Abstract

One of the rarer phenomena and less studied side effect of lithium-induced hypercalcemia is catatonia. Lithium is widely used to treat acute mania as well as maintenance therapy for bipolar disorder (BPD). However, not much is known about the uncommon catatonic presentation produced by hypercalcemia. In this case, we present a 55-year-old male with a past psychiatric history of schizoaffective disorder, bipolar type maintained on lithium therapy, presenting with catatonia and altered mental status. Upon presentation, we observed symptoms of mutism, rigidity, immobility and staring, and he was subsequently found to have hyperparathyroid-induced hypercalