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Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report

BACKGROUND: Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky – especially for acute manic episodes. We present such a case whereby the application...

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Autores principales: Oulis, Panagiotis, Karapoulios, Evangelos, Kouzoupis, Anastasios V, Masdrakis, Vasilios G, Kontoangelos, Konstantinos A, Makrilakis, Konstantinos, Karakatsanis, Nikolaos A, Papageorgiou, Charalambos, Katsilambros, Nikolaos, Soldatos, Constantin R
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092422/
https://www.ncbi.nlm.nih.gov/pubmed/17922898
http://dx.doi.org/10.1186/1744-859X-6-25
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author Oulis, Panagiotis
Karapoulios, Evangelos
Kouzoupis, Anastasios V
Masdrakis, Vasilios G
Kontoangelos, Konstantinos A
Makrilakis, Konstantinos
Karakatsanis, Nikolaos A
Papageorgiou, Charalambos
Katsilambros, Nikolaos
Soldatos, Constantin R
author_facet Oulis, Panagiotis
Karapoulios, Evangelos
Kouzoupis, Anastasios V
Masdrakis, Vasilios G
Kontoangelos, Konstantinos A
Makrilakis, Konstantinos
Karakatsanis, Nikolaos A
Papageorgiou, Charalambos
Katsilambros, Nikolaos
Soldatos, Constantin R
author_sort Oulis, Panagiotis
collection PubMed
description BACKGROUND: Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky – especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient whose physical condition was already compromised by DM. METHODS: 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 manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days. RESULTS: The patient's mental state improved steadily and on discharge, 3 weeks later, she showed an impressive improvement rate of over 70% on the YMRS. Moreover, she remains normothymic 6 months after discharge, with OXC at 1200 mg/day. CONCLUSION: Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium or, alternatively, a combination of an antipsychotic with valproate or carbamazepine. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics increase glucose levels 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. 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, randomized clinical trials attesting to its efficacy unambiguously.
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spelling pubmed-20924222007-11-23 Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report Oulis, Panagiotis Karapoulios, Evangelos Kouzoupis, Anastasios V Masdrakis, Vasilios G Kontoangelos, Konstantinos A Makrilakis, Konstantinos Karakatsanis, Nikolaos A Papageorgiou, Charalambos Katsilambros, Nikolaos Soldatos, Constantin R Ann Gen Psychiatry Case Report BACKGROUND: Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky – especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient whose physical condition was already compromised by DM. METHODS: 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 manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days. RESULTS: The patient's mental state improved steadily and on discharge, 3 weeks later, she showed an impressive improvement rate of over 70% on the YMRS. Moreover, she remains normothymic 6 months after discharge, with OXC at 1200 mg/day. CONCLUSION: Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium or, alternatively, a combination of an antipsychotic with valproate or carbamazepine. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics increase glucose levels 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. 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, randomized clinical trials attesting to its efficacy unambiguously. BioMed Central 2007-10-08 /pmc/articles/PMC2092422/ /pubmed/17922898 http://dx.doi.org/10.1186/1744-859X-6-25 Text en Copyright © 2007 Oulis et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Oulis, Panagiotis
Karapoulios, Evangelos
Kouzoupis, Anastasios V
Masdrakis, Vasilios G
Kontoangelos, Konstantinos A
Makrilakis, Konstantinos
Karakatsanis, Nikolaos A
Papageorgiou, Charalambos
Katsilambros, Nikolaos
Soldatos, Constantin R
Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report
title Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report
title_full Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report
title_fullStr Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report
title_full_unstemmed Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report
title_short Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report
title_sort oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092422/
https://www.ncbi.nlm.nih.gov/pubmed/17922898
http://dx.doi.org/10.1186/1744-859X-6-25
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