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Letters to the Editor / General Hospital Psychiatry 26 (2004) 164 –169
cipitate hypomania or worsen aggressive behavior [4]. In the index case, the patient’s fluoxetine was increased to 80 mg/day, and one wonders if this unmasked an underlying bipolar diathesis (patient’s family history was positive for affective illness). Thus, caution is advised in prescribing antidepressants in patients with AS with a family history of affective illness. Harpreet S. Duggal, M.D. Western Psychiatric Institute and Clinic Pittsburgh, PA USA doi:10.1016/j.genhosppsych.2003.10.003 References [1] Bradley Ng, Au M, Verhoeven M, Johnston L, Perkins C. The diagnosis of Asperger’s syndrome in an adult presenting with an index episode of mania. Gen Hosp Psychiatry 2003;25:295–300. [2] Duggal HS, Dutta S, Sinha VK. Mood stabilizers in Asperger’s syndrome. Aus N Z J Psychiatry 2001;35:290 –1. [3] Frazier JA, Doyle R, Chiu S, Coyle JT. Treating a child with Apserger’s disorder and comorbid bipolar disorder. Am J Psychiatry 2002; 159:13–21. [4] Duggal HS. Bipolar disorder with Asperger’s disorder. Am J Psychiatry 2003;160:184 –5.
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ture of bipolar disorder in Asperger’s Syndrome (AS), given that the literature is currently restricted to only case series and single reports spread over various ethnicities and age groups from preadolescence to adulthood. There has been a case series where mania has responded to a single mood stabilizer [1]. As our case has highlighted, the diagnosis of both conditions remains a clinical challenge and may be underrecognized. Therefore, the literature may not be representative of patients with bipolar disorder and AS. Treatment regimes must be tailored to the individual. The dosages stated in the report were for the acute management of mania, so could not be considered as high dosages for a refractory illness. Secondly, the use of antidepressants at a high dosage may precipitate a manic episode in an individual with a family history of affective disorders, irrespective of co-morbid AS. Nevertheless, I agree that the literature available would suggest that caution and robust monitoring is needed when prescribing antidepressants in patients with AS and a family history of affective disorders. Bradley Ng, MD Department of Psychiatry Rotorua Hospital Rotorua, New Zealand doi:10.1016/j.genhosppsych.2003.10.002
Reply: letter to the editor Dear Sir, I thank Dr Duggal for the above comments. I would caution drawing conclusions concerning the refractory na-
Reference [1] Damose J, Stine J, Brody L. Medication induced hypomania in Asperger’s disorder. J Am Acad Child Adoles Psychiatry 1998;37:248 –9.
cipitate hypomania or worsen aggressive behavior [4]. In the index case, the patient’s fluoxetine was increased to 80 mg/day, and one wonders if this unmasked an underlying bipolar diathesis (patient’s family history was positive for affective illness). Thus, caution is advised in prescribing antidepressants in patients with AS with a family history of affective illness. Harpreet S. Duggal, M.D. Western Psychiatric Institute and Clinic Pittsburgh, PA USA doi:10.1016/j.genhosppsych.2003.10.003 References [1] Bradley Ng, Au M, Verhoeven M, Johnston L, Perkins C. The diagnosis of Asperger’s syndrome in an adult presenting with an index episode of mania. Gen Hosp Psychiatry 2003;25:295–300. [2] Duggal HS, Dutta S, Sinha VK. Mood stabilizers in Asperger’s syndrome. Aus N Z J Psychiatry 2001;35:290 –1. [3] Frazier JA, Doyle R, Chiu S, Coyle JT. Treating a child with Apserger’s disorder and comorbid bipolar disorder. Am J Psychiatry 2002; 159:13–21. [4] Duggal HS. Bipolar disorder with Asperger’s disorder. Am J Psychiatry 2003;160:184 –5.
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ture of bipolar disorder in Asperger’s Syndrome (AS), given that the literature is currently restricted to only case series and single reports spread over various ethnicities and age groups from preadolescence to adulthood. There has been a case series where mania has responded to a single mood stabilizer [1]. As our case has highlighted, the diagnosis of both conditions remains a clinical challenge and may be underrecognized. Therefore, the literature may not be representative of patients with bipolar disorder and AS. Treatment regimes must be tailored to the individual. The dosages stated in the report were for the acute management of mania, so could not be considered as high dosages for a refractory illness. Secondly, the use of antidepressants at a high dosage may precipitate a manic episode in an individual with a family history of affective disorders, irrespective of co-morbid AS. Nevertheless, I agree that the literature available would suggest that caution and robust monitoring is needed when prescribing antidepressants in patients with AS and a family history of affective disorders. Bradley Ng, MD Department of Psychiatry Rotorua Hospital Rotorua, New Zealand doi:10.1016/j.genhosppsych.2003.10.002
Reply: letter to the editor Dear Sir, I thank Dr Duggal for the above comments. I would caution drawing conclusions concerning the refractory na-
Reference [1] Damose J, Stine J, Brody L. Medication induced hypomania in Asperger’s disorder. J Am Acad Child Adoles Psychiatry 1998;37:248 –9.