Hyperammonemic encephalopathy is an unusual side-effect of the treatment with valproic acid. According to several sources, this side effect could be underdiagnosed and underreported.

We present the case of a 54-year-old patient institutionalized in a psychiatric hospital who was referred to a general hospital after an episode of delirium of unknown etiology. The patient had been diagnosed with Schizoaffective disorder 26 years prior to his admittance and had started treatment with valproic acid the previous month.

A case report is presented alongside a review of the relevant literature regarding valproate-induced hyperammonemic encephalopathy, its differential diagnosis and treatment.

During his hospital stay, the patient underwent a complete panel of tests including CT Scan, EEG, toxic panel and complete blood tests. In them the only altered parameter was hyperammonemia, therefore valproic acid was removed and was treated with lactulose and rifaximin to reduce ammonium levels.

Hyperammonemic encephalopathy in the context of the treatment with valproic acid is a side-effect which is more prevalent than what was thought in the past. Valproate could reduce ammonium elimination therefore increasing the levels of the molecule. It should be administered carefully in cases where the patient may be presenting with other causes of increased ammonium metabolism or decreased elimination. It is important to bear in mind this possible side-effect to increase patient’s safety.

No significant relationships.

Lymphocytic colitis is an unusual side-effect of the treatment with SSRIs particularly sertraline. According to several sources, this side effect could be underdiagnosed and underreported.

We present the case of a 31-year-old female patient who presented watery non-bloody diarrhea for a month. The patient had been diagnosed with Persistent Depressive Disorder six years prior to the episode and was being treated with sertraline.

A case report is presented alongside a review of the relevant literature regarding Lymphocytic colitis, its differential diagnosis and treatment.

The case was coordinated between the out-patient psychiatry department and the patient’s Family Medicine specialist. The patient underwent a complete panel of tests including blood and stool test, and colonoscopy. The biopsy showed results compatible with the aforementioned diagnosis. Since the only pharmacological treatment which could cause or trigger lymphocytic colitis was sertraline, it was removed and treatment with oral budesonide was started with good results.

Lymphocytic colitis in the context of the treatment with SSRIs, particularly sertraline, is a side-effect which is more prevalent than what was thought in the past. A close coordination between psychiatrists and GP is of vital importance for the adequate treatment of mental health problems and treatment’s side-effects. It is important to bear in mind this possible side-effect to increase patient’s safety.

No significant relationships.

Electroconvulsive therapy (ECT) is the most acutely effective treatment for severe treatment-resistant depression. However, there are concerns about its cognitive side-effects and we cannot yet confidently predict who will experience these. Telomeres are DNA-protein complexes that maintain genomic integrity. In somatic cells, telomeres shorten with each cell division. Telomere length (TL) can thus provide a measure of ‘biological’ aging. TL appears to be reduced in depression, though results are mixed. We sought to test the following hypotheses: (1) that TL would be shorter in patients with depression compared to controls; (2) that TL would be a predictor of response to ECT; and (3) that shorter TL would predict cognitive side-effects following ECT.

We assessed TL in whole blood DNA collected from severely depressed patients (n = 100) recruited as part of the EFFECT-Dep Trial and healthy controls (n = 80) using quantitative real-time polymerase chain reaction. Mood and selected cognitive measures, including global cognition, re-orientation time, and autobiographical memory, were obtained pre-/post-ECT and from controls.

Our results indicate that TL does not differ between patients with depression compared to controls. TL itself was not associated with mood ratings and did not predict the therapeutic response to ECT. Furthermore, shorter baseline TL is not a predictor of cognitive side-effects post-ECT.

Overall, TL assessed by PCR does not represent a useful biomarker for predicting the therapeutic outcomes or risk for selected cognitive deficits following ECT.