Neurotoxicity with Therapeutic Lithium Levels: A Case Report

Neurotoxicity with Therapeutic Lithium Levels: A Case Report
Journal of Psychiatric Practice, 02/12/09

Grueneberger EC et al. - This case report describes the history and hospital course of an otherwise healthy 20-year-old male with bipolar I disorder who developed symptoms of severe lithium toxicity, culminating in a seizure, despite a level of lithium of only 0.8 mEq/L, within the usual therapeutic range. The discussion emphasizes that lithium toxicity is diagnosed by clinical symptoms and can occur even at usual therapeutic blood levels.

 

 

Atypical antipsychotic drugs and the risk of sudden cardiac death
New England Journal of Medicine, 01/22/09

Ray WA et al. ? Current users of typical and atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death. Methods

• Retrospective cohort study of Medicaid enrollees in Tennessee for calculation of adjusted incidence of sudden cardiac death among current users of antipsychotic drugs
• Primary analysis: baseline users of single typical (44,218) and atypical (46,089) drugs and matched nonusers of antipsychotic drugs (186,600)
• Secondary analysis of antipsychotic drug users with no baseline diagnosis of schizophrenia or related psychoses and matched nonusers by propensity score
• Propensity score: predicted probability as users of antipsychotic drugs

Results

• Current users of typical and atypical antipsychotic drugs had higher rates of sudden cardiac death than did nonusers of antipsychotic drugs, with adjusted incidence-rate ratios of 1.99 and 2.26, respectively
• Incidence-rate ratio for users of atypical antipsychotic drugs vs users of typical antipsychotic drugs: 1.14
• Former users of antipsychotic drugs had no significantly increased risk (incidence-rate ratio, 1.13)
• For both drug classes, risk for current users increased significantly with increasing dose
• For users of typical antipsychotic drugs, incidence-rate ratios increased from 1.31 for low doses to 2.42 for high doses
• For users of atypical agents, incidence-rate ratios increased from 1.59 for low doses to 2.86 for high doses
• Similar findings in cohort matched for propensity score.