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.