Clinical and Research ReportUses of Intravenous Valproate in Geriatric Psychiatry
Section snippets
Case 1
Mr. M., an 85-year-old widowed man with a 50-year history of bipolar disorder, was referred from his nursing home for involuntary admission to our Geropsychiatry Inpatient Unit for refusing to take medications, stating that as a priest, a doctor, and an undercover FBI agent, he knew they were poison. The apparent precipitant of this manic episode was the impending third anniversary of his wife's death. Medical history included Parkinson's disease, hypertension, congestive heart failure, and
Case 2
Ms. X., a 67-year-old divorced woman with a 30-year history of bipolar disorder, was involuntarily admitted to our Geropsychiatry Inpatient Unit after being brought to the emergency room by police for walking the streets in an open gown. This behavior was preceded by 2 weeks of insomnia, irritability, and threats to her children that began after stopping her valproate. Past medical history was remarkable for breast cancer, congestive heart failure, and lithium toxicity. Ms. X. was highly
Case 3
Mr. B., a 91-year-old widowed man with a 3-year history of Alzheimer's dementia, was referred from his assisted living facility for evaluation of increasing agitation over the past 2 weeks, involving flailing his limbs and hitting staff. He was also recently unable to take fluids, food, or medication by mouth because of difficulty swallowing. He had been prescribed donepezil, quetiapine, lorazepam, and zolpidem, to no avail. Medical history was remarkable for recent repeated hospitalizations
DISCUSSION
These three cases suggest that IV valproate administered without initial loading and in divided doses is well tolerated and may be an effective treatment for acute symptoms of mania and for dementia-related agitation in geriatric patients who are unwilling or unable to take oral medication. This is consistent with reports that oral valproate is well tolerated and effective in open-label trials in elderly patients with mania or dementia-related agitation.2., 10. Controlled clinical trials are
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Cited by (18)
Intravenous valproate in the treatment of acute manic episode in bipolar disorder: A review
2020, Journal of Affective DisordersCitation Excerpt :Interestingly, IV valproate seems to be efficacious not only in adults but also in adolescents and elderly patients. Specifically, Regenold and Prasad (2001) explored the efficacy of IV valproate in 2 cases of BD-I manic patients, aged 85 and 67 years old respectively. In the first case, the administration of IV valproate up to 500 mg over the course of one day and then switched to oral valproate resulted in a good clinical response, despite the persistence of delusions.
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2010, American Journal Geriatric PharmacotherapyEvidence-based pharmacological treatment of geriatric bipolar disorder
2005, Psychiatric Clinics of North AmericaPharmacotherapy of bipolar disorder in old age: Review and recommendations
2004, American Journal of Geriatric PsychiatryCitation Excerpt :There are no available data regarding the efficacy of atypical agents in elderly BP patients. Mixed-age patients benefit from using adjunctive risperidone with DVP and/or LI, but few patients over age 55 were included in these reports.34,35 Olanzapine monotherapy is superior to placebo in manic mixed-age patients.34,36
Effectiveness and safety of intravenous valproate in agitation: a systematic review
2022, Psychopharmacology
This work was supported by an unrestricted grant from Abbott Laboratories.