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Guest Editorial
Highlighting Bipolar II Disorder
Gordon Parker, MD, PhD, DSc, FRANZCP
(PDF)

In Review
Neurobiological Findings in Bipolar II Disorder Compared With Findings in Bipolar I Disorder
Brent M McGrath, BSc, MSc, Phillip H Wessels, MD, FRCPC, Emily C Bell, BSc, MSc, Michele Ulrich, BSc, Peter H Silverstone, MB, BS, MD, MRCPsych, FRCPC
(PDF)

Bipolar II Disorder: An Overview of Recent Developments
George Hadjipavlou, MA, MD, Hiram Mok, MA, MB, BCh, BAO, FRCPC, Lakshmi N Yatham, MBBS, MRCPsych, FRCPC3 (PDF)

Review Paper
Bipolar Disorder: It’s All in Your Mind? The Neuropsychological Profile of a Biological Disorder
Gin S Malhi, BSc, MB, ChB, MRCPsych, FRANZCP, Belinda Ivanovski, Ssc Psychol, M Clin Psychol, Viktoria Szekeres, BSc,Psychol
(PDF)

Original Research
Impact of Culture on Depressive Symptoms of Elderly Chinese Immigrants
Glenda MacQueen, MD, PhD, FRCPC
Daniel WL Lai, PhD
(PDF)

Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Nicole Smolla, PhD, Jean-Pierre Valla, MD, MSc, Lise Bergeron, PhD, Claude Berthiaume, MSc, Marie St-Georges, MPs
(PDF)

Command Hallucinations Among Asian Patients With Schizophrenia
Theresa MY Lee, MBBS, MMed, Siow Ann Chong, MBBS, MMed, Yiong Huat Chan, PhD, Gangaharan Sathyadevan, MBBS, MRCPsych
(PDF)

The Centre for Addiction and Mental Health Concurrent Disorders Screener
Juan C Negrete, MD, FRCPC, Jane Collins, MSc, Nigel E Turner, PhD, Wayne Skinner, MSW
(PDF)

Validation de la version française du questionnaire de Sociotropie-Autonomie de Beck et collègues
Mathilde M Husky, MSc, Olivier S Grondin, MSc, Philippe D Compagnone, PhD
(PDF)

Brief Communication
Depressive Symptoms and Alcohol Consumption Among Nonalcoholic Depression Patients Treated With Desipramine
Benjamin I Goldstein, MD, PhD, Ayal Schaffer, MD, FRCPC, Anthony Levitt, MD, FRCPC, Ari Zaretsky, MD, FRCPC, Russell T Joffe, MD, FRCPC, Virginia Wesson, MD, R Michael Bagby, PhD
Pierre Bleau, MD, FRCPC
(PDF)

Letters to the Editor
(PDF)

Safety of Clozapine in 2 Successive Pregnancies

Revisiting the Diagnostic Challenges of Secondary Mania and Bipolar Disorder in a Patient With Borderline Hyperthyroidism

Dyslipidaemia and Psychiatric Patients

Dream Contents in Patients With Major Depressive Disorder

Sensory Deprivation and Disorders of Perception

Re: The Internet’s Impact on the Practice of Psychiatry

Response: The Internet’s Impact on the Practice of Psychiatry

Denial and Avoidance in an Unusual Case of Death From Breast Cancer

Interferon-Induced Mania

Drug-Induced Psychosis After Long-Term Treatment With Levetiracetam

Priapism

An Ounce of Prevention: “COPEing with Toddler Behaviour”

Internet Gaming Addiction

Letters to the Editor

Drug-Induced Psychosis After Long-Term Treatment With Levetiracetam

Dear Editor:
Psychiatric adverse effects are an often-seen feature of treatment with newer antiepileptic drugs. Levetiracetam is a new anticonvulsant with an unknown mechanism of action. There have been some reports about levetiracetam-induced psychosis, mainly in children (1,2). To our knowledge, all cases occurred at the onset of levetiracetam intake. We report on the case of a woman, aged 30 years, who developed psychotic syndromes after an increase in levetiracetam dosage.

Case Report

Mrs H had an 11-year history of myoclonal epilepsia of unknown etiology. The patient was admitted to our department owing to levetiracetam-induced psychosis by the neurological department, where she had been treated for 11 days prior. On admission to the neurological department, Mrs H had been treated with levetiracetam 1750 mg and lamotrigine 275 mg. After 3 days, primidone 250 mg was added to therapy, and on the following day, the levetiracetam dosage was increased to 2250 mg. Since admission, she had been seizure free. During the evening of the ninth and the following day after admission, she was agitated and nervous. The following day she was afraid of suffering new seizures, was distrustful, and refused to take further medication. There was some evidence of acoustic hallucinations also, but the patient denied these. The next day she showed aggressive tendencies toward the nurses and tried to leave the hospital. She was admitted to our acute psychiatric ward, where restraint was necessary. On admission she screamed, talked to imaginary persons, was agitated, and showed aggressive behaviour. We started medication with lorazepam 2 mg, zuclopenthixol 25 mg, and diazepam 10 mg. The levetiracetam dosage was reduced to 1500 mg, and lamotrigine and primidone were continued unchanged. The following day intake of olanzapine 10 mg was started. Restraint was necessary for the first 2 days. On the evening of the second day, she calmed down and regained orientation and insight into her illness. On the third day, she reported acoustic hallucinations again: a female voice told her she had been given the wrong medicine. On the fourth day, her overall behaviour returned to normal, and she was readmitted to the neurological department.

In the literature, prevalence rates of levetiracetam-induced psychosis range from less than 1% to 1.4% (3–5). Mula and others report certain risk factors, including a history of febrile convulsions, status epilepticus or previous psychiatric history, or lamotrigine cotherapy (5). Only lamotrigine cotherapy was given in our patient. Levetiracetam-induced psychosis normally occurs about 1 week after the start of treatment. In our case, the patient received a stable dosage of levetiracetam for about 1 year, with psychosis occurring 1 week after the dosage was increased. However, psychosis is a side effect of levetiracetam therapy that can also occur after long-term treatment. In certain patients, risk-factors should be clinically monitored, specifically when the dosage is changed.

References

1. Kossoff EH, Bergey GK, Freeman JM, Vining EP. Levetiracetam psychosis in children with epilepsy. Epilepsia 2001;12:1611–3.

2. Youroukos S, Lazopoulou D, Michelakou D, Karagianni J. Acute psychosis associated with levetiracetam. Epileptic Disord 2003;2:117–9.

3. Ben Menachem E and Gilland E. Efficacy and tolerability of levetiracetam during 1-year follow-up in patients with refractory epilepsy. Seizure 2003;3:131–5.

4. Cramer JA, De Rue K, Devinsky O, Edrich P, Trimble MR. A systematic review of the behavioral effects of levetiracetam in adults with epilepsy, cognitive disorders, or an anxiety disorder during clinical trials. Epilepsy Behav 2003;2:124–32.

5. Mula M, Trimble MR, Yuen A, Liu RS, Sander JW. Psychiatric adverse events during levetiracetam therapy. Neurology 2003;5:704–6.

Kristina Bayerlein, MD;
Helge Frieling, MD;
Barabara Beyer, MD;
Johannes Kornhuber, PhD;
Stefan Bleich, PhD
Erlangen, Germany