Bipolar Research Today is a free monthly online journal that collates and summarizes the latest research about Bipolar, including details on bipolar disorder, symptoms, treatment, depression, medication. | ||||||||
|
Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 Diabetes Mellitus: a case-report.Oulis P, Karapoulios E, Kouzoupis AV, Masdrakis VG, Kontoangelos KA, Makrilakis K, Karakatsanis NA, Papageorgiou C, Katsilambros N, Soldatos CR
ABSTRACT: BACKGROUND: Type-1 diabetes mellitus (DM) is a life-long serious condition with devastating systemic complications, which often render risky the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, especially acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would jeopardize the patient's already compromised by DM physical condition. CASE PRESENTATION: We report the case of a 55-year-old female with a history of type-1 DM since the age of 11, and severe ocular and renal vascular complications thereof. While on the waiting-list for pancreatic islet-cell transplantation, she developed a full-blown manic episode which proved recalcitrant to a two month-long ambulatory treatment with gabapentin 2g/day, lorazepam 7.5 mg/day and quetiapine 300 mg/day. Moreover, her refractory mental state affected adversely her already compromised glycemic control, requiring her emergency psychiatric hospitalization. On admission, she scored 52 on the Young Mania Rating Scale (YMRS). Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day in ten days. The patient's mental state improved steadily and on discharge, three weeks later, her score on the YMRS had dropped to 15, showing an impressive improvement rate of over 70%. Nausea and sedation were the only transient side-effects of OXC. Moreover, she remains normothymic six months after discharge, on OXC at 1200 mg/day as a mood-stabilizing treatment. Of note, her glycemic control has been restored. DISCUSSION: Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium salts or, alternatively, a combination of an antipsychotic with valproate or carbamazepine, possibly with a benzodiazepine as an adjunctive medication. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics -both typical and atypical ones- increase glucose level and thus were also relatively contra-indicated. Moreover, the imminent post-transpantation immunosupressant treatment with immuno-modulating medicines also contra-indicated both valproate and carbamazepine because of the attendant increased risk for leucopenia or even agranulocytosis. CONCLUSION: Despite the severe methodological limitations of case-reports in general, the present one suggests that OXC as monotherapy might be both safe and efficacious in the treatment of acute mania in patients with early-onset type-1 DM, whose already compromised physical condition constitutes an absolute or relative contra-indication for the administration of standard treatments, though there are no, as yet, large randomized clinical trials attesting to its efficacy unambiguously. Published 9 October 2007 in Ann Gen Psychiatry, 6(1): 25.
© 2004-2008 Bipolar Research Today. All Rights Reserved. |
| ||||||
