Lithium Toxicity and Neuroleptic Malignant Syndrome in a Patient with Bipolar Disorder

Abstract

A combination of treatments are usually preferred by psychiatrists in managing acute manic exacerbations in patients with bipolar disorder. The most commonly used mix of psychotropic drugs to control mania consists of a known mood stabilizer - such as lithium or divalproex - plus an antipsychotic, though, these drugs can cause serious side effects. Neuroleptic Malignant Syndrome (NMS) occurs rarely in patients taking antipsychotic drugs and this infrequency makes diagnosis difficult in critically ill, Intensive Care Unit (ICU) patients. On the other hand, lithium toxicity can occur frequently in patients with bipolar disorder due to its narrow therapeutic index. Although rare, lithium toxicity and NMS may occur simultaneously in patients using antipsychotics and lithium together, resulting in severe morbidity or even mortality. The following research describes a patient on concomitant olanzapine and lithium treatment, who was diagnosed with NMS and lithium toxicity.