Catatonia-like events after valproic acid with risperidone and sertraline

• Published in: Neuropsychiatry, neuropsychology, and behavioral neurology Vol. 11; no. 3; p. 157
• Main Author: Lauterbach, E C
• Format: Journal Article
• Language: English
• Published: United States 01.07.1998
• Subjects: Adult; Anticonvulsants - adverse effects; Anticonvulsants - pharmacokinetics; Antidepressive Agents - adverse effects; Antidepressive Agents - pharmacokinetics; Antipsychotic Agents - adverse effects; Antipsychotic Agents - pharmacokinetics; Catatonia - chemically induced; Drug Interactions; Drug Therapy, Combination; Female; Globus Pallidus - drug effects; Globus Pallidus - physiology; Humans; Psychotic Disorders - drug therapy; Risperidone - adverse effects; Risperidone - pharmacokinetics; Sertraline - adverse effects; Sertraline - pharmacokinetics; Valproic Acid - adverse effects; Valproic Acid - pharmacokinetics
• ISSN: 0894-878X

A patient with schizoaffective disorder developed signs of catatonia while on a regimen of valproic acid, sertraline, and risperidone. The catatonic features evolved for the first time after a single dose of valproate and were alleviated by lorazepam. The same catatonic signs recurred after a second dose of valproate and again remitted after lorazepam. Catatonia did not recur subsequent to discontinuing valproate, and the patient had tolerated the combination of valproate and risperidone in the past without developing catatonia. Although the catatonia in this case initially appears to be paradoxical, the phenomenon is actually consistent with current models of catatonia. A unique drug interaction may account for this phenomenon. Possible pharmacokinetic and pharmacodynamic explanations are discussed, including the relation of catatonia to increased activity of the medial globus pallidus and current models of catatonia.