Journal of Case Reports in Practice (JCRP)
Baclofen induced psychosis in a patient with bipolar disorder
ARA HOSSEINPOOR , SEYYED MOHAMMAD MAHDY MIRHOSSEINI , REZA BIDAKI
1Medical student, Isfahan University of medical sciences, Isfahan, Iran,2Medical student, Isfahan university of medical sciences, Isfahan, Iran,3Psychiatrist, RafsanjanUniversity of medical sciences, Rafsanjan, Iran.
Many drugs can cause psychiatric symptoms.
Psychiatric symptoms may ensue after treatment,
The patient is a known case of bipolar disorder, this
following underlying illness, or unrecognized mental
time considered as mania phase. He was also a heavy
disorder. Dosage escalation, drug overdoses or even
smoker for 600pack/year along with 20 years history
withdrawal of some drugs may also cause symptoms
of opium dependency and four year history of oral
such as anxiety, psychosis, delirium, agitation or
drug intake. He was also on medical drugs at the
depression. In this article we briefly report a
moment with poor medical adherence. His past
baclofen-induced psychological problem . This case
medical psychiatric therapy includes trihexyphenidyl
2mg daily, lorazepam 1m/Hs, sodium valporate
neuropsychiatric adverse drug reactions after starting
400mg daily, risperidone 2mg every night. Within the
baclofen use in patients with a current or past history
last two months, his therapy has been irregular, and
of mental disorder. In rare cases, baclofen induced
since the last 20 days, he only took lorazepam and
mania is reported (1,2). In another series baclofen
lrihexyphenidyl. He has no history of any other
withdrawal led to manic manifestation (3).8
organic problem except for hypercholesterolemia.
Mania may occur during treatment, particularly in
His medication at the time of admission was
patients susceptible to bipolar spectrum. Drugs such
halopridol 10mg IM, bipridene 5mg IM, oral
as levodopa, corticosteroids and anabolic-androgenic
methadone 14cc daily, cholodiazpoxide 10mg three
times daily, sodium valproate 200mg twice daily. His
antidepressants and monoamine oxidase inhibitors
imaging including brain computerized tomography,
can induce mania in patients with pre-existing bipolar
EEG, and all his laboratory tests was normal. Due to
disorders. Management involves discontinuation or
disease flare up, seven sessions of Electroconvulsive
dose reduction of the culprit drug when possible,
Therapy (ECT) performed. Psychotic and mood
otherwise antipsychotic drugs or lithium may be
symptoms recovered completely after ECT therapy.
A 47 year old man presented with psychiatric
assessment, a drug-induced mood disorder after using
symptoms and mood disorder following ingestion of
baclofen is proposed. It seems that psychosis and
eight pills of baclofen. He was admitted with
mood disorder secondary to drug effects are and
insomnia, delirium, visual and auditory hallucination,
more severe and potentially refractory to treatment.
persecutory delusion, spontaneous tearing, and astrong suicidal ideation. Also opposite sided
symptoms like anxiety, verbal and physical
1. Wolf, M.E., et al., Mania associated with the use of
aggression and uncontrollable burst of hyper -
baclofen. Biol Psychiatry, 1982. 17(6): p. 757-9.
motility was observed. This was his fourth admission
2. Stewart, J.T., A case of mania associated with
due to psychiatric problems. Later, he showed
high-dose baclofen therapy. J Clin Psychopharmacol,
apathy, hesitation in speaking and is reluctant to
being questioned. He has been absolutely symptom-
3. Chawla, J.M. and R. Sagar, Baclofen-induced
free between these episodes. Previous episode was
psychosis. Ann Pharmacother, 2006. 40(11): p. 2071-3.
4. Tutkunkardas, M.D. and N.M. Mukaddes, Drug
induced mania in a boy with high functioning autism.
Rafsanjan university of medical sciences,
Psychopharmacol Bull, 2010. 43(2): p. 82-5.
Moradi hospital, Psychiatry department, Rafsanjan, Iran.
5. Peet, M. and S. Peters, Drug-induced mania. Drug
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