipsychotic treatment.