Anti-Leucine-Rich Glioma-Inactivated 1 (Anti-LGI 1) Limbic Encephalitis and New-Onset Psychosis: A Case Report.

Anti-leucine-rich glioma-inactivated 1 limbic encephalitis (Anti-LGI 1 LE) is a subtype of autoimmune encephalitis (AE) and the most common cause of limbic encephalitis (LE). Clinically, it can have an acute to sub-acute onset of confusion and cognitive impairment, facial-brachial dystonic seizures (FDBS), and psychiatric disturbances. The clinical manifestations are varied, and its diagnosis requires high clinical suspicion to avoid delay in the treatment. When patients manifest mostly psychiatric symptoms, the disease may not be immediately recognized. We aim to report a case of Anti-LGI 1 LE in which the patient presented acute psychotic symptoms and was initially diagnosed with unspecified psychosis. We present a case of a patient with sub-acute behavioral changes, short-term memory loss, and insomnia who was brought to the emergency department after a sudden episode of disorganized behavior and speech. On medical examination, the patient presented persecutory delusions and indirect signs of auditory hallucinations. An initial diagnosis of unspecified psychosis was performed. Investigations revealed right temporal epileptiform activity in the electroencephalogram (EEG), abnormal bilateral hyperintensities in the temporal lobes in the brain magnetic resonance imaging (MRI), and a positive titer of anti-LGI 1 antibodies (Abs) in serum and cerebrospinal fluid (CSF), leading to a diagnosis of anti-LGI 1 LE. The patient was treated with intravenous (IV) steroids and immunoglobulin and later with IV rituximab. In patients that predominantly present with psychotic and cognitive disorders the diagnosis of anti-LGI 1 LE can be delayed predisposing them to a poorer prognosis (permanent cognitive impairment - especially short-term memory loss - and persistent seizures). It is necessary to be aware of this diagnosis when evaluating acute to sub-acute psychiatric illness developing with cognitive impairment (specially with memory loss) to avoid diagnosis delays and long-term sequelae.

Lithium Intoxication after Bariatric Surgery: A Case Report.

Bariatric surgery is a therapeutic option to treat obesity in (carefully selected) patients with psychiatric disorders. About half of the patients referred for bariatric surgery have a diagnosis of (at least one) mental disorder and most of them are treated with psychotropic drugs. This procedure may modify the bioavailability of drugs and lithium is no exception. However, although absorption seems to decrease in most drugs, in the case of lithium, there is a high risk of toxicity. In this article, we describe the case of a 44-year-old female patient with lithium intoxication after bariatric surgery. We conducted a review of the published clinical cases in the scientific literature about lithium toxicity after bariatric surgery, and we propose potential preventive clinical solutions. It is essential to increase awareness of changes to the absorption of psychotropic drugs in the post-surgery period, particularly in the case of lithium. Regular postoperative clinical and laboratory monitoring of lithium serum levels is strongly recommended.

A cirurgia bariátrica é uma opção terapêutica no tratamento da obesidade em doentes, selecionados cuidadosamente, com perturbação psiquiátrica. Cerca de metade dos doentes referenciados para cirurgia bariátrica têm diagnosticada, pelo menos, uma perturbação mental, estando a maioria medicada com psicofármacos. Este procedimento pode alterar significativamente a biodisponibilidade dos fármacos e o lítio não é exceção. Contudo, apesar da absorção parecer diminuir na maioria dos fármacos, no caso do lítio existe um elevado risco de toxicidade. Neste artigo, descreve-se o caso de uma doente de 44 anos com um quadro de intoxicação por lítio pós-cirurgia bariátrica. Realizou-se uma revisão dos casos clínicos descritos na literatura de toxicidade ao lítio pós-cirurgia bariátrica e apresentam-se potenciais soluções clínicas preventivas. É essencial uma maior consciencialização das alterações na absorção dospsicofármacos pós-cirurgia, particularmente no caso do lítio. Recomenda-se fortemente uma monitorização, de forma mais regular, pós-cirúrgica clínica e laboratorial dos níveis séricos de lítio.