Introduction. Lithium and olanzapine are one of the mainstay drugs in the management of bipolar affective disorder (both acute and maintenance). In clinical.
DELHI PSYCHIATRY JOURNAL Vol. 15 No.1
APRIL 2012
Case Report
Cog-Wheel Rigidity in a Young Adolescent due to Short Term Lithium — Olanzapine Combination Therapy Sujit Kumar Kar1, Anubhav Rathi2, Prabhat Sitholey3 Department of Psychiatry, C.S.M. Medical University, Lucknow, U.P. - 226003 2 Department of Psychiatry, UCMS & GTB Hospital, Delhi-110095 3 Consultant Psychiatrist, Lucknow-226 003 U.P.
1
Introduction Lithium and olanzapine are one of the mainstay drugs in the management of bipolar affective disorder (both acute and maintenance). In clinical practice, the combinations of these two drugs are commonly used in the management of acute phase of mania. Lithium has a narrow therapeutic index and side effects are fairly common with its use. The psycho-neurological side effects of lithium are: dysphoria, lack of spontaneity, slow reaction time, memory difficulties, altered creativity, tremor (postural), dysarthria, ataxia, neuromuscular irritability, seizures, coma, death, peripheral neuropathy, benign intracranial hypertension, myasthenia gravis like syndrome and lowered seizure threshold 1. The side effects of olanzapine include: metabolic disturbances (dyslipidemia, insulin resistance and hyperglycaemia), weight gain, sedation, dry mouth, constipation, tachycardia, peripheral edema, orthostatic hypotension (usually during initial doses), tardive dyskinesia and rash (last two are rare side effects). Although this combination (of lithium and olanzapine) is safe but it may, however result in a synergistic increase in the symptoms of lithium-induced neurological side effects and neuroleptic (olanzapine) extrapyramidal symptoms. 1 There have been several reports of extra-pyramidal side effects (e.g. tremor, oro-facial or whole body movements and cogwheel rigidity) after lithium- antipsychotic combination therapy2-7 and specifically with lithium-olanzapine combi216
nation. 8,9 However, to the best of author ’s knowledge there has been no case report till date on children and adolescents developing cog-wheel rigidity on lithium-olanzapine combination. We hereby report, case of a young adolescent with mania who developed cog-wheel rigidity on short term lithium-olanzapine combination therapy (
