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Indian Journal of Psychiatry
Medknow Publications
Publication Date
  • Case Report
  • Medicine
  • Psychology


Indian Journal of Psychiatry, April 1988,30(2), pp 201-203 LITHIUM-INDUCED PARADOXICAL NEUROTOXICITY- A RISK FACTOR CHITTARANJAN ANDRADE1 B.N. GANGADHAR2 S.M. CHANNABASAVANNA3 Introduction Though lithium-induced neurotoxic- ity usually occurs when serum lithium ex- ceeds 2.0 mEq/1, reports and reviews document its occurence with serum lithium within the therapeutic range (Strayhorn and Nash 1977; Hansen and Amidsen 1978; Speirs and Hirsch 1978; West and Meltzer 1979). Neurotoxicity has even been described with serum lithium bet- ween 0.4 and 0.5 mEq/l (Hansen and Amidsen 1978). Many hypotheses have been suggested to explain this paradoxical neurotoxicity. These include: interactions with other drugs such as haloperidol and diuretics (Strayhorn and Nash 1977), diphenylhydantoin (Speirs and Hirsch 1978) and phenothiazines (Spring 1979); tissue retention (Strayhorn and Nash 1977); seizure diathesis (Strayhorn and Nash 1977); high pretoxic global ratings of psychotic symptomatology and anxiety (West and Meltzer 1979); old age (Van der Velde 1971); schizophrenia (Shopsin and Gershon 1973); intercurrent medical ill- ness (Shopsin and Gershon 1973; Strayhorn and Nash 1977). Persistence of neurological deficits after recovery is also known, but not fol- lowing paradoxical neurotoxicity (Hansen and Amidsen 1978; Schou, 1984). Cerebel- lar deficits are most common, but pyramidal signs or cognitive deficits may also occur (Schou 1984). We present the course and outcome of a case of lithium-induced paradoxical neurotoxicity, discuss certain unusual fea- tures, and suggest a hypothesis to explain our observations. Case Report R., a 20 year old female, moderately mentally-retarded as per the diagnosis at a previous consultation, was brought with a 4 month history of psychological dysfunction fulfilling the criteria for a diagnosis of mania on DSM III. Physical examination was nor- mal. She was started on lithium carbonate, 300mg thrice daily. Eight

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