474 - Special considerations for lithium use in Older Age Bipolar Disorder

Lithium is the oldest and still one of the most frequently prescribed mood stabilizers in the treatment of bipolar disorder. Though, the implications of lithium use in the older population remain less understood. This work aims to provide an understanding of the impact of lithium in older age bipolar disorder, including tolerability and efficacy.A non-systematic review was performed on PubMed database, using the key words “lithium older adult bipolar disorder” and references from recent international bipolar disorder guidelines.There is an evidence base that lithium is effective in older age bipolar disorder. Aging-associated pharmacokinetic and pharmacodynamic changes as well as increased rates of medical comorbidities and polypharmacy predispose older patients to a higher risk of lithium toxicity. Careful monitoring and adjustment of lithium dosage is especially important in older adults to minimize the risk of toxicity.

The syndrome of irreversible lithium-effectuated neurotoxicity: Clinical case and review

IntroductionLithium is a mood stabilizer used in the treatment of bipolar disorder. Lithium has recently been associated to permanent neurological damage namely persistent cerebelar dysfunction as well as peripheral and central neuropathies.ObjectivesTo present a clinical case of a probable Syndrome of Irreversible Lithium-effectuated Neurotoxicity (SILENT) and a review of the literature concerning this rare syndrome.AimsIncrease awareness and knowledge of SILENT.MethodsPsychiatric and psychological evaluation of a probable clinical case of SILENT and review of the literature using the key words “lithium neurotoxicity” and “Syndrome of Irreversible Lithium-effectuated Neurotoxicity”.ResultsA 54-year-old female patient was admitted in our hospital due to involuntary lithium intoxication, with acute renal and cardiovascular failure, neurological, metabolic and electrolytic dysfunction in an acute confusional state and in need of dialysis. The patient clinical picture rapidly improved although, when she achieved normal lithium seric levels, it was observed a worsening of the preexisting confusional state followed by two consecutive generalized tonic-clonic convulsions and a partial convulsion. A short time after, it was recognized the development of a persistent catatonic state. It was detected urinary incontinence and repetitive, monosyllabic, incoherent, short phrased speech featuring echolalia, together with emotional lability and incongruous affect. The patient slightly improved with the introduction of anti-Parkinson's pharmacotherapy.ConclusionsThis clinical case raises several differential diagnoses due to its psychiatric and neurologic characteristics. We conclude that the most probable diagnosis is SILENT.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Anomalous temperature-dependent Raman scattering in lithium hydrazinium sulfate

Results of a polarized Raman scattering study of single crystal lithium hydrazinium sulfate, LiN2H5SO4, over a temperature interval from 11 to 300 K are discussed. Unusual temperature dependence of the band center scattering intensity is observed in a few intramolecular hydrazinium modes, intramolecular sulfate ion modes, and lattice modes. The intensity of these modes increases with increasing temperature from 11 K to about 175 K, then abruptly decreases over a small interval between 175 and 200 K. Above 200 K the band center intensity then exhibits normal behavior, slowly decreasing with increasing temperature. Possible explanations for this anomalous behavior are discussed. Key words: lithium hydrazinium sulfate, proton conductor, Raman spectroscopy.