European Psychiatry - Volume 33 - March 2016

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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 ∗, H. Salgado , S. Viveiros , P. Coya
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.
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.
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.
EW152
Evaluation of psychomotor/motor
disturbances in elderly medical
inpatients
G. McCarthy ∗, O. Fitzpatrick , D. O’Neill , D. Meagher ,
D. Adamis
1 Sligo Mental Health Services, Psychiatry, Sligo, Ireland
2 NUI Galway, Sligo Medical Academy, Sligo, Ireland