Sodium valproate and related preparations have recently undergone regulatory review following concern about effects on the unborn child and doctors' failure to communicate risk. The issues are wider. Valproate is overused in psychiatry based on the false perception that ‘ease’ of use equates to better safety than alternatives. Valproic acid can disrupt fundamental physiological processes, the consequences of which are poorly understood and little discussed in the psychiatric literature. Valproate may be useful in a small number of patients with bipolar disorder but current prescribing patterns are unjustified. Perception needs to change.

Antipsychotic related urinary symptoms are recognised and they remain a potential treatment-limiting sideeffect of clozapine. This article reports the incidence and management of two cases of clozapine-associated incontinence in psychiatrically stable patients. Both cases occurred during treatment and appear to have a similar pathophysiology, which may be related to the atypical nature of clozapine therapy. We searched the PubMed and MEDLINE databases for articles published from 1980 to 2008 that contain the keywords 'clozapine and enuresis, ‘clozapine and incontinence,’ ‘clozapine and seizures’. We also manually searched the bibliographies of these articles for related sources, and explored the reported treatment options to this side-effect of clozapine therapy. Both patients gave an informed consent.

A 35-year-old South Asian Muslim male was admitted for acute psychotic episode to an urban acute psychiatric unit. In the context of ongoing religious delusions, and on his request to fast during the Islamic month of Ramadan we made alterations to his medication dosing schedule. We discuss the clinical implications of such practice.

The present study was conducted to investigate whether several GABAergic drugs could affect immobility in the behavioral “despair” test (swimming test). The subacute (3 injections) treatment with the GABA-B agonist baclofen 0.5 mg/kg (BC05) partially antagonised the antiimmobility action of imipramine (IMI), whereas muscimol 0.00125 mg/kg (MU ; GABA-A agonist) did not affect the imipramine effect on immobility. The highest doses of baclofen alone increased immobility time, and no effect of muscimol alone was observed on this measure. Other experiments indicated that different doses of δ-α-aminovaleric acid (a GABA-B antagonist and GABA-A agonist) or progabide (a GABA A/B agonist with clinical antidepressive properties) did not modify immobility time. On the other hand, sodium valproate (VPA), chronically administered, was effective in reducing the time of immobility of rats in the swimming test, at doses which did not alter motor activity in an open field test. Since there is evidence indicating that valproate can be considered as a GABA-mimetic agent, the present data is consistent with other results showing an antidepressant-like activity of agents which enhance GABAergic transmission.