Lithium Treatment In a Tuberous Sclerosis Case Presented With Bipolar Disorder and Aggressive Behavior
Abstract
Tuberous sclerosis is a genetic disorder, characterized by hamartomatous growths in multiple organs such as brain, skin, eyes, heart and kidneys. Central nervous system symptoms have been reported in a majority of patients, and structural lesions in the brain may be frequently defined. In tuberous sclerosis patients, among the most common psychiatric disorders are mood disorders, autism, and attention deficit hyperactivity disorder. Psychotic disorders including schizophrenia are also additional comorbidities previously reported. Herein, a tuberous sclerosis case suffering from epileptic seizures, bipolar disorder with psychotic symptoms and aggressive behavior, treated with lithium along with antiepileptics and antipsychotics is presented. Male patient, 22 years old, previously diagosed with tuberous sclerosis, was brought by his family to the psychiatric emergency unit, and hospitalized due to aggressive behavior attacking his mother with a knife . Psychiatric evaluation revealed irritable mood, visual hallucinations, and persecutory delusions, accompanied by disorganized speech, poor thought content, and poor insight. The seizures were treated with topiramate and oxcarbazepine. Psychotic symptoms responded to risperidone and quetiapine. Finally, mood symptoms and aggressive behavior were controlled after the addition of lithium. A significant proportion of patients with tuberous sclerosis suffer from psychiatric disorders, and some of them from mood disorders and psychosis. Aggressive and disruptive behaviors also have been reported. Effective treatment is very important to relieve psychiatric symptoms as well as to increase patients’ quality of life. Lithium may be a beneficial option to control mood symptoms and aggressive behavior in tuberous sclerosis.
References
- Curatalo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet 2008;372:657–68. https://doi.org/10.1016/S0140-6736(08)61279-9
- Muzykewicz DA, Newberry P, Danforth N, Halpern EF, Thiele EA. Psychiatric comorbid conditions in a clinic population of 241 patients with tuberous sclerosis complex. Epilepsy Behav 2007;11:506–13. https://doi.org/10.1016/j.yebeh.2007.07.010
- Aşan İF, Türe S, Gökçay A, Karasoy H. Tuberoskleroz Kompleksi ve Otizm. J Neurol Sci 2006;23:312–7.
- Roach ES, Sparagana SP. Diagnosis of tuberous sclerosis complex. J Child Neurol 2004;19:643–9. https://doi.org/10.1177/088307380401 90090301
- DiMario FJ Jr, Sahin M, Ebrahimi-Fakhari D. Tuberous sclerosis complex. Pediatr Clin North Am 2015;62:633–48. doi: 10.1016/j. pcl.2015.03.005
- Weiner DM, Ewalt DH, Roach ES, Hensle TW. The tuberous sclerosis complex: a comprehensive review. J Am Coll Surg 1998;187:548–61.
- Northrup H, Kruger DA, on behalf of the International Tuberous Sclerosis Complex Consensus Group. Tuberous Sclerosis Complex Diagnostic Criteria Update: Recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol 2013;49:243–54. https://doi.org/10.1016/j. pediatrneurol.2013.08.001
- Süer DG, Erbil H. Familyal tuberoskleroz. Ret-Vit 1996;3:661–4.
- Erol İ, Savaş T, Şekerci S, Yazıcı N, Erbay A, Demir Ş, ve ark. Tüberoskleroz kompleksi; Tek merkez deneyimi. Türk Ped Arş 2015;50:51–60.
- Holmes GL, Stafstrom CE; Tuberous Sclerosis Study Group. Tuberous sclerosis complex and epilepsy: recent developments and future challenges. Epilepsia 2007;48:617–30. https://doi. org/10.1111/j.1528-1167.2007.01035.x
- Saltık S, Karatoprak EY, Taşel E. Characteristics snd the clinical prognosis of epilepsy in patients with a diagnosis of tuberous sclerosis complex. Turk Arch Ped 2013;48:123–30. https://doi. org/10.4274/tpa.116
- Volkmar FR, MCPartland JC. From Kanner to DSM-5: autism as an evolving diagnostic concept. Annu Rev Clin Psychol 2014;10:193– 212. https://doi.org/10.1146/annurev-clinpsy-032813-153710
- Joinson C, O’Callaghan FJ, Osborne JP, Martyn C, Harris T, Bolton PF. Learning disability and epilepsy in an epidemiological sample of individuals with tuberous sclerosis complex. Psychol Med 2003;33:335–44.
