CLOMIPHENE CITRATE AS A POSSIBLE CAUSE OF A PSYCHOTIC REACTION DURINGINFERTILITY TREATMENT

Secondary side-effects often occur in women undergoing hormonal stimul ation treatment with clomiphene citrate, In general 10.4% of women exp erience hot hushing, 5.5% have complaints caused by enlargement of the ovaries and 3.5% experience central nervous symptoms (nervousness, sl eeplessness, headaches, visual disturbances, vertigo), During ovarian stimulation with clomiphene citrate for in-vitro fertilization, a 32 y ear old patient developed psychotic symptoms, commencing 3 days after initiation of treatment, Hospitalization in the psychiatric ward becam e necessary when severe formal and rational thought disturbances arose together with perceptory and sensory delusions, Under neuroleptic tre atment the symptoms improved, Nevertheless, follow-up psychiatric care on an outpatient basis was deemed necessary, The infertility treatmen t was continued with human menopausal gonadotrophin stimulation, Psych iatric instability occurred neither at this point nor during the 2 yea r follow-up observation period, Both an exogenous psychosis (ICD F23.9 ) as well as the exacerbation of an endogenous psychosis (ICD F29) may be considered for the differential diagnosis, The stimulation with cl omiphene citrate in connection with the physical and psychic stress of the infertility therapy can be regarded as the trigger factor, For pa tients with evidence of psychiatric illness in their case history, ovu lation-inducing substances such as clomiphene citrate should be implem ented with particular care.