Psychopharmacologist's Serve as EXPERTS for COMPLEX Neuropsychiatric Cases – SILENT SYNDROME

What Is Lithium

Lithium is a mood stabilizer medication that works in the brain. It is approved for the treatment of bipolar disorder (also known as manic depression).

Symptoms of depression include:

• Depressed mood — feeling sad, empty, or tearful

• Feeling worthless, guilty, hopeless, or helpless

• Loss of interest or pleasure in normal activities

• Sleep and eat more or less than usual (for most people it is less)

• Low energy, trouble concentrating, or thoughts of death (suicidal thinking)

• Psychomotor agitation (‘nervous energy’)

• Psychomotor retardation (feeling like you are moving in slow motion)

Symptoms of mania include:

• Feeling irritable or “high”

• Having increased self esteem

• Feeling like you don’t need to sleep

• Feeling the need to continue to talk

• Feeling like your thoughts are too quick (racing thoughts)

• Feeling distracted

• Getting involved in activities that are risky or could have bad consequences (e.g., excessive spending)

Possible Side Effects of Lithium?

• Headache

• Nausea or vomiting

• Diarrhea

• Dizziness or drowsiness

• Changes in appetite

• Hand tremors

• Dry mouth

• Increased thirst

• Increased urination

• Thinning of hair or hair loss

• Acne-like rash

SILENT

SILENT: the Syndrome of Irreversible Lithium-Effectuated Neurotoxicity. First named in the 1980s, with the original case report dating back to 1949 when lithium chloride was being used as a substitute for table salt.

SILENT syndrome is defined as prolonged neurological complications of lithium toxicity despite removal of the medication and normalization of serum lithium levels. Lithium is known to have slow absorption into the central nervous system making serum concentrations unreliable when correlating clinically.

Toxicological Approach to Patient Case

Patient presents to emergency department with acute kidney injury, course tremors, ataxia and significant confusion. Blood Lithium level at trough 0.8 mEq/L, patient undergoes treatment for diagnosed lithium toxicity. Post discharge, patient hires a medical malpractice attorney to alleging catastrophic injuries secondary to prescribing Physicians negligence.

Critical to the case is the identification of SILENT syndrome versus an acute lithium toxicity. An expert psychopharmacologist/toxicologist has the education and experience to delineate these distinct presentations.