Differential sensitivities to risperidone and olanzapine in a human immunodeficiency virus patient

Biol Psychiatry. 1998 Oct 15;44(8):791-4. doi: 10.1016/s0006-3223(97)00552-0.


Background: Neuroleptic sensitivity presents a considerable problem for the treatment of psychosis in the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV)-positive patient population. As yet, there are few data on the response of these patients to newer atypical antipsychotic medications.

Methods: We present the detailed medication history of a 33-year-old man with AIDS, who had a prior history of extrapyramidal symptoms (EPS) with both typical antipsychotics and risperidone, and was treated with olanzapine for major depression with psychotic features.

Results: The patient developed akathisia in a dose-dependent manner at dosages between 10 and 15 mg daily of olanzapine, but no EPS. Akathisia responded to dose reduction and use of beta-adrenergic blockade.

Conclusions: The AIDS patient may exhibit sensitivity even to newer atypical antipsychotics. The lack of EPS and response to a beta-blocker underscore the different mechanisms causing akathisia and EPS.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Akathisia, Drug-Induced / physiopathology
  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use
  • Benzodiazepines
  • Dose-Response Relationship, Drug
  • HIV Infections / complications
  • HIV Infections / psychology*
  • Humans
  • Male
  • Olanzapine
  • Pirenzepine / adverse effects
  • Pirenzepine / analogs & derivatives*
  • Pirenzepine / therapeutic use
  • Risperidone / adverse effects*
  • Risperidone / therapeutic use


  • Antipsychotic Agents
  • Benzodiazepines
  • Pirenzepine
  • Risperidone
  • Olanzapine