SYMPOSIA

Poster Presentations
fulfilling the diagnostic criteria of the DSM-IV for schizophrenia. He had been hospitalized several times and underwent various treatment
regimens (including electroconvulsive therapy) in the past for acute schizophrenic episodes. He had been in remission with clozapine 500
mg/day for approximately one year before relapse occurred as a result of treatment noncompliance. He was admitted to hospital with
exacerbation of positive symptoms. He was started on clozapine 50 mg/day and titrated up to 500 mg/day. A significant improvement
was observed in positive symptoms. However, he developed compulsive hand washing behavior in the 3rd week of the treatment. He had
been spending 5 to 8 hours a day washing his hands although he recognized that it was senseless. He did not have a history of obsessivecompulsive
disorder. We assumed clozapine-induced obsessive compulsive symptoms and gradually decreased the dosage of clozapine
which resulted in aggravation of positive symptoms and elevated mood. Therefore, valproic acid 1000 mg/day was added to the regimen
of clozapine 500 mg/day. Two weeks after starting valproic acid, the patient`s positive symptoms and elevated mood were significantly
reduced and his compulsive hand-washing disappeared. He was discharged and in a 3 month-follow-up, he was maintained well under a
combined treatment with clozapine and valproic acid.
Discussion: Our patient developed hand-washing compulsion during treatment with clozapine,an atypical antipsychotic, which
disappeared after augmentation of valproic acid. Although a few case reports have mentioned the efficacy of valproic acid in the treatment
of OCD, there is only one case report showing alleviation of clozapine-induced OCD symptoms with valproic acid augmentation in a
patient with schizophrenia. In light of our case report, we suggest that valproic acid may be a choice when treating OCD symptoms which
may appear as an adverse effect of atypical antipsychotics in patients with schizophrenia. Case-controlled studies are required to establish
the efficacy of valproic acid in the treatment of antipsychotic-induced OCD symptoms before definitive conclusions can be reached.
Key words: Clozapine, obsessive compulsive behavior, schizophrenia, valproic acid, augmentation
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S125-6
[PP-009] Ref. No: 227
Treatment of bipolar disorder in adolescents: A case report
Çagdas Hunkar Yeloglu 1 , Hulya Guveli 1 , Kadir Sarp 3 , Bulent Bahceci 2 , Cicecek Hocaoglu 2
1Psychiatry Clinic, Rize Training and Research Hospital, Rize-Turkey
2Department of Psychiatry, Rize University, Faculty of Medicine, Rize-Turkey
3Gynecology and Pediatrics Hospital, Trabzon-Turkey
E-mail: chocaoglu@superonline.com
Bipolar disorder in adolescents is a chronic and recurrent psychiatric disorder with significant short-term and long-term morbidity. Bipolar
disorder can occur with different clinical manifestations in the adolescent stage compared to the adult form and usually results in a wrong
diagnosis. Mixed and rapid cycling type mania can be seen more frequently in adolescents than adults. This disorder often results in poor
academic and social-family performance, legal problems, and increased risk of suicide. For these reasons, it should be treated in a timely
and effective manner. However, information on the treatment of bipolar disorder in children and adolescents is limited. We discussed
prospective studies with more reliable methods that have been published in the last 10 years. With the recent indication of risperidone,
aripiprazole, quetiapine and olanzapine for treatment of bipolar disorders in children and adolescents, the atypical antipsychotics are
rapidly becoming a first-line treatment option. The effectiveness of lithium and other mood-stabilizing drug are also supported in
monotherapy and combination treatment. Studies concerning the pharmacological treatment of bipolar disorders in adolescents have
commonly focused on the treatment of manic episodes, and very few data are available regarding the treatment of bipolar depression,
maintenance treatments, and comorbid diseases. Also, further studies examining the safety, efficacy, tolerability and neurobiological
effects of psychotropic medications in children and adolescents with or at familial risk for developing bipolar disorder are needed. In this
case report, we will review clinical manifestations, differential diagnosis, and current treatment approaches of bipolar mood disorder. To
this end, we will present and discuss the case, and the relevant literature, of a 16 year old female inpatient, who has received treatment at
our clinic, has had a bipolar mood disorder diagnosis for 2 years and has been taking an atypical antipsychotic medication with lithium.
Key words: Bipolar disorder, treatment, adolescents
References:
1. Kılınçaslan A, Savaş HA. Çocuk ve Ergenlerde İki Uçlu Bozukluğun İlaçla Tedavisinde Yeni Gelişmeler Güncel Psikiyatri ve Psikonörofarmakoloji 2011;1(1):24-36.
2. Taylor E. Managing bipolar disorders in children and adolescents. Nat Rev Neurol 2009;5(9):484-91.
3. Sayar K, Öztürk M, Özer AÖ. Üç Olgu Nedeniyle Ergenlik Döneminde Bipolar Bozukluk Van Tıp Dergisi, 2000; 7(2):66-77.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S126
S126 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org