title: Clinical outcomes and low-dose levocarnitine supplementation in psychiatric inpatients with documented hypocarnitinemia: a retrospective chart review.
abstract: BACKGROUND
  Metabolic encephalopathy is one of the crucial manifestations of carnitine deficiency. In psychiatric patients, low serum carnitine levels may result from chronic valproate therapy. Despite the widespread use of valproate in psychiatry, neither carnitine deficiency nor supplementation has been studied in a psychiatric population.
  
  
  OBJECTIVE
  To describe clinical outcomes in hospitalized psychiatric patients with documented hypocarnitinemia who were receiving oral levocarnitine supplementation.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  In 38 patients with hypocarnitinemia, a low-dose oral levocarnitine supplementation, in association with comprehensive psychiatric therapy, did not result in any adverse psychiatric or medical outcomes, and was associated with overall improved behavioral, cognitive, and motor functioning. Initially all patients had some degree of cognitive impairment, but after correction of carnitine serum levels, scores on the Mini-Mental State Examination (MMSE) improved in most of the patients (mean improvement 5.5 points, P <0.0001), and normalized in 11 cases. This allowed a correction of the diagnosis in 8 of 14 patients who had initially been diagnosed with dementia. African-American patients achieved significantly lower serum carnitine levels and MMSE scores than Caucasian patients with comparable therapy.
  
  
  CONCLUSIONS
  We hypothesize that correction of carnitine depletion, either by levocarnitine supplementation or by valproate dose reduction, may enhance recovery from hypocarnitinemia-associated encephalopathy in psychiatric patients. Our findings also suggest that ethnic traits may affect carnitine bioavailability as well as cognitive outcomes in this clinical context. Further studies of carnitine metabolism and supplementation in psychiatric patients are warranted.
authors.affiliation: South Carolina Department of Mental Health and University of South Carolina School of Medicine, Columbia, SC, USA.mirocuturic@yahoo.com
authors.forename: Miroslav
authors.initials: M
authors.lastname: Cuturic
authors.forename: Ruth K
authors.initials: RK
authors.lastname: Abramson
authors.forename: Robert R
authors.initials: RR
authors.lastname: Moran
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D018692:Antimanic Agents / Q000009:adverse effects; D001928:Brain Diseases, Metabolic / Q000188:drug therapy / Q000209:etiology; D002331:Carnitine / Q000008:administration & dosage / Q000172:deficiency* / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014635:Valproic Acid / Q000009:adverse effects
chemical_list: D018692:Antimanic Agents; D014635:Valproic Acid; D002331:Carnitine