Adult ; Delirium ; chemically induced ; Female ; Humans ; Thiocarbamates ; poisoning

We report an elderly patient who developed severe delirium and extrapyramidal signs after initiation of lithium-olanzapine combination. On hospital admission, serum levels of lithium were found to be 3.0 mM/L which were far above toxic level. Immediate discontinuation of both drugs resulted in complete resolution of most of the symptoms except for perioral dyskinesia which persisted for three more months. We critically discussed the differential diagnosis of lithium intoxication and assessed confounding factors which induce delirium and extrapyramidal signs related with combination therapy of lithium and olanzapine.
Antipsychotic Agents/adverse effects/therapeutic use ; Basal Ganglia Diseases/*chemically induced ; Benzodiazepines/adverse effects/therapeutic use ; Bipolar Disorder/drug therapy ; Delirium/*chemically induced ; Drug Therapy, Combination ; Female ; Humans ; Lithium/*adverse effects/therapeutic use ; Middle Aged

Systemic steroids are highly effective for patients with moderate-to-severe asthma exacerbations. Steroid-induced psychosis is known to be one of the adverse effects of steroid therapy, although infrequent. However, there is no reliable method of predicting steroid psychosis. We experienced the case of a 40-year-old asthmatic man who had previously taken steroids without any psychological side effect, but became acutely delirious after receiving some doses of steroids, higher than the previous doses, under a condition of emotional stress. The mean dose of prednisolone administered was 82 mg/day (1.37 mg/kg/day) for 10 days but the patient had taken two courses of steroids (0.82 mg/kg/day and 0.5 mg/kg/day, respectively) for asthma exacerbations without any psychiatric episodes during the previous year.At this time, the patient was under a condition of emotional stress related to family reasons. The asthmatic exacerbation of this case may be precipitated from sudden emotional stress and the following treatment with a high dose of steroida should be used cautiously due to the possibility of psychotic side reactions.
Adult ; Asthma/drug therapy ; Case Report ; Delirium/*chemically induced ; Glucocorticoids, Synthetic/administration & dosage/*adverse effects ; Human ; Male ; Prednisolone/administration & dosage/*adverse effects