This is a cross-sectional, two-year follow up study. The authors determined the varied presentations of delirium, dementia and other organic disorders to assess their mortality and outcome. They described the diagnosis of patients suffering from the psychiatric effects of those organic states and compared their symptom resolution and mortality between those with the acute and chronic varieties during their index hospitalization and again, 24 months later. Although mortality rates did not differ, patients with the acute syndrome had significantly better outcomes in terms of symptom resolution as compared to those with the chronic syndrome (p=0.001). Patients with symptom resolution upon discharge did not show statistically significant lower mortality rates.
Lithium therapy is a common treatment for affective disorders and is widely regarded as a lifesaving drug. However, because its elimination is almost wholly unchanged via the kidneys, both acute and long-term adverse effects relating to toxicity may occur, including declining renal function and nephrogenic diabetes insipidus (DI). DI may be difficult to detect and is frequently preceded by dehydration and which, in our patient, was discovered by chance. We describe a case of an elderly woman on chronic lithium therapy for bipolar affective disorder who initially presented with dehydration from vomiting but possibly developed extra-pontine myelinolysis (EPM) after over-zealous correction of hyponatraemia. Steroids administered appeared to have prevented further progression but a persisting hyperosmolar state then alerted us to the presence of nephrogenic DI. Although both conditions were later successfully reversed with no obvious chronic sequelae, the recovery of the patient was protracted. Clinicians should be vigilant for complications of managing dehydration states in people prescribed with lithium.
Depression is usually associated with changes in the endogenous hormonal system. The most important hormonal modifications are elevation of the serum cortisol level as well as the reduction of endogenous sex hormone levels. These changes have advanced side effects on a bone metabolism and bone remodelling process, which consequently, lead to the declining in bone mineral density and increase the risk of bone fractures, which is reported by current studies.