Am J Psychiatry 1979; 136:963-966
Copyright © 1979 by American Psychiatric Association
Paradoxical lithium neurotoxicity: a report of five cases and a hypothesis about risk for neurotoxicity
AP West and HY Meltzer
There have been many reports of probable lithium-induced organic brain
syndromes occurring when serum lithium levels are within or close to the
therapeutic range. The authors report on five patients who developed
clinical syndromes suggestive of severe neurotoxicity during lithium
treatment. In all cases lithium levels were between .75 and 1.7 mEq/liter.
The patients who developed neurotoxicity had markedly higher global ratings
of psychotic symptomatology and anxiety in the pretoxic period than did
patients who never deveoped neurotoxicity. When the acute manic state is
characterized by marked psychotic symptoms and intense anxiety, it may be
associated with increased vulnerability to the development of severe
lithium neurotoxicity.
