CYCLOSPORINE-INDUCED DEPRESSIVE PSYCHOSIS IN A LIVER TRANSPLANT PATIENT: A CASE REPORT
Autori:
Siniša Telarović, Srđana Telarović, Mate Mihanović
Sažetak
Sažetak. Udio iatrogeno izazvanih psihotičnih stanja u populaciji psihijatrijskih bolesnika nije zanemariv. Prikazana je 62-godišnja bolesnica s primarnom dijagnozom ciroze jetre izazvane autoimunim hepatitisom, kod koje se tri mjeseca nakon ortotopne transplantacije jetre (OLT) razvila epizoda depresivne psihoze. Pojava simptoma i znakova depresivne psihoze u izravnoj je svezi s primjenom maksimalne doze imunosupresiva ciklosporina, dane zbog laboratorijskih znakova odbacivanja transplantata (porast transaminaza). S obzirom na premorbidno uredan neurološki i psihijatrijski status, analizirani su i drugi mogući uzročni čimbenici neurotoksičnosti i indukcije psihoze (razina kolesterola, magnezija, konkomitantna terapija itd.). Depresivna psihoza izazvana ciklosporinom rjeđe je opisana u literaturi, nasuprot znatno češćem ciklosporinskom deliriju.
Summary
Summary. Psychotic conditions of iatrogenic nature form a non-negligible portion of psychiatric practice. In this paper we present a case of a 62-year-old patient with the primary diagnosis of autoimmune hepatitis-induced cirrhosis who following the orthotopic liver transplantation developed an episode of depressive psychosis. The appearance of symptoms and signs directly correlated with the administration of the maximal dose of cyclosporine. The dose was upwardly titrated because the laboratory results (an increase in transaminase level) had indicated the transplant rejection. Because psychiatric and neurological examinations prior to the episode showed no abnormalities, other plausible causative factors such as the level of cholesterol and magnesium and the concomitant therapy were also analysed. In contrast to the more frequent cyclosporine-induced delirium, cyclosporine-induced depressive psychosis has been rarely reported in the literature.
