Delirium associated with lithium-quetiapine combination.
OBJECTIVE
Acute lithium intoxication is a frequent complication of this treatment used for manic depressive disorders. Because lithium has a narrow therapeutic index and widespread use, its neuropsychiatric side effects are more prevalent than those of other psychotropic medications. There are only few reports about it within therapeutic serum levels. The question of toxic interactions resulting from combinations of lithium and neuroleptic drugs is largely based on anecdotal reports.


METHODS
We report here a case of a patient with schizophrenia with severe delirium developed shortly after initiation of a lithium-quetiapine combination therapy, despite therapeutic doses of both medications.


CONCLUSIONS
The psychiatric symptoms disappeared when lithium was stopped. We interpret these symptoms as delirium with pseudodementia at therapeutic lithium serum levels. Our conclusion is that lithium-induced neurotoxicity should be suspected in any patient receiving lithium in combination with neuroleptics or any other clinical variable. In such cases, regardless of lithium serum levels, the clinician should consider immediate discontinuation of the medication.
Division of Psychiatry, Ministry of Health Mental Health Center, Faculty of Health Sciences Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
Chanoch
C
Miodownik
Awad
A
Alkatnany
Katherina
K
Frolova
Vladimir
V
Lerner
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000097:blood; D003693:Delirium / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D003975:Diazepam / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D018020:Lithium Compounds / Q000009:adverse effects* / Q000097:blood; D008297:Male; D008875:Middle Aged; D000069348:Quetiapine Fumarate; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome; D028761:Withholding Treatment
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D006993:Hypnotics and Sedatives; D018020:Lithium Compounds; D000069348:Quetiapine Fumarate; D006220:Haloperidol; D003975:Diazepam