Glutaric Acidemia Type II Associated with Bipolar Affective Disorder

Inborn errors of metabolism represent rare but important causes of psychiatric disorders in adolescents or adults. Here we describe a young male presenting with symptoms of bipolar affective disorder with underlying metabolic disorder. During hospitalization he was noticed to have increased sensitivity to antipsychotics, lithium and had poor response to treatment. He was detected to have metabolic impairment in terms of fluctuating levels of serum bilirubin and ammonia. There was family history of early deaths in his siblings. He was investigated for underlying metabolic disorder and Tandem mass spectroscopy of the blood showed increased concentrations of short, medium and long-chain acylcarnitines suggestive of glutaric acidemia type-II (GAII). Although neurological complications have been reported, psychiatric manifestations have not been reported to be associated with GAII. Also the poor response of bipolar disorder to medication and increased sensitivity to side effects of psychotropic medication needs to be understood in the light of the underlying metabolic disorder (German J Psychiatry 2011; 14: 48-50).