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2018, Cilt 9, Sayı 2, Sayfa(lar) 195-199
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LITHIUM TREATMENT IN A TUBEROUS SCLEROSIS CASE PRESENTED WITH BIPOLAR DISORDER AND AGGRESSIVE BEHAVIOR
Ürün Özer1, Mert Batmaz2, Zeynep Ezgi Balçık3
1Acıbadem Üniversitesi Atakent Hastanesi, Psikiyatri, İstanbul, Türkiye
2Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Psikiyatri, İstanbul, Türkiye
3Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Nöroloji, İstanbul, Türkiye
Keywords: Tuberous sclerosis, mood disorders, psychosis, aggressive behavior, lithium

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.