engleski

Side-effects as limitations in the treatment of a patient with bipolar affective disorder

Aim: To show difficulties in the treatment of a patient with bipolar affective disorder and emotionally unstable personality disorder due to the development of dermatological side effects in the form of Steven’s Johnson syndrome (SJS). Method: A case report. Result: Female patient aged 62 with bipolar affective disorder and emotionally unstable personality disorder has been in psychiatric treatment at the University Psychiatric Hospital Vrapče since 2016. She has been in outpatient treatment since she was 16 years old and her psychopharmacology treatment was changed several times due to side-effects. While she was hospitalized at our clinic for the first time, she was treated with duloxetine, lamotrigine, quetiapine and lorazepam. The remission of her psychiatric symptoms was accomplished, but she developed punctiform rash followed by intense itching. This side-effect was diagnosed as SJS and her medications, with the exception of lorazepam, were discontinued. The rash gradually receded and her mental state remained stable so she was discharged from the hospital. After two months of solely lorazepam treatment, a new depressive episode occurred. During the new hospitalization, psychopharmacology treatment included maprotiline, bupropion and aripiprazole. Again, after a shorter remission, she was admitted to the hospital due to depressive episode and therapy was changed to maprotiline and lithium. Although she had adequate lithium serum concentration, there was no therapeutic response. Within few days, she developed allergic reaction to lithium presented with redness of the face and parts of the body. Lithium was left out of the therapy and aripiprazole was added, but only with partial success as her psychiatric symptoms worsened after two months. Conclusion: This case is presented to emphasize that the adverse effect profile, especially serious adverse effects like SJS make great limitations in psychopharmacological treatment and prolong the suffering of our patients.

side-effects ; Steven Johnson syndrome ; bipolar disorder

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