In one such case, McGovern described an elderly female patient, with a history of endogenous depression,

who developed tremor, vertigo, ataxia and dysphasia, following the initiation of lithium within normal therapeutic serum levels [McGovern, 1983]. In addition, Brown and colleagues described the case of a 64-year-old woman with a 25-year history of schizoaffective disorder who developed delirium following treatment Inhibitors,research,lifescience,medical with lithium, also within the therapeutic serum level [Brown and Rosen, 1992]. Tricyclic antidepressants can also cause neurological side effects such as confusion, impaired memory and paresthesia [Joint Formulary Committee, 2011]. Although, there are no case reports of dyspraxia associated with tricyclic antidepressants when used alone in the literature. However, there is an increased risk of selleck chemicals llc toxicity when tricyclic antidepressants are used in combination with lithium. Worrall Inhibitors,research,lifescience,medical and colleagues published a case describing slowly developing constructional dyspraxia and mild dysphasia in a 50-year-old female patient with a 2-year history of endogenous depression [Worrall and Gillham, 1983]. After responding to a combination Inhibitors,research,lifescience,medical of lithium and amitriptyline for 14 months, she began to complain of difficulties in finding words in conversation and of memory impairment. These problems resolved completely

when the lithium was stopped and amitriptyline continued. In our report, we describe a case of delirium presenting with prominent dyspraxia at therapeutic lithium serum Inhibitors,research,lifescience,medical levels, following several years of uneventful lithium selleck kinase inhibitor administration, but within 3 months of the addition of clomipramine. The case described above [Worrall

and Gillham, 1983] improved when lithium was stopped but this presentation resolved when clomipramine was withdrawn. This suggests that an idiosyncratic interaction between tricyclic antidepressants and Inhibitors,research,lifescience,medical lithium can cause delirium with dyspraxia. Case report A 57-year-old retired lorry driver was regularly reviewed because of bipolar affective disorder and obsessive–compulsive disorder (predominantly obsessional thoughts or ruminations). He had several cardiovascular risk factors including non-insulin-dependent diabetes, hypertension and hypercholesterolemia. Clomipramine was titrated up to 150 mg nocte in addition to long-standing lithium carbonate (Priadel®) 800 mg nocte and quetiapine 500 mg nocte. There Batimastat were no neurological or gastrointestinal signs of lithium toxicity but mild memory problems emerged a few months thereafter (MMSE 27/30). Clomipramine and quetiapine doses were reduced to 50 mg nocte and 300 mg nocte respectively to address any anticholinergic side effects but the patient required admission for assessment of an apparent dementing illness 4 months later. Dyspraxia was the presenting complaint but the deterioration was delirious in nature with nocturnal worsening, visual misinterpretations and disorientation.