- De Vries PJ, Whittemore VH, Leclezio L, Byars AW, Dunn D, Ess KC, et al. Tuberous sclerosis associated neuropsychiatric disorders (TAND) and the TAND Checklist. Pediatr Neurol 2015;52:25–35. https://doi. org/10.1016/j.pediatrneurol.2014.10.004
- Hunt A, Shepherd C. A prevalence study of autism in tuberous sclerosis. J Autism Dev Disord 1993;23:323–39.
- Chung TK, Lynch ER, Fiser CJ, Nelson DA, Agricola K, Tudor C, et al. Psychiatric comorbidity and treatment response in patients with tuberous sclerosis complex. Ann Clin Psychiatry 2011;23:263–9.
- Prather P, de Vries PJ. Behavioral and cognitive aspects of tuberous sclerosis complex. J Child Neurol 2004;19:666–74. https://doi.org/10 .1177/08830738040190090601
- Raznahan A, Joinson C, O’Callaghan F, Osborne JP, Bolton PF. Psychopathology in tuberous sclerosis: an overview and findings in a population-based sample of adults with tuberous sclerosis. J Intellect Disabil Res 2006;50:561–9. https://doi. org/10.1111/j.1365-2788.2006.00828.x
- Ulukök MD, Meral H, Özcan T, Yücel G. Bipolar disorder: a result of tuberous sclerosis complex? Causapedia 2014;3:987.
- Haq MZ, Dubey I, Khess CR, Das U, Kumar R. Bipolar disorder and tuberous sclerosis complex: is it a mere coincidence? CNS Spectr 2009;14:643–7.
- Hunt A, Dennis J. Psychiatric disorder among children with tuberous sclerosis. Dev Med Child Neurol 1987;29:190–8.
- İncecik F, Hergüner Ö, Özcan K, Altunbaşak A. Tuberosklerozlu 19 olgunun geriye dönük olarak değerlendirilmesi. Turk Ped Arş 2006;41:156–60.
Abstract
Tuberoskleroz beyin, deri, göz, kalp ve böbrek gibi çok sayıda organda hamartomatöz büyümenin gözlendiği genetik bir hastalıktır. Merkezi sinir sistemi belirtileri hastaların çoğunda bildirilmiştir ve sıklıkla beyinde yapısal lezyonlara rastlanır. Tuberoskleroz hastalarında en sık rastlanan psikiyatrik bozukluklar arasında otizm, duygudurum bozuklukları ve dikkat eksikliği hiperaktivite bozukluğu sayılmaktadır. Şizofreni dahil psikotik bozukluklar da bildirilen eştanılardandır. Burada epileptik nöbetler, psikotik belirtili bipolar bozukluk ve şiddet davranışı gözlenen, antiepileptik ve antipsikotiklerin yanısıra lityumla tedavi edilen bir olgu sunulmuştur. Yirmi iki yaşında, önceden bilinen tuberoskleroz tanısı olan erkek hasta, ailesi tarafından acil psikiyatri ünitesine getirilerek, şiddet davranışı annesine bıçakla saldırma nedeniyle yatırıldı. Psikiyatrik muayenede irritabl duygudurum, görsel varsanılar ve perseküsyon sanrıları, dezorganize konuşma, fakirleşmiş düşünce içeriği saptandı ve içgörüsü az olarak değerlendirildi. Hastanın nöbetleri topiramat ve okskarbazepinle, psikotik belirtileri risperidon ve ketiyapinle tedavi edildi. Duygudurum belirtileri ve agresif davranışları ise lityumla kontrol altına alındı. Tuberoskleroz olgularının önemli bir kısmında psikiyatrik bozukluklar görülmektedir ve bunlardan bir kısmını duygudurum bozuklukları ve psikoz oluşturmaktadır. Bu olgularda agresif ve yıkıcı davranışlar da bildirilmiştir. Etkin tedavi hastaların psikiyatrik belirtilerini iyileştirmenin yanı sıra yaşam kalitesini arttırmada da büyük önem taşımaktadır. Tuberoskleroz olgularında lityum, hem duygudurum belirtilerinin hem de agresif davranışların kontrolünde yararlı bir seçenek olabilir.
References
- Curatalo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet 2008;372:657–68. https://doi.org/10.1016/S0140-6736(08)61279-9
- Muzykewicz DA, Newberry P, Danforth N, Halpern EF, Thiele EA. Psychiatric comorbid conditions in a clinic population of 241 patients with tuberous sclerosis complex. Epilepsy Behav 2007;11:506–13. https://doi.org/10.1016/j.yebeh.2007.07.010
- Aşan İF, Türe S, Gökçay A, Karasoy H. Tuberoskleroz Kompleksi ve Otizm. J Neurol Sci 2006;23:312–7.
- Roach ES, Sparagana SP. Diagnosis of tuberous sclerosis complex. J Child Neurol 2004;19:643–9. https://doi.org/10.1177/088307380401 90090301
- DiMario FJ Jr, Sahin M, Ebrahimi-Fakhari D. Tuberous sclerosis complex. Pediatr Clin North Am 2015;62:633–48. doi: 10.1016/j. pcl.2015.03.005
- Weiner DM, Ewalt DH, Roach ES, Hensle TW. The tuberous sclerosis complex: a comprehensive review. J Am Coll Surg 1998;187:548–61.
- Northrup H, Kruger DA, on behalf of the International Tuberous Sclerosis Complex Consensus Group. Tuberous Sclerosis Complex Diagnostic Criteria Update: Recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol 2013;49:243–54. https://doi.org/10.1016/j. pediatrneurol.2013.08.001
- Süer DG, Erbil H. Familyal tuberoskleroz. Ret-Vit 1996;3:661–4.
- Erol İ, Savaş T, Şekerci S, Yazıcı N, Erbay A, Demir Ş, ve ark. Tüberoskleroz kompleksi; Tek merkez deneyimi. Türk Ped Arş 2015;50:51–60.
- Holmes GL, Stafstrom CE; Tuberous Sclerosis Study Group. Tuberous sclerosis complex and epilepsy: recent developments and future challenges. Epilepsia 2007;48:617–30. https://doi. org/10.1111/j.1528-1167.2007.01035.x
- Saltık S, Karatoprak EY, Taşel E. Characteristics snd the clinical prognosis of epilepsy in patients with a diagnosis of tuberous sclerosis complex. Turk Arch Ped 2013;48:123–30. https://doi. org/10.4274/tpa.116
- Volkmar FR, MCPartland JC. From Kanner to DSM-5: autism as an evolving diagnostic concept. Annu Rev Clin Psychol 2014;10:193– 212. https://doi.org/10.1146/annurev-clinpsy-032813-153710
- Joinson C, O’Callaghan FJ, Osborne JP, Martyn C, Harris T, Bolton PF. Learning disability and epilepsy in an epidemiological sample of individuals with tuberous sclerosis complex. Psychol Med 2003;33:335–44.
- De Vries PJ, Whittemore VH, Leclezio L, Byars AW, Dunn D, Ess KC, et al. Tuberous sclerosis associated neuropsychiatric disorders (TAND) and the TAND Checklist. Pediatr Neurol 2015;52:25–35. https://doi. org/10.1016/j.pediatrneurol.2014.10.004
- Hunt A, Shepherd C. A prevalence study of autism in tuberous sclerosis. J Autism Dev Disord 1993;23:323–39.
- Chung TK, Lynch ER, Fiser CJ, Nelson DA, Agricola K, Tudor C, et al. Psychiatric comorbidity and treatment response in patients with tuberous sclerosis complex. Ann Clin Psychiatry 2011;23:263–9.
- Prather P, de Vries PJ. Behavioral and cognitive aspects of tuberous sclerosis complex. J Child Neurol 2004;19:666–74. https://doi.org/10 .1177/08830738040190090601
- Raznahan A, Joinson C, O’Callaghan F, Osborne JP, Bolton PF. Psychopathology in tuberous sclerosis: an overview and findings in a population-based sample of adults with tuberous sclerosis. J Intellect Disabil Res 2006;50:561–9. https://doi. org/10.1111/j.1365-2788.2006.00828.x
- Ulukök MD, Meral H, Özcan T, Yücel G. Bipolar disorder: a result of tuberous sclerosis complex? Causapedia 2014;3:987.
- Haq MZ, Dubey I, Khess CR, Das U, Kumar R. Bipolar disorder and tuberous sclerosis complex: is it a mere coincidence? CNS Spectr 2009;14:643–7.
- Hunt A, Dennis J. Psychiatric disorder among children with tuberous sclerosis. Dev Med Child Neurol 1987;29:190–8.
- İncecik F, Hergüner Ö, Özcan K, Altunbaşak A. Tuberosklerozlu 19 olgunun geriye dönük olarak değerlendirilmesi. Turk Ped Arş 2006;41:156–60.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | June 1, 2018 |
| Published in Issue | Year 2018Issue: 2 |