Table of Contents Table of Contents
Previous Page  171 / 812 Next Page
Information
Show Menu
Previous Page 171 / 812 Next Page
Page Background

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S116–S348

S167

EW149

The syndrome of irreversible

lithium-effectuated neurotoxicity:

Clinical case and review

F. Leite

1 ,

, H. Salgado

2

, S. Viveiros

3

, P. Coya

3

1

Matosinhos, Portugal

2

Hospital de Magalhães Lemos, Servic¸ o C, Porto, Portugal

3

Centro Hospitalar do Porto, Servic¸ o de Psiquiatria de Ligac¸ ão e

Psicologia Clínica, Porto, Portugal

Corresponding author.

Introduction

Lithium is a mood stabilizer used in the treatment

of bipolar disorder. Lithium has recently been associated to perma-

nent neurological damage namely persistent cerebelar dysfunction

as well as peripheral and central neuropathies.

Objectives

To present a clinical case of a probable Syndrome

of Irreversible Lithium-effectuated Neurotoxicity (SILENT) and a

review of the literature concerning this rare syndrome.

Aims

Increase awareness and knowledge of SILENT.

Methods

Psychiatric and psychological evaluation of a proba-

ble clinical case of SILENT and review of the literature using the

key words “lithium neurotoxicity” and “Syndrome of Irreversible

Lithium-effectuated Neurotoxicity”.

Results

A 54-year-old female patient was admitted in our hos-

pital due to involuntary lithium intoxication, with acute renal and

cardiovascular failure, neurological, metabolic and electrolytic dys-

function in an acute confusional state and in need of dialysis.

The patient clinical picture rapidly improved although, when she

achieved normal lithium seric levels, it was observed a worsening

of the preexisting confusional state followed by two consecutive

generalized tonic-clonic convulsions and a partial convulsion. A

short time after, it was recognized the development of a persistent

catatonic state. It was detected urinary incontinence and repetitive,

monosyllabic, incoherent, short phrased speech featuring echolalia,

togetherwith emotional lability and incongruous affect. The patient

slightly improved with the introduction of anti-Parkinson’s phar-

macotherapy.

Conclusions

This clinical case raises several differential diagnoses

due to its psychiatric and neurologic characteristics. We conclude

that the most probable diagnosis is SILENT.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.267

EW150

Psychiatric symptoms as a

presentation of central nervous

system involvement in Chagas disease,

a case report

G. Martinez-Ales

, A. Fraga , V. Bonan , E. Roman , A. Palao ,

B. Rodriguez-Vega , M.F. Bravo

Hospital Universitario La Paz, Psychiatry, Madrid, Spain

Corresponding author.

Introduction

Psychiatric symptoms set forth brain dysfunction at

several levels. Behavioral disturbances, although frequently asso-

ciated to primary psychiatric disorders, call for a previous discard

of neurologic treatable causes.

Case report

We report the case of a 30-year-old gentleman,

receiving outpatient psychological treatment and follow-up for a

3-month history of low mood, abulia, apathy, generalized malaise,

weight loss and insomnia. Non-structured jealous delusions were

also present. No neurological deficit was found. After CT of the

brain, a space occupying lesion, suggestive of glioblastoma mul-

tiforme, was found. Further studies, including biopsy and a MR,

led to the diagnosis of central nervous system Chagas, related to a

previously unknown HIV infection in AIDS status, and condition-

ing a secondary central hipothyroidism. Careful treatment of the

etiological factors, along with symptomatic relieve with low dose

paliperidone, led to the resolution of the symptoms.

Discussion

The majority of patients suffering from neurologic

diseases develop psychiatric symptoms over the course of their ill-

ness, with or without the presence of classical disturbances, such

as weakness, sensory loss or seizures. Modern psychiatry uses a

complex disease model, therefore necessarily integrating anatomy,

biochemistry and function during every diagnostic approach.

Conclusion

It is necessary to rule out frequent treatable

causes, thus involving both psychopatological and neuroscientific

approach to psychiatric disturbances. However, while underlying

causes are often difficult to treat, psychiatric symptoms respond to

existing pharmacologic and nonpharmacologic therapies.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.268

EW151

Psychotic symptoms in a patient

diagnosed with temporal lobe

epilepsy and schizoaffective disorder

G. Martinez-Ales

, V. Baena , I. Rubio , B. Rodriguez-Vega ,

V. Bonan , E. Roman , M.F. Bravo

Hospital Universitario La Paz, Psychiatry, Madrid, Spain

Corresponding author.

Introduction

Epilepsy is considered a complex neurological dis-

order, and its clinical picture can resemble many different cerebral

dysfunctions, including those associated to major psychiatric dis-

orders.

Case report

We report the case of a 52-year-old gentleman, with

a 30-year history of schizoaffective disorder and of complex par-

tial epilepsy with secondary generalization. He was admitted to

an emergency room due to a voluntary overdose with 8mg of

clonazepam. The patient explained how he had recently experi-

enced visual hallucinations and insomnia, symptoms that originally

led to the psychotic diagnosis. He had previously presented these

symptoms, along with stupor, delusions and lability, as a pro-

drome of complex motor epileptic decompensations. Thus, he

took the overdose not to suffer seizures. After carefully recons-

tructing the clinical history, psychiatric admissions had shown

seizures, and periods of clinical stability had been achieved by

regulating antiepileptic medication. Eslicarbazepine and lamotrig-

ine reintroduction, and quetiapine withdrawal, led to symptomatic

remission.

Discussion

Epilepsy and major psychiatric disorders show a high

comorbidity. There has been an effort to even include epilepsy

and psychosis in a unique diagnosis (alternant psychosis). Fur-

thermore, polimorphism and restitutio ad integrummay resemble

classic cycloid psychosis. In this case, chronological study showed

all symptoms could be explained by one disorder.

Conclusion

Epilepsy includes a variety of neuropsychiatric symp-

toms. It can be difficult to withdraw psychiatric diagnoses from

patients after years of follow-up. However, a carefully taken med-

ical history clarifies temporal criteria.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.269

EW152

Evaluation of psychomotor/motor

disturbances in elderly medical

inpatients

G. McCarthy

1 , 2 ,

, O. Fitzpatrick

1

, D. O’Neill

1

, D. Meagher

3

,

D. Adamis

1

1

Sligo Mental Health Services, Psychiatry, Sligo, Ireland

2

NUI Galway, Sligo Medical Academy, Sligo, Ireland