Delirium and extrapyramidal symptoms due to a lithium-olanzapine combination therapy: a case report.
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.
Tuglu
Cengiz
C
Department of Psychiatry, Trakya University, Edirne, Turkey. ctuglu@hotmail.com
Erdogan
Esin
E
Abay
Ercan
E
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
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D008094:Lithium; D000077152:Olanzapine