[Psychotic illness during treatment with clomifen]

Area of Science:

• Psychiatry
• Pharmacology
• Reproductive Medicine

Background:

• Bipolar disorder (manic-depressive illness) is a complex mental health condition.
• Clomiphene citrate is a widely used medication to induce ovulation for infertility treatment.
• Women with pre-existing psychiatric conditions may be more susceptible to medication side effects.

Observation:

• A 25-year-old woman with bipolar disorder experienced a psychotic episode during clomiphene citrate treatment.
• The psychotic episode presented with distinct symptoms, including altered consciousness, psychomotor abnormalities, and paranoid-hallucinatory syndrome with transient neurological deficits.
• These symptoms differed significantly from her previous and subsequent psychotic episodes.

Findings:

• No organic cause for the psychotic episode was identified despite thorough investigation, other than the use of clomiphene citrate.
• The clinical presentation suggests a potential pathogenetic role for clomiphene citrate in inducing psychosis.
• Similarities were noted with certain post-partum psychoses, further supporting a potential drug-induced mechanism.

Implications:

• Clomiphene citrate may pose a risk for inducing unique psychotic episodes in susceptible individuals, particularly those with a history of psychiatric disorders.
• Enhanced vigilance and diagnostic efforts are warranted when prescribing clomiphene citrate to patients with a known psychiatric history.
• Further research is needed to elucidate the neurobiological mechanisms underlying clomiphene citrate-induced psychosis and identify at-risk populations.