[Hepatic reactions to psychiatric drugs]

Hepatic Drug Reactions can be divided in predictable and nonpredictable. The vast majority of drugs produce nonpredictable reactions, unless the patient had a previous reaction with the same drug. There are two main pathological lesions produced by drugs: one is a cholestasis with mild portal inflammation. The other is a viral hepatitic like lesion with variable degree of necrosis. Less frequent are chronic hepatitis, cirrhosis, esteatosis, peliosis, intrahepatic thrombosis. Cholestasis is a benign and reversible lesion. The hepatitic lesion could produce an extensive necrosis with mortality between 2-20 per cent. Very often the diagnosis of drug reaction is made by exclusion of other etiologies. Patients on prolonged treatments with multiple drugs, should be monitored periodically with the study of liver enzymes.