Valproate (VPA) is widely used for acute and maintenance therapy of bipolar disease and it is the most prescribed drug for epilepsy treatment worldwide. VPA-induced hyperammonemia is a serious and unusual advers effect of VPA treatment.

We aimed to describe the 20 year-old-woman bipolar case of VPA induced hyperammonemic encephalopaty with therapeutic VPA levels and normal liver functions.

The case will be discussed.

The patient complained of confusion, disorientation, somnolance, agitation and slurred speech at the end of the first week of VPA treatment. VPA blood level was 116.5 μg/mL (N:50-125) and ammonia level was 237 μmol/L (N:10-50). Other laboratory tests including serum transaminases (both ALT and AST) and coagulation profile (PT, PTT and INR) were normal. After discontinuation of VPA treatment and hydration, these symptoms have disappeared dramatically. After 24 hours, blood ammonia level was 80 μmol/L and patient returned the baseline mental status.

Hyperammonemia occurs due to inhibition of mitochondrial enzymes in the urea cycle by valproic acid. Hyperammonemia and encephalopathy can develop even at therapeutic concentrations without elevated liver function enzymes. Clinicians should be aware that VPA- induced hyperammonemia and encephalopathy is still one of the most feared side effects of VPA which may require emergent management.

The aim of study was to evaluate mood and impulsivity in obese people with binge eating disorder.

A total of 149 obese subjects [71 with Binge Eating Disorder (BED) and 78 without BED] were included in the study and compared to 151 non-clinical populations. They were assessed with the Structured Clinical Interview (SCID-I), Eating Attitudes Test (EAT), Beck Depression Inventory (BDI), and Barrat Impulsiveness Scale-11 (BIS-11).

The ratio of obese subjects with BED is 47,6%. Obesity and BED prevalence was higher in female patients. Childhood obesity was significantly more frequent in obese subjects with BED (p < 0.05). the history of admission to psychiatry clinics and the ratio of suicide attempt were more frequent in obese group. the ratio sixty one of the 146 (41,2%) subjects with obesity had diagnosed as depressive disorder according to DSM-IV criteria. Thirty three of 71 BED (46,5%) had diagnosed as depressive disorder. there are no significant differences between BED(+) and BED(-) groups for depression (p > 0.05). Cognitive impulsivity and nonplanning activity scores of depressive group were significantly higher than the subjects without depression. (p < 0.05). Cognitive impulsivity scores of depressive obese were significantly higher than the obese without depression (p < 0.05).

[Table-1].

Obesity is strongly related with depression and impulsivity. Impulsivity was significantly higher in depressive obese subjects than non-depressive ones. Futhermore, impulsivity was a prominent feature in obese subjects with BED. This also provides clues for influences of each of these two characteristics on obesity.