HIDDEN DANGER IN PSYCHIATRY: DRUG-INDUCED CHOLESTASIS AS AN UNDERRECOGNISED ADVERSE EFFECT

Abstract

Drug-induced liver injury (DILI) often goes overlooked due to its non-specific symptoms. If left untreated, even acute liver injury could lead to serious complications. We reported the case of a 50 y old female who presented with symptoms of acute gastroenteritis and urinary tract infection. Initially, liver function tests revealed elevated aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin levels. The patient’s history of multiple psychiatric medications: tablet chlorpromazine, tablet olanzapine, capsule fluoxetine, and tablet diazepam, raised suspicion of DILI. The updated Roussel Uclaf Causality Assessment Method (RUCAM) scoring indicated “possible” causality for all four drugs, with chlorpromazine receiving the highest score. All psychiatric medications were discontinued, and the repeated liver function test after eight days demonstrated significant improvement. This case highlighted the importance of liver function monitoring in patients receiving psychotropic polypharmacy and underscored the value of structured causality tools such as RUCAM in guiding clinical decisions.