Acute pancreatitis induced by valproic acid

S Khouadja,L Zarrouk,C Ben Taleb,R Melki

doi:10.1192/j.eurpsy.2021.1706

Abstract

IntroductionValproic acid (VPA) is a commonly prescribed medication for epilepsy, migraine and especially bipolar disorder therapy. Although the common adverse effect associated with VPA are typically benign, less common adverse effects can occur; these include acute pancreatitis.ObjectivesDescribe the clinical and therapeutic characteristics of a case of acute pancreatitis induced by VPA with a review of the literature.MethodsWe report the case of a patient who presented an acute pancreatitis induced by VPA. The data was collected from the patient’s medical file. A review of the literature was performed by selecting articles from the PubMed search engine using ‘acute pancreatitis and valproic acid’ and ‘drug induced acute pancreatitis’ as key words.ResultsThis is a 51-year-old male patient with a history of type 2 diabetes, dyslipidaemia and psychiatric follow-up for bipolar disorder type I on lithium. He was admitted for a resistant depressive episode. We opted for the combination of two mood stabilizers (VPA and lithium). On the third day of treatment, the patient reported epigastric pain with incoercible vomiting. Laboratory tests showed increased levels of pancreatic enzymes and a biological inflammatory syndrome. The diagnosis of acute stage A pancreatitis was made.VPA was discontinued and the patient was put on symptomatic treatment with favourable outcome after one week. The etiological investigation ruled out other causes of acute pancreatitis. As a result, iatrogenic origin was retained.ConclusionsThis case supports the idea that acute pancreatitis may be induced by VPA, it has no predictable factors.DisclosureNo significant relationships.

Highlights

The relevance of this research is determined by the fact that an important scientific task of the modern clinical classification of mental disorders is the productive combination of the most valuable for the practical use of categorial and dimensional of the characteristics in in a particular clinical picture of a disease
Categorical characteristic used according to the systematics of schizotypal disorder (Kotsiubinskii A.P, 2018) published in the National Guide «Psychiatry», which includes the following syndromes: obsessivephobic, dysmorphophobic, non-delusional hypochondria, heboid, histrionophoric, impulsive-dysfunctional, schizoaffective, dissociativedisintegrative, autistic, dismotivative, amotivative
The cases were characterised by i) incorporation of videogame content into hallucinations and delusions, ii) identification with a videogame character and subsequent distress provoked by hearing the character’s voice and iii) self-induced Game Transfer Phenomena (GTP) as selfsoothing behaviour when reducing playing time

Summary

Introduction

Tourette’s syndrome (ST) is a neuropsychiatric disorder that presents with combination of motor and vocal tics for at least one year time.Only few cases of comorbidity with psychotic disorder has been described. Results: The patient (male, born in 1997 otherwise healthy)presented at the age of 6 with spitting.He subsequently progressed with severe motor tics, vocalizations, coprolalia, impulsivity, destructivity, repetitive motor rituals.No treatment showed to be efficacious and safe. He dropped out of the school, the family has to move to the rural area; his social withdrawal was intensified by psychotrauma (assaulted by police officer due to seemingly disorderly conduct). At the age of late adolescence he started to make fantastic statements Later on he admitted having visual and audial hallucinations and responding to them; the Kandinsky–Clérambault syndrome was detected. Symptoms and exitement are partially controlled by diazepam and clozapine; the patient needs assistance in all routines of self – care.The patient’s mother has a mild form of motor tics; her

Results