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Valacyclovir-Induced Psychosis and Manic Symptoms in an Adolescent Young Woman With Genital Herpes Simplex

Received December 18, 2007; revised March 4, 2008; accepted March 6, 2008. From the Division of Consultation–Liaison Psychiatry, SUNY Upstate University, Syracuse, NY. Send correspondence and reprint requests to Sunny P. Aslam, M.D., Division of Consultation–Liaison Psychiatry, SUNY Upstate University, 1702 University Hospital, Syracuse, NY 13210. e-mail: aslams{at}upstate.edu
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Genital herpes is a common and painful infection. Its prevalence within the United States is estimated to be 40 million to 60 million people. Three medications, acyclovir, valacyclovir, and famciclovir, have been shown to reduce the duration and severity of the disease. OBJECTIVE: The authors report on the first known case of valacyclovir-induced psychosis with symptoms of mania in a young woman with no previous psychiatric history. METHOD: The patient presented with irritable mood and grandiose delusions 72 hours after starting valacyclovir for genital herpes. Valacyclovir treatment was stopped, and risperidone was initiated. RESULTS: The symptoms continued after stopping the valacyclovir, but improved with risperidone. DISCUSSION:There are reports of neuropsychiatric side effects with valacyclovir’s structural analogs in elderly patients with renal dysfunction. Clinicians should be aware that valacyclovir may induce psychosis with manic presentation in young, healthy patients without a psychiatric history.

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