Idiopathic Unconjugated Hyperbilirubinemia (Gilbert's Syndrome) and Concurrent Psychotropic Drug Administration

Abstract

Gilbert's Syndrome is a benign familial condition in which unconjugated hyperbilirubinemia occurs in the absence of structural liver disease or hemolysis. Phenothiazines and tricyclic medications are often withheld in patients with preexisting liver disease. The authors present four patients with Gilbert's Syndrome and concurrent psychiatric illness. Administration of phenothiazine antipsychotics or tricyclic antidepressants proved beneficial and produced no adverse effects on hepatic function. The authors discuss clinical aspects of Gilbert's Syndrome in psychiatric patients and conclude that phenothiazine antipsychotic medication should not necessarily be withheld from these patients.

Gilbert's syndrome in a patient with predominantly negative symptoms of schizophrenia

“…It is an unconjugated hyperbilirubinemia, without liver disease or hemolysis, characterised by intermittent jaundice usually associated with fasting or intercurrent illness [4]. Several previous case reports show an association between the improvements in total bilirubin and mental state [5,6]. We report the case of a young man with mainly negative symptoms of schizophrenia in whom there has been little improvement in mental state despite an improvement in total bilirubin.…”

“…To date there have been two case series [5,6] of Gilbert's syndrome associated with schizophrenia. All the patients were overtly psychotic on admission and their mental state improved with the administration of antipsychotic medication.…”