Did the adverse reaction improve when the drug was discontinued or a specific antagonist was given?Ĥ. Did the adverse events appear after the suspected drug was given? Yes (+2)ģ. Are there previous conclusive reports on this reaction? Yes (+1)Ģ. ![]() The probability of the adverse drug reaction is concluded from the total score (Definite if the overall score is 9 or greater, Probable for a score of 5-8, Possible for 1-4 and Doubtful if the score is 0).ġ. This tool examine factors such as the temporal association of drug administration and event occurrence, alternative causes for the event, drug levels, dose – response relationships and previous patient experience with the medication. We used the Naranjo Adverse Drug Reaction Probability Scale (1) to determine the likelihood of whether an adverse drug reaction is related to this specific drug or may be related to other factors. Lamotrigine was never re-started again and she was maintained on a combination of lithium and quetiapine with good effect. When the lamotrigine was eventually stopped after one week, there was complete cessation of abnormal perceptions. More importantly, there was no evidence of accompanying manic symptoms or severe depressive symptoms to explain these symptoms and also no alcohol or drug use.įollowing a psychiatric review, the dose of lamotrigine was reduced to 25 mg which resulted in immediate reduction in the intensity of the abnormal perceptions. With the dose of lamotrigine increased to 50 mg daily after the initial two weeks, she started to report worsening of these abnormal perceptions which developed into more complex visual and auditory hallucinations. On the same day of lamotrigine introduction, the patient started to experience visual hallucinations that she never had before (please see patient’s perspective for detailed description of her hallucinations). The initial dose of lamotrigine was 25 mg daily for two weeks in line with dose recommendation from manufacturer and drug guides. She agreed on the introduction of lamotrigine as an adjunctive medication to lithium. However, few months later, she reported relapse in her symptoms (mainly reporting features of bipolar depression) despite adequate lithium levels. The introduction of lithium and gradual titration resulted in significant improvement in her symptoms and mood stability. She was diagnosed with bipolar affective disorder and failed to achieve remission of symptoms on two different antipsychotic medications (quetiapine and olanzapine) and anticonvulsant medication (sodium valproate) before starting lithium carbonate. There was no history of psychotic symptoms and no family history of mental illness. She was referred for psychiatric evaluation with “anxiety and depressive symptoms” and failure to respond to antidepressant treatment which was prescribed by her General Practitioner.ĭuring the psychiatric assessment, she reported long history of recurrent episodes of elevated mood and depression dating back to her late teens with clear description of distinct periods of mood elevations lasting for few weeks and longer periods of persistent low mood. ![]() She has a diagnosis of congenital adrenal hyperplasia (21 hydroxylase deficiency) and is on long term corticosteroid replacement (prednisolone 4 mg once daily and fludrocortisoneġ00 mcg once daily) and she is under the care of an endocrinologist. We report the case of 36 year old white Caucasian female who used to work as a driving instructor and living with her parents. ICD 10: International Classification of Disesases. Keywords: Anticonvulsants Bipolar Affective Disorders Drug interactions and side effects Education and training Mood stabilisersĪbbreviations: BAD: Bipolar affective disorder. Hallucinations following lamotrigine treatment in non-epileptic patients is extremely rare reaction and only few similar case reports are reported in literature.Īwareness of this rare but serious side effect is important to avoid confusion with other psychotic symptoms related to mental illness and avoid unnecessary treatment. She started to report complex auditory and visual hallucinations which started two days after starting lamotrigine (25 mg once daily) and increased with its dose increase to 50 mg once daily two weeks later and resolved completely with stopping it. Her dose of lithium was 800 mg once daily with satisfactory lithium levels. Lamotrigine was introduced as an adjunctive medication with her lithium carbonate. The patient has been on two previous medications (quetiapine and sodium valproate) without significant improvement and only showed partial response to lithium. ![]() We report a rare case of hallucinations in a patient with bipolar affective disorder BAD without any history of psychosis or epilepsy following the introduction of lamotrigine as an add-on medication to her current treatment with lithium carbonate. Cite this article as: BJMP 2014 7(2):a714
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |