{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:32:59Z","timestamp":1782901979534,"version":"3.54.5"},"reference-count":11,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,6,18]],"date-time":"2022-06-18T00:00:00Z","timestamp":1655510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neuropsychopharm Rep"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Antipsychotics with dopamine (D2) receptor antagonism can be effective for emesis in cancer patients. Extrapyramidal symptoms (EPS) induced by typical antipsychotics can be exacerbated by other D2 receptor antagonists. We describe a case of persistent EPS induced by long\u2010term, intermittent administration of low\u2010dose olanzapine along with metoclopramide for emesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>A 59\u2010year\u2010old pancreatic cancer patient underwent chemotherapy for 7 months. He was referred to the psychiatry department because of restlessness and insomnia. Although he did not have obvious depressive symptoms, he was anxious about the cancer treatment. For chemotherapy\u2010induced nausea, he had been prescribed 5\u00a0mg of olanzapine intermittently for 7 months. He had last used the drug 9\u2009days before presenting it to us. Additionally, he received metoclopramide and palonosetron as antiemetics. We considered akathisia and cancer\u2010related anxiety\/agitation as possible causes of restlessness and insomnia, and prescribed clonazepam. However, his symptoms worsened, resulting in hospitalization. We reconsidered his symptoms as cancer\u2010related anxiety\/agitation and prescribed quetiapine. Although it was effective, he had tremors and was assessed by a neurologist. Considering the clinical manifestations of rigidity, postural reflex disorder, and a mask\u2010like face, we suspected drug\u2010induced parkinsonism and replaced quetiapine with biperiden on the next day, leading to his discharge after 2\u2009weeks. He did not have symptom recurrence even after discontinuation of biperiden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Long\u2010term, intermittent administration of low\u2010dose antipsychotics with other antiemetics having D2 receptor antagonism can cause prolonged EPS. Especially in cancer patients, who often require polypharmacy, clinicians should consider exacerbated adverse effects due to drug interactions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/npr2.12277","type":"journal-article","created":{"date-parts":[[2022,6,18]],"date-time":"2022-06-18T12:58:27Z","timestamp":1655557107000},"page":"380-383","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prolonged extrapyramidal symptoms induced by long\u2010term, intermittent administration of low\u2010dose olanzapine along with metoclopramide for emesis: A case report"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-8316","authenticated-orcid":false,"given":"Shoko","family":"Sakamoto","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry Osaka Metropolitan University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5320-6569","authenticated-orcid":false,"given":"Yasuhiko","family":"Deguchi","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Osaka Metropolitan University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sawako","family":"Uchida","sequence":"additional","affiliation":[{"name":"Department of Hepatology Osaka Metropolitan University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Itoh","sequence":"additional","affiliation":[{"name":"Department of Neurology Osaka Metropolitan University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Osaka Metropolitan University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,18]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Cancer incidence of Japan 2017 [internet]. Japan: Cancer and disease control division ministry of health labour and welfare. 2017. [updated April 2020; cited April 2020]. Available from:https:\/\/www.e\u2010stat.go.jp\/stat\u2010search\/files?page=1&layout=datalist&toukei=00450173&tstat=000001133323&cycle=7&year=20170&month=0&tclass1=000001133363&tclass2=000001133366&result_back=1&tclass3val=0"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4511"},{"key":"e_1_2_13_4_1","volume-title":"Clinical guidelines for gastrointestinal symptoms in cancer patients","author":"Nakajima N","year":"2017"},{"issue":"2","key":"e_1_2_13_5_1","first-page":"91","article-title":"Oral dyskinesia caused by long term antipsychotic drugs treatment: a case report","volume":"26","author":"Susa C","year":"2011","journal-title":"J Gerodont"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2013.0610"},{"key":"e_1_2_13_7_1","unstructured":"Clinical practice guideline for antiemetic therapy 2018 [internet]. Japan Society of Clinical Oncology. [updated Oct 2018 ; cited Oct 2015]. Available from:http:\/\/www.jsco\u2010cpg.jp\/guideline\/29.html"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30678-3"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12712"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"7128909","DOI":"10.1155\/2016\/7128909","article-title":"Overlapping of serotonin syndrome with neuroleptic malignant syndrome due to linezolid\u2010fluoxetine and olanzapine\u2010metoclopramide interactions: a case report of two serious adverse drug effects caused by medication reconciliation failure on hospital admission","volume":"2016","author":"Mazhar F","year":"2016","journal-title":"Case Rep Med"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S116686"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.5455\/bcp.20120419121147"}],"container-title":["Neuropsychopharmacology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/npr2.12277","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/npr2.12277","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/npr2.12277","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T13:58:16Z","timestamp":1692626296000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/npr2.12277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,18]]},"references-count":11,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1002\/npr2.12277"],"URL":"https:\/\/doi.org\/10.1002\/npr2.12277","archive":["Portico"],"relation":{},"ISSN":["2574-173X","2574-173X"],"issn-type":[{"value":"2574-173X","type":"print"},{"value":"2574-173X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,18]]},"assertion":[{"value":"2022-04-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}