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Alprazolam/levetiracetam Psychiatric disorders: case report

A 20-year-old man developed depressive symptoms, deliberate self-cutting behaviour and suicidal ideation resulting in a suicide attempt during treatment with levetiracetam for epilepsy. Additionally, chronic alprazolam abuse also contributed to the development of these reactions [routes not stated; not all dosages and duration of treatments to reaction onsets stated]. The man presented in a psychiatry consultation-liaison service following a suicide attempt by hanging. He had been receiving levetiracetam 500mg two times a day for epilepsy; however, he developed new onset depressive symptoms including deliberate self-cutting behaviour soon after treatment initiation, and he stopped the drug abruptly. He also had chronic multiple substance use disorder including alprazolam, cannabinoids, alcohol and remote use of lysergic acid diethylamide. After levetiracetam discontinuation, he developed a seizure and attempted suicide in postictal state. He was brought to the hospital by family member, and his condition stabilised on the trauma service. Further he developed aspiration pneumonia [aetiology unspecified], and he was shifted to the inpatient medicine service for its management. Anamnesis revealed that he had previous episodes of self-cutting behaviour; however, he denied any suicide attempts. Urine toxicology screen was found negative. He reported multiple hospitalisations for recurrent seizures and falls due to noncompliance with prescribed antiepileptic medications. He had developed a grand mal seizure complicated by postictal psychosis manifesting in the form of command auditory hallucinations few days following the antiepileptic drug discontinuation. He reported to have attempted suicide under the command of his auditory hallucinations. The series of psychiatric disorders were attributed to chronic alprazolam abuse, levetiracetam treatment, poorly controlled seizure disorder and various psychological stressors. The man was treated with valproate semisodium [divalproex sodium] for seizures following stabilisation of his medical condition. Subsequently, he was transferred to inpatient psychiatry and treated with citalopram for his depressive symptoms. He was discharged on citalopram following complete resolution of his depressive symptoms and psychiatric instability, and was advised regular psychiatric follow-up. Esang M, et al. Levetiracetam and Suicidality: A Case Report and Literature Review. Primary Care Companion for CNS Disorders 22: no pagination, No. 4, 30 Jul 2020

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Reactions 29 Aug 2020 No. 1819