Infertility-therapies/olanzapine/valproic acid
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Hypomania and mania, constipation and transaminitis: case report A 34-year-old woman developed hypomania and mania during treatment with cetrorelix, chorionic gonadotropin, follitropin-α and menotropin as hormonal therapy for egg harvesting. Additioanlly, she also developed constipation and transaminitis during treatment with olanzapine and valproic acid for bipolar disorder [routes and duration of treatments to reactions onset not stated; not all dosages and outcomes stated]. The woman was admitted to the psychiatry unit of hospital one week after worsening of manic symptoms, including paranoia, psychomotor agitation, impulsive spending, irritable mood, disorganised behaviour and was disheveled. Prior to admission, she had auditory hallucinations and catatonic symptoms which disappeared on admission. She was intermittently disoriented to place and time. Her psychiatric history included admission for bipolar disorder type-I at the age of 20 years. She had received amitriptyline with good response. At that time, she was discharged on olanzapine and valproic acid. One month later, she had second admission for depression which was stabilised after addition of bupropion. Thereafter, she had good treatment adherence for 14 years without major mood episodes. For several years, she had been receiving clonazepam 0.5mg twice a day as required, valproic acid at therapeutic doses and quetiapine for insomnia at bedtime occasionally. One month prior to admission, she underwent egg harvesting procedure. During this procedure, she completed 9-day course of follitropin alfa [Gonal-F] 75U injections twice a day and menotropin [Menopur] injections containing recombinant follicle stimulating hormone/luteinizing hormone 75/75U once a day at bedtime. On day 5 of the procedure, she was given cetrorelix [Cetrotide; cetrorelix acetate] 0.25mg injections daily for 4 days. On day 12 of the procedure, she received a single injection of chorionic gonadotropin [human chorionic gonadotropin] 10 000U at 36h prior to the egg harvesting procedure. A few days after initial gonadotropin injections, she developed hypomanic symptoms including elevated mood, increased sexual activity, increased energy and racing thoughts. These symptoms continued despite adherence to clonazepam and valproic acid throughout the procedure and a month thereafter. Five days prior to admission, she developed full manic symptoms due to nonadherence to her medications. The woman received unspecified mood stabilising treatment with rapid escalation of antipsychotic doses on admission. Her valproic acid level was 6 µg/mL. She required seclusion for multiple times due to aggressive behavior and multiple IM injections of unspecified medication. However, her psychiatric condition deteriorated and disorganised behaviour persisted despite this treatment. The woman was restarted on valproic acid with normal therapeutic blood level. Over the subsequent few days, she was treated with clonazepam 1mg thrice daily and olanzapine 30 mg/day. She also received lorazepam 8mg, chlorpromaz
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