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Delirium associated with lithium-quetiapine combination
Chanoch Miodownik1, Awad Alkatnany, Katherina Frolova
1Division of Psychiatry, Ministry of Health Mental Health Center, Faculty of Health Sciences Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
Clinical Neuropharmacology
|June 4, 2008
Summary
Lithium-quetiapine combination therapy can cause severe delirium even at therapeutic levels. Discontinue lithium immediately if neurotoxicity is suspected, regardless of serum levels, to resolve psychiatric symptoms.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Lithium is a common treatment for bipolar disorder, but has a narrow therapeutic index.
- Neuropsychiatric side effects of lithium are common, with few reports at therapeutic serum levels.
- Toxic interactions between lithium and neuroleptics are largely based on anecdotal evidence.
Purpose of the Study:
- To report a case of severe delirium in a schizophrenia patient treated with lithium and quetiapine.
- To investigate potential neurotoxicity from combined lithium and neuroleptic therapy at therapeutic doses.
Main Methods:
- Case report of a schizophrenia patient.
- Initiation of lithium-quetiapine combination therapy.
- Monitoring of patient's psychiatric symptoms and lithium serum levels.
Main Results:
- The patient developed severe delirium shortly after starting lithium-quetiapine.
- Psychiatric symptoms resolved upon discontinuation of lithium.
- Delirium occurred despite therapeutic serum levels of lithium.
Conclusions:
- Lithium-induced neurotoxicity should be suspected in patients on combined lithium and neuroleptic therapy.
- Clinicians should consider immediate lithium discontinuation if neurotoxicity is suspected, irrespective of serum levels.
- This case highlights the potential for severe adverse psychiatric effects even within therapeutic ranges.
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