Suneeta Kumari, MD, MPH Project Manager Department of Psychiatry and Behavioral Sciences Howard University Hospital Washington, DC
R. Sridhar, MD Medical Director Vatsalya Hospital Mysore, India
Murali Rao, MD Professor and Chair Department of Psychiatry and Behavioral Sciences Loyola University Chicago, Illinois
Mr. X, age 67, develops cognitive impairment, gait disturbance, and urinary incontinence. He has been taking valproic acid for 8 years to treat bipolar depression. What is your diagnosis?
Mr. X apparently had cerebral atrophy with enlarged ventricles that was consistently evident for 10 years (Figure 2), although he has been maintained on valproic acid for 8 years. What is intriguing in this case is that discontinuing valproic acid relieved the triad of incontinence, imbalance, and memory deficits indicative of NPH. Mr. X remains free of these symptoms.
Bottom Line Identifying signs and symptoms of normal pressure hydrocephalus (NPH) and implementing effective treatment can be challenging. Psychiatric symptoms are common in the context of idiopathic NPH—making it crucial for psychiatrists to (1) evaluate patients who have symptoms of NPH while taking valproic acid therapy and (2) identify atypical cases through neuroimaging.
Related Resources
Pitschel-Walz G, Bäuml J, Bender W, et al. Psychoeducation and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study. 2006;67(3):443-452.
Sajatovic M, Levin JB, Sams J, et al. Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder. Bipolar Disord. 2015;17(6):653-661.
Drug Brand Name Aripiprazole • Abilify
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
