Compulsive Biting and Chewing with Mixed Amphetamine Salts: A Case Report.

Q3 Medicine Innovations in clinical neuroscience Pub Date : 2024-06-01 eCollection Date: 2024-04-01
Melissa Free, Hena Choi, Ritika Baweja
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Abstract

Stimulants are the first-line pharmacological treatment for attention deficit hyperactivity disorder (ADHD). We present the unique case of a patient who developed a chewing compulsion when taking mixed amphetamine salts (MAS). A 32-year-old female patient with a past medical history of gastroesophageal reflux disease (GERD), gastroparesis, and migraines was seen for initial psychiatric assessment due to concerns for irritability. She was diagnosed with post-traumatic stress disorder (PTSD); generalized anxiety disorder; ADHD, inattentive type; and unspecified bipolar disorder. Lamotrigine was started and titrated to 25mg twice per day, with improved mood stability. MAS immediate-release (IR) was started at 2.5mg and titrated to 5mg daily for ADHD. She then experienced an uncontrollable urge to chew, finding relief when chewing on a child's teething necklace, which provided satisfaction and a reduction in anxiety. She denied jaw tightness or teeth grinding. The dose of MAS IR was reduced to 2.5mg daily with improvement in symptoms and later increased again to 5mg daily, which she was then able to tolerate. Stereotyped biting behaviors have been observed in rats with the use of amphetamines, and the onset of compulsive behavior has emerged in children with the use of dextroamphetamine. However, this is the first known case of compulsive chewing or biting movements reported in humans with MAS use. This case highlights the need to assess patients for adverse events, such as compulsive biting and chewing movements or other oral facial stereotypies, after commencement of stimulants, including MAS.

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混合安非他明盐强迫性咬嚼:病例报告
兴奋剂是治疗注意力缺陷多动障碍(ADHD)的一线药物。我们介绍了一个独特的病例,患者在服用混合苯丙胺盐(MAS)时出现了咀嚼强迫症。一名 32 岁的女性患者既往有胃食管反流病 (GERD)、胃痉挛和偏头痛病史,因担心易怒而接受了初步精神评估。她被诊断为创伤后应激障碍(PTSD)、广泛性焦虑症、注意力不集中型多动症以及不明双相情感障碍。她开始服用拉莫三嗪,剂量为 25 毫克,每天两次,情绪稳定性有所改善。开始服用 MAS 速释片(IR),剂量为 2.5 毫克,之后逐渐增加到每天 5 毫克,用于治疗多动症。之后,她出现了无法控制的咀嚼冲动,在咀嚼小孩的磨牙项链时得到了缓解,这让她感到满足并减轻了焦虑。她否认有下颌紧绷或磨牙现象。MAS IR 的剂量减少到每天 2.5 毫克,症状有所改善,后来又增加到每天 5 毫克,她随后能够耐受。在使用苯丙胺类药物的大鼠身上观察到过刻板的咬人行为,在使用右旋苯丙胺的儿童身上也出现过强迫行为。然而,这是已知的第一例使用苯丙胺类兴奋剂的人类出现强迫性咀嚼或撕咬动作的报告。本病例突出表明,在开始服用包括 MAS 在内的兴奋剂后,有必要对患者进行不良事件评估,如强迫性咀嚼运动或其他口腔面部刻板行为。
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来源期刊
Innovations in clinical neuroscience
Innovations in clinical neuroscience Medicine-Psychiatry and Mental Health
CiteScore
2.10
自引率
0.00%
发文量
87
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