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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV1204

Valacyclovir-induced exacerbation of psychosis in an older woman with schizophrenia: a case report

VALACYCLOVIR EXACERBATED PSYCHOSIS IN AN ELDERLY WOMAN WITH SCHIZOPHRENIA: A CASE REPORT

An acute exacerbation of psychotic symptoms was observed after completion of valacyclovir treatment for herpes zoster in an older patient with chronic schizophrenia.

The aim is to broaden the spectrum of valacyclovir-associated neuropsychiatric effects by reporting a psychotic exacerbation temporally associated with antiviral treatment. This case report evaluated a 71-year-old woman with chronic schizophrenia who presented with a one-week history of progressively worsening auditory and visual hallucinations despite adherence to maintenance risperidone treatment. Two weeks earlier, the patient had been started on valacyclovir 1 g orally three times daily for 7 days for herpes zoster involving the left trigeminal dermatome; within 24 hours after completing treatment, she reported vivid visual hallucinations of unfamiliar faces on surrounding surfaces and auditory hallucinations commanding her to stop taking her medication and restrict her food intake. Associated symptoms included insomnia, psychomotor agitation, anxiety, and unilateral temporal headache. Diagnostic evaluation showed that she was alert and oriented to person, place, and time (AOx3), with coherent speech; noncontrast brain computed tomography and urine toxicology screening were negative, and vital signs were within normal limits. A complete blood count showed a hemoglobin level of 10.9 g/dL and an MCV of 78.2 fL, while a metabolic panel showed a BUN level of 66 mg/dL and a creatinine level of 23 mg/dL. The clinical course included admission to the emergency department on day 0, an increase in the risperidone dose on day 1, and discharge with planned outpatient follow-up on day 7. The absence of an identified structural, metabolic, or toxicological cause points to the accumulation of the neurotoxic metabolite 9-carboxymethoxymethylguanine (CMMG) as a biologically plausible mechanism. According to the authors, this is the first report of a possible valacyclovir-associated exacerbation of chronic schizophrenia and indicates that drug-induced neuropsychiatric toxicity should be considered when psychotic symptoms acutely worsen following antiviral treatment, while alternative causes must still be thoroughly investigated.

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