A Rare Occurrence of Delayed Olanzapine-Induced Oculogyric Crisis in a Postpartum Patient: A Case Report.

Abstract

Oculogyric crisis (OGC) is an acute dystonic reaction characterized by involuntary upward deviation of the eyes, often linked to the use of antipsychotic medications. While commonly associated with first-generation antipsychotics (FGAs) due to their higher propensity to cause extrapyramidal symptoms (EPS), OGC remains a rare but documented occurrence with second-generation antipsychotics (SGAs). SGAs, including olanzapine, are generally preferred in clinical practice due to their reduced risk of EPS; however, they are not completely devoid of such adverse effects. The emergence of OGC in the context of SGAs, particularly in unique clinical scenarios, highlights the importance of awareness and careful management of potential adverse effects in clinical practice. This case report presents a rare instance of OGC in a 25-year-old postpartum woman following an independent reduction in her olanzapine dosage, a medication usually associated with a low risk of dystonia. The patient, with no previous psychiatric history, had been treated with olanzapine for postpartum depression with psychotic features and demonstrated stability. The onset of OGC, occurring three months after the initiation of olanzapine and precipitated by stressors such as interpersonal conflicts and high-pressure situations, underscores the critical need for comprehensive patient education on the dangers of unsupervised medication adjustments. It also highlights the importance of vigilant monitoring, particularly in vulnerable populations, such as postpartum patients. This case underscores the necessity for individualized treatment approaches and highlights the rarity and clinical significance of OGC in patients on SGAs, contributing to the understanding of atypical presentations associated with these medications.