it is an unusual " atypical " antipsychotic , as the " atypical " profile of the new antipsychotics clozapine , olanzapine , quetiapine , and risperidone has been linked to combined antagonism of serotonin 2 ( 5-ht2 ) and dopamine 2 ( d2 ) receptors , whereas amisulpride has negligible affinity for 5 ht2 receptors and is specific for dopamine d2 and d3 receptors in the limbic rather than striatal structures .
there are reports of amisulpride being used for the management of bipolar disorders . however , there are very few reports of mania induced by amisulpride . here
we describe a young male who developed mania while on amisulpride , a newer antipsychotic drug introduced in india .
a 18-year - old unmarried hindu male presented with a history suggestive of schizophrenia for the last 2 years .
the illness had an acute onset with complaints of suspiciousness , hearing voices not heard by others , violent abusive behavior , disturbed biological functions , and decreased self care .
he was started on risperidone 4 mg along with trihexyphenidyl 2 mg and lorazepam 6 mg per day .
gradually , over a period of 1 month , he showed improvement in the symptoms .
subsequently , trihexyphenidyl and lorazepam were tapered and he was maintained on risperidone 4 mg per day for the next 1 and a half year .
however , he would still be lethargic , would prefer to remain alone and would be inattentive at class .
he would not interact with others and not take active part in various household functions .
he was prescribed amisulpride for the negative symptoms along with risperidone 4 mg that was continued .
it was initiated at 50 mg per day and was increased to 100 mg per day after 4 days of initiation it .
after 10 days of 100 mg dose , the patient developed a manic episode , characterized by decreased need for sleep , over talkativeness , hyperactivity , persistent elevated mood , disinhibited behavior , over - grooming , and distractibility .
amisulpride was stopped and he was prescribed lorazepam 4 mg on as and when required basis .
the patient was followed up after 1 week and during this time there was substantial improvement in his manic symptoms with ymrs score of 17 .
to the best of our knowledge of mania due to first amisulpride was reported by murphy in 2003 . however , in the case described by murphy , the patient was also on citalopram , an antidepressant , though its discontinuation did not led to improvement in manic symptoms .
also , the patient was initiated on olanzapine immediately which would also probably have antimanic effects . in our case ,
use of the naranjo adverse drug reaction probability scale and edward 's criteria both indicate a probable relationship between the manic episode and short - term exposure to amisulpride therapy . the manic symptoms with amisulpride can be postulated to be due to the fact that amisulpride in low doses ( < 10 mg / kg ) , preferentially blocks presynaptic d2/d3 receptors , resulting in enhanced dopamine transmission . increased dopamine metabolites and increased dopamine transmission
this case report highlights the fact that close monitoring of patients on amisulpiride should be done for manic symptoms .
this is also important because of the fact that atypical antipsychotic drugs ( including amisulpride ) are used for the treatment for bipolar disorder .
open label studies have shown that amisulpride may be useful for patients with bipolar disorder .
also , as low doses enhance dopamine transmission , and high doses reduce dopamine transmission , it might be prudent to start amisulpride at the recommended target dose at the initiation of therapy .
 amisulpride is an atypical antipsychotic used for the management of schizophrenia and other conditions like dysthymia . 
 it has also been used for the management of bipolar disorders as an add on therapy . here , 
 we report a patient of schizophrenia who developed a manic episode while on amisulpride . 
Introduction
Case Report
Discussion