Article Type: Case Reports
Hiccups in Attention-Deficit/ Hyperactivity Disorder Under Methylphenidate Treatment
Ismail Akaltun, Hamza Ayaydin, Tayfun Kara
Attention-deficit/ hyperactivity disorder is one of the most commonly observed pediatric psychiatric disorders in today’s child and adolescent psychiatry clinics. Methylphenidate (MPH), a psychostimulant that acts on the dopaminergic system, is frequently used in treatment. Several studies have been performed concerning hiccups, and although some neurological mechanisms have been described, the pathophysiology is still unclear. However, neurotransmitter changes and hypo-/hyperdopaminergic states are known to lead to hiccups. A 7-year-old boy was brought by his parents to our clinic due to hyperactivity, inability to remain still, frequent boredom, and compulsive talking. ADHD was diagnosed on the basis of DSM-5 diagnostic criteria following psychiatric assessments, and MPH was initiated. Hiccups had developed and persisting 3-4 hours after medication administration. Hiccups had resumed when the drug was administered again, and stopped after 3-4 hours. Resolution in cases of hiccups treated with MPH is probably associated with improvement of a hypodopaminergic state through MPH raising dopamine levels. Additionally, we think that MPH can also trigger hiccups (as in our case) by causing a hyperdopaminergic state. We therefore think that further studies are needed in order to clarify the etiology of hiccups and the relationship with drug interactions.

Key words: Attention-deficit/ hyperactivity disorder, hiccup, methylphenidate, child
Psychiatry and Behavioral Sciences 2018;8(2):86-8
REFERENCES
1. Childress A, Mehrotra S, Gobburu J, McLean A, DeSousa NJ, Incledon B. Single-dose pharmacokinetics of hld200, a delayed-release and extended-release methylphenidate formulation, in healthy adults and in adolescents and children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2018;28(1):10-8.

2. Nausheen F, Mohsin H, Lakhan SE. Neurotransmitters in hiccups. Springerplus 2016;5(1): 1357.

3. Ray P, Zia UI Haq M, Nizamie SH. Aripiprazole-induced hiccups: a case report. Gen Hosp Psychiatry 2009;31(4):382-4.

4. Ercan ES, Amado S, Somer O, Cikoglu S. Development of a test battery for the assessment of attention deficit hyperactivity disorder. Turkish Journal of Child and Adolescent Mental Health 2001;8(3):132-45.

5. Kose S, Akin E, Cetin M. Adverse drug reactions and causality: the Turkish version of Naranjo Adverse Drug Reactions Probability Scale. Psychiatry and Clinical Psychopharmacology 2017;27(2):205-6.

6. Becker DE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog 2010;57(4):150-6.

7. Arita H, Oshima T, Kita I, Sakamoto M. Generation of hiccup by electrical stimulation in medulla of cats. Neurosci Lett 1994;175(1-2):67-70.

8. Wilens TE. Effects of methylphenidate on the catecholaminergic system in attention-deficit/hyperactivity disorder. J Clin Psychopharmacol 2008;28(3Suppl.2):S46-53.

9. Kranke P, Eberhart LH, Morin AM, Cracknell J, Greim CA, Roewer N. Treatment of hiccup during general anaesthesia or sedation: a qualitative systematic review. Eur J Anaesthesiol 2003;20(3):239-44.

10. Kutuk MO, Tufan AE, Guler G, Yildirim V, Toros F. Persistent hiccups due to aripiprazole in an adolescent with obsessive compulsive disorder responding to dose reduction and rechallenge. Oxf Med Case Reports 2016;4:66-7.

11. Kutuk MO, Guler G, Tufan AE, Kutuk O. Hiccup due to aripiprazole plus methylphenidate treatment in an adolescent with attention deficit and hyperactivity disorder and conduct disorder: a case report. Clin Psychopharmacol Neurosci 2017;15(4):410-2.
Online ISSN: 2636-834X
Creative Commons License This work is licensed under a Creative Commons Attribution 3.0 Unported License