Lithium: contributor to movement disorder sensitivity after anoxic brain injury?

Although lithium-induced dystonia has been well documented in the literature, conflicting evidence discusses whether a patient may be susceptible to adverse effects from the drug after an anoxic brain injury. More recent literature discusses that lithium may, in fact, be neuroprotective. This case report presents a 35-year-old male who, after an anoxic brain injury after a suicide attempt, developed lithium-induced dystonia with characteristic symptoms of sustained muscle contractions, repetitive movements, and postures, which was not markedly improved with benztropine or benzodiazepines. It is postulated that because this patient received a depot neuroleptic with a subsequent anoxic brain injury, he may have become more sensitive to lithium and its rare complications.

Andrew Voyce in conversation with Jerome Carson

PurposeThis paper aims to provide a profile of Andrew Voyce.Design/methodology/approachAndrew gives a short biography and is then interviewed by Jerome. Areas covered in the interview include the central role of Mrs Thatcher in closing down the old asylums, homelessness, education, benefits and digital art.FindingsAndrew's recovery from long term mental health problems has seen him return to higher education. He failed to get his undergraduate degree, but decades later and with the encouragement of workers in the community, he completed both undergraduate and postgraduate studies. He talks of the negative impact of asylum care, especially the terrible side effect of akathisia, which resulted from the depot neuroleptic medication.Originality/valueThis paper shows a remarkable journey of recovery, from a life of being a “revolving door” patient, to homelessness, to re‐establishing an ordinary life in the community. The inmate's perspective is one that has largely been absent from narratives of asylum care.

Evidence for use of depot neuroleptic medication

Objective:To review the evidence guiding conventional and atypical depot neuroleptic usage.Method:A search of biomedical electronic databases including Medline, Embase, PsychInfo and Cochrane was performed. Hand searching of journals was also carried out.Results:Depot neuroleptics are safe and effective in the maintenance treatment of patients with schizophrenia. There is some evidence to support the use of depot neuroleptics in illnesses other than schizophrenia. The evidence base guiding depot usage is sparse.Conclusions:Although guidelines are emerging there is a pressing need for rigorous well designed trials of depot antipsychotic usage. The advent of atypical depot antipsychotic preparations should stimulate research in this important area of clinical practice.

Outcome Comparison of Patients Receiving Oral or Depot Neuroleptic Medication

Three outcome measures of psychiatric treatment were retrospectively compared between two groups of acutely hospitalized psychotic patients who had been prescribed either oral haloperidol ( n = 58) or depot haloperidol ( n = 95) as the only medication at the time of discharge. There were no significant differences between the groups on demographic variables, including sex, age, and ethnicity. There were no significant differences between the groups on keeping the initial outpatient appointment, in readmission history over a 4-yr. follow-up, or in length of time to subsequent readmission, if any. It appears that there is no benefit in choosing one form of medication over the other from a clinical perspective, as neither appears more clinically efficacious when examined on these outcome variables. However, there is a significant difference in cost of the two forms of the medication in favor of the oral form, making the oral form more favorable if cost is to be minimized.