Summary

A report on the development of a schizophrenia-like disorder after the start of etanercept in a middle-aged woman who had no history of psychiatric illness. Etanercept was discontinued and she was treated with sulpiride for 6 months. There has been no relapse of psychosis since etanercept was discontinued, despite being off sulpiride for 3 months. Unfortunately, subsequent treatment she has had for her rheumatoid arthritis has not afforded the same level of symptom control as etanercept. This report points to the need for more research into the differential impact of reduced-tumor necrosis factor (TNF) α levels in the different regions of the brain. It highlights the need for pharmacovigilance especially in individuals on etanercept and other TNF inhibitors. It also highlights the need to systematically consider differential diagnosis before arriving at a diagnosis of psychiatric illness even in the presence of highly suggestive constellation of symptoms.