Lithium Plus Olanzapine: One of the Most Effective Combinations for Bipolar Disorder. A Case Report and a Concise Review of the Literature

Background: The recurrent nature of Bipolar Disorder (BD) is the main cause of disability associated with the illness. Despite the proliferation of drugs approved for the maintenance phase of BD, the relapse rate is still high. The combination of drugs, especially the potentiation of mood-stabilizers with second-generation antipsychotics, may reduce the risk of relapse and rehospitalization. However, studies on the efficacy of specific combinations are scarce. Case presentation: The clinical case of a 28-year-old woman involuntarily admitted to an Acute Psychiatric Unit is presented. She suffers a manic postpartum episode with mixed and psychotic features. During the hospitalization, she is successfully treated with a combination of lithium plus olanzapine. In the discussion, a concise narrative review of the scientific literature on the efficacy of such a combination in BD is made. Conclusion: The association of lithium plus olanzapine is one of the combinations with most evidence on its efficacy in BD, especially in mixed-featured episodes. Tolerability concerns should not be an obstacle to its use, although they must be considered

Psychotic Features Among Patients in the Prodromal Stage of Dementia with Lewy Bodies During Longitudinal Observation

Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features, including hallucinations, depression, catatonia, and delusions before the onset of cognitive impairment. However, the characteristic features of these psychotic symptoms in prodromal DLB have not been sufficiently described. Objective: To clarify and describe the psychotic features of prodromal DLB before overt cognitive impairment. Methods: The authors analyzed the characteristic psychotic features of prodromal DLB in 21 subjects who developed severe psychotic symptoms without dementia and were diagnosed as DLB after the longitudinal observation period. They were then confirmed to have DLB through indicative and supportive biomarkers of scintigraphy. Results: The psychotic features included a wide variety of symptoms, but convergent to three principal categories: catatonia, delusions-hallucinations, and depression and/or mania. Catatonia was observed in nine cases, five were delusional-hallucinatory, and seven were manic and/or depressive. Seven of the 21 cases exhibited delirium during longitudinal observation. A psychotic state repeatedly appeared without any trigger in 20 of the 21 patients. All subjects developed cognitive impairment at 9.1±4.6 (mean±SD) years after the initial appearance of psychotic symptoms, and subsequently diagnosed with DLB at 71.3±6.1 (mean±SD) years. Conclusion: Elderly patients with psychotic symptoms, such as catatonia, delusion-hallucination, manic and/or depressive features, and delirium without dementia, could indicate symptomatic psychosis or a prodromal stage of any neurocognitive disorder such as DLB. Therefore, further extensive workout (e.g., radioisotope neuroimaging) is required to avoid misdiagnosis.

Haloperidol-induced isolated lingual dystonia

A 28-year-old woman presenting with agitation and mania with psychotic features developed symptoms of isolated lingual dystonia shortly after the initiation of a haloperidol concentrate regimen.

Psychotic Features as Initial Presentation of Intracranial Epidermoid of Suprasellar Origin

Intracranial epidermoids are rare congenital lesions which account for around 1% of all intracranial tumors. They present most commonly in cerebello-pontine angle followed by suprasellar region, along with different intracranial areas. The most common presentation includes headache, cranial nerve deficiets, seizures, raised intracranial pressure. It is extremely uncommon for epidermoid tumors to present with psychiatric symptoms. We present a case of 38 year old female with history of psychosis for 2 years with personality change, disorganised behavior and delusions. An episode of increased sedation and semi-consciousness led to neuroimaging which revealed a large epidermoid tumor of suprasellar region and interpeduncular region. Surgical resection of the epidermoid was done and patient was maintained on drug treatment. Keywords: Epidermoid tumour, Psychosis

Carbamazepine drug reaction involving high fevers during the COVID-19 era

Carbamazepine has demonstrated anticonvulsant properties and is used for a variety of indications in psychiatry and neurology. Total daily doses typically range from 200 to 1200 mg/d, generally divided into 2 doses. Carbamazepine has a broad side-effect profile but is not typically thought to produce high fevers in the absence of a hypersensitivity syndrome. This is a case of a probable adverse drug reaction to carbamazepine consisting of fever without severe major organ involvement. In this instance, a patient in a manic episode with psychotic features was briefly transferred to a COVID-19 unit to rule out coronavirus infection before the fever resolved.