[Clinical and physiopathologic study of the hepatotoxicity of psychotropic drugs including the antiepileptics].

The goal of this article is to inform psychiatrists of the hepatotoxicity of certain drugs used for the treatment of psychiatric disorders. A review of biochemical pathways lends support to the argument that toxicity is due to certain toxic metabolites. The physiopathology of these disorders, which are rare, requires an appreciation of an individual's biochemical make up which can explain the quantity of active metabolites produced, the occurrence of immunological reactions and the contributing factor of enzymatic induction resulting from the simultaneous prescription of several medications. The most serious disorder is cytotoxic hepatitis which has a 10 to 20 per cent mortality. The molecules which may cause this affection in less than one out of a thousand cases are the hydrazide M.A.O. inhibitors and valproic acid. These medications should not be prescribed without being aware of their drawbacks and after a failure to achieve improvement with other drugs having a similar action. Obviously it is important to prescribe no more than moderate doses, and to avoid prescribing medications which, together can occasion enzymatic induction. The most common complication is obstructive jaundice for which the clinical and biological diagnosis should be made early in the course of the disorder. The medication should be stopped immediately and further prescription, in patients who have already presented this disorder, when a molecule is known to have certain toxic side effects (phenothiazines and tricyclics), suspended this surveillance should be carried out over a three months period. The occurrence of jaundice during a period of treatment is not always iatrogenic. It is always necessary to ascertain the etiology by asking a specialist to do a complete workup.