Normann C, Brandt C, Berger M, Walden J
University of Freiburg, Department of Psychiatry and Psychotherapy, Germany.
Pharmacopsychiatry. 1998 Sep;31(5):201-4. doi: 10.1055/s-2007-979328.
We report the case of a bipolar patient developing severe delirium and extrapyramidal signs shortly after initiation of a lithium-neuroleptic combination therapy. Clinical presentation, EEG changes and lithium plasma levels showed a close correlation. The delirium was reversible when all drugs were stopped; however, dyskinesia was found to be persistent after a period of 6 months. This rare syndrome is difficult to differentiate from lithium intoxication and neuroleptic malignant syndrome. Given the additional use of valproate and biperiden in this patient, valproate encephalopathy and anticholinergic delirium are further differential diagnoses. To avoid this serious pharmacodynamic drug interaction, patients should be closely monitored when lithium-neuroleptic comedication is started.
我们报告了一例双相情感障碍患者，在开始锂盐与抗精神病药物联合治疗后不久出现严重谵妄和锥体外系症状。临床表现、脑电图变化和血浆锂水平显示出密切相关性。当停用所有药物时，谵妄是可逆的；然而，6个月后发现运动障碍持续存在。这种罕见的综合征很难与锂中毒和抗精神病药物恶性综合征相鉴别。鉴于该患者额外使用了丙戊酸盐和安坦，丙戊酸脑病和抗胆碱能谵妄是进一步的鉴别诊断。为避免这种严重的药效学药物相互作用，开始锂盐与抗精神病药物联合用药时应密切监测患者。
