Valproate Induced Behavioral Dysregulation in an Adolescent with Intellectual Disability: A Case Report

Abstract

Ayodola A Adigun and Karla Molinero

A 14-year-old with mild intellectual disability and autism spectrum disorder was admitted to a long-term psychiatric hospital with complaints of treatment resistant aggressive behavior. Her psychopharmacologic regime was Depakote 1500mg, Intuniv XR 2mg twice daily, and Inderal 10 mg thrice daily, for her mood and behavior symptoms, and prn Ativan and Benadryl for acute episodes of agitation. Despite multiple medication trials, she was continued on Depakote for seven months prior to her admission to long term care. During the first month in long term care, she had over 20 emergency interventions due to physical aggression. She was also witnessed to exhibit abnormal behavior and self-harm during this time. There were concerns that Depakote may be contributing to her dysregulated behavior, thus the medication was slowly down-titrated while her other scheduled medications and dosages remained the same. The patient started to require fewer emergency interventions with noted improvement in her behavior. After the complete termination of Depakote, clinical observations were remarkable for mitigation of aggressive and abnormal behavior as evidenced by the patient going six weeks without any emergency intervention. Behavioral dysregulation is a possible adverse effect of valproate. Individuals with intellectual disabilities are most vulnerable to polypharmacy for management of aggression, behavioral problems, and other psychiatric comorbidities. There is a need for pharmacovigilance on the negative behavioral effects in patients receiving valproate.

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