Managing Psychosis in Acute Intermittent Porphyria: A Case Report on Olanzapine Use

Acute intermittent porphyria (AIP) is the most common type of acute porphyria, caused by reduced porphobilinogen deaminase activity, leading to accumulations of neurotoxic compounds. Symptoms usually include abdominal pain, autonomic dysfunction, neurological involvement, and psychiatric symptoms. Neuropsychiatric symptoms such as psychosis are common and may contribute to diagnostic delays. We report a case of a middle-aged woman presenting with psychiatric and neurovisceral symptoms of AIP. This report discusses the case of a 41-year-old woman with no prior psychiatric history presenting with an acute onset of psychotic symptoms, including persecutory, erotomanic, and Capgras delusions, disorganized behavior, and agitation, along with physical symptoms of acute abdominal pain and autonomic disturbances. An extensive organic workup revealed elevated urinary porphobilinogen, which confirmed the diagnosis of AIP. The patient was treated medically, and her psychiatric symptoms completely resolved with olanzapine within eight days, without adverse effects. This case reveals the importance of considering AIP in patients presenting with acute psychosis, particularly when accompanied by autonomic and abdominal symptoms. Olanzapine appears to be a safe and effective treatment for AIP-related psychosis, though careful monitoring is essential due to the variable drug responses and potential hepatic risks. Further studies are needed to establish standardized treatment guidelines for neuropsychiatric symptoms in AIP.