title: Delirium and extrapyramidal symptoms due to a lithium-olanzapine combination therapy: a case report.
abstract: We report an elderly patient who developed severe delirium and extrapyramidal signs after initiation of lithium-olanzapine combination. On hospital admission, serum levels of lithium were found to be 3.0 mM/L which were far above toxic level. Immediate discontinuation of both drugs resulted in complete resolution of most of the symptoms except for perioral dyskinesia which persisted for three more months. We critically discussed the differential diagnosis of lithium intoxication and assessed confounding factors which induce delirium and extrapyramidal signs related with combination therapy of lithium and olanzapine.
authors.affiliation: Department of Psychiatry, Trakya University, Edirne, Turkey. ctuglu@hotmail.com
authors.forename: Cengiz
authors.initials: C
authors.lastname: Tuglu
authors.forename: Esin
authors.initials: E
authors.lastname: Erdogan
authors.forename: Ercan
authors.initials: E
authors.lastname: Abay
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001480:Basal Ganglia Diseases / Q000139:chemically induced*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D003693:Delirium / Q000139:chemically induced*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008094:Lithium / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D000077152:Olanzapine
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D008094:Lithium; D000077152:Olanzapine