Neurological side effects of lithium

Özdin, Selçuk; Sarısoy, Gökhan

doi:10.5455/jmood.20130521121833

Cited by 3 publications

(5 citation statements)

References 58 publications

(79 reference statements)

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“…Serious neurological findings such as encephalopathy, parkinsonism and ataxia may occur in lithium intoxication. Various drugs can be used in parkinsonism due to the combination of lithium and risperidone [2]. We tried pramipexole treatment in this case, and we found the case worth presenting because of the complete complete resolution of symptoms.…”

Section: Introductionmentioning

confidence: 87%

“…In lithium-induced parkinsonism, symptoms such as bradykinesia, resting tremor, and cogwheel are seen. Although the mechanism of lithiuminduced parkinsonism is not clear, some researchers have focused on factors such as a decrease in the amount of dopamine in the striatum, the cholinergic effect of lithium with its anticholinesterase effect, and the previous damage to the basal ganglia in patients with parkinsonism [2].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have reported that benztropine is not effective on tremor and cogwheel symptoms in the treatment of lithium-induced parkinsonism. Drugs reported to be effective in these symptoms are primidone, β-blockers and amantadine [2].…”

Section: Introductionmentioning

confidence: 99%

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2022

Clin Med Rev Case Rep

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Lithium is a drug that has been used in the treatment of bipolar disorder for many years. Due to its narrow therapeutic range, systemic side effects can be seen frequently. Serious side effects can occur even in non-toxic doses. We present a case of parkinsonism and encephalopathy developed in a patient with normal lithium blood level who used lithium and risperidone combination therapy for bipolar disease.

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Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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2022

Clin Med Rev Case Rep

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“…Nonetheless, despite its first-line status and its demonstrated overall efficacy in these settings, lithium therapy has been shown to be ineffective or poorly tolerated in a significant proportion of patients. In addition, it has a narrow therapeutic range and requires regular blood level monitoring, as severe or toxic effects can occur at twice the therapeutic dose [9]. Its narrow therapeutic range is an especially important consideration in older patients as their renal excretion becomes less efficient, resulting in an increased risk of lithiumassociated toxic effects [9].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, it has a narrow therapeutic range and requires regular blood level monitoring, as severe or toxic effects can occur at twice the therapeutic dose [9]. Its narrow therapeutic range is an especially important consideration in older patients as their renal excretion becomes less efficient, resulting in an increased risk of lithiumassociated toxic effects [9]. On the other hand, clinical evidence of the efficacy of carbamazepine in the treatment of bipolar disorder emerged in the early 1970s.…”

Section: Introductionmentioning

confidence: 99%

Extended-release carbamazepine versus lithium in management of acute mania in male inpatients with bipolar I disorder

Shafti

H²

2018

Psychiatry and Clinical Psychopharmacology

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INTRODUCTION:Since extended-release formulations of CBZ have been developed to decrease daily fluctuations in serum CBZ concentrations and improve dosing convenience, several large clinical trials have recently been conducted to assess the efficacy and tolerability of this form of CBZ in bipolar disorder. In the present assessment, extendedrelease carbamazepine has been compared with lithium, in a head-to-head evaluation, to assess its efficacy and safety in a group of non-Western patient population with diagnosis of acute mania. METHOD: Fifty male inpatients with diagnosis of bipolar I disorder, according to Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5), entered into a 3-week study, for random assignment to extended-release carbamazepine or lithium carbonate. The assessment had been accomplished as a double-blind design, while the patients, staff, prescribers, and assessor were unaware of the prescribed drugs that were packed into identical capsules. Primary outcome measure in the present assessment was Manic State Rating Scale (MSRS), which had been scored at baseline and weekly intervals up to the third week. Also, insight and overall illness severity and improvement had been rated by the Schedule for Assessment of Insight (SAI), Clinical Global Impressions-Global Improvement Scale (CGI-I), and Clinical Global Impressions-Severity Scale (CGI-S), respectively. Treatment effectiveness had been analysed by t-test and repeated measures analysis of variance (ANOVA). Statistical significance had been defined as p-value ≤.05. RESULTS: While mean total score of MSRS improved significantly by both lithium and extended-release carbamazepine at the end of the third week, between-group analysis displayed significant advantage of lithium, regarding both frequency and intensity, at the end of trial. Mean total score of SAI showed significant improvement by both of them. However, again, the CGI-I demonstrated significant improvement by extended-release carbamazepine and lithium, CGI-S revealed significant progress only by lithium. Moreover, the effect size (ES) analysis showed large improvement of MSRS with lithium and medium improvement by extended-release carbamazepine. Post hoc power analysis showed an intermediate power of 0.42 on behalf of the present assessment. CONCLUSION: Although both extended-release carbamazepine and lithium were helpful for improvement of manic symptoms, treatment with lithium seems to be more advantageous. ARTICLE HISTORY

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Ciddi Nörolojik Bulgularla Birlikte Giden Lityum Zehirlenmesi Olgusu

TUĞ,

ŞAHİN CAN,

ALTUNÖZ

et al. 2023

Balıkesir Medical Journal

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Lithium is used for the treatment of bipolar disorder and some other psychiatric disorders. Due to the narrow therapeutic range, intoxications are common. In this case, chronic lithium intoxication with severe neurological symptoms was discussed in light of the literature. A 72-year-old female patient. The patient had been receiving psychiatric treatment for 7 years with the diagnosis of unipolar depression. In the 6th month of lithium use, she was brought by her relatives with complaints of drowsiness, tremor, muscle twitching, and difficulty walking. On examination, consciousness was confused, there was no cooperation orientation and there was general rigidity, tremor, fasciculations, and ataxic gait. Vital signs; blood pressure 147/92 mmHg, heart rate 69 bpm, SpO2: 94%. The laboratory tests: lithium 2.98 mEq/L, potassium 5.8 mmol/l, sodium 129 mmol/l, creatinine 1.66 mg/dl, urea 166 mg/dl. The patient was transferred to the internal medicine clinic with the diagnosis of lithium intoxication. Lithium treatment was discontinued. On the 7th day, her neurological symptoms improved with supportive treatment, and biochemical parameters returned to normal. A lithium concentration of more than 3.5 mEq/L was defined as severe poisoning. Neurological findings are prominent in severe poisonings. Especially, geriatric population is at greater risk. In our case; age, use of three different groups of diuretics as antihypertensive treatment, and urinary tract infection were defined as factors that predispose to poisoning. In this case, it's emphasized that although the lithium blood level isn't very high, severe neurological symptoms can be seen clinically in the presence of risk factors.

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Neurological side effects of lithium

Cited by 3 publications

References 58 publications

Untitled

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Extended-release carbamazepine versus lithium in management of acute mania in male inpatients with bipolar I disorder

Ciddi Nörolojik Bulgularla Birlikte Giden Lityum Zehirlenmesi Olgusu

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