Three patients with affective disorders with psychotic features were
refractory to various combinations of psychotropic agents (antipsychotics,
antidepressants, and lithium). Closer scrutiny revealed a seizure history
in two patients and unusual neuropsychiatric features in the third patient.
Subsequent substitution of carbamazepine for the antipsychotic resulted in
control of the patients' psychoses. The authors describe clinical features
that may identify the patient who may respond to carbamazepine. The
mechanism of carbamazepine's psychotropic effects through its hypothesized
ability to inhibit limbic system kindling is discussed. The case reports
emphasize the need for careful neuropsychiatric assessment of patients who
are refractory to conventional treatments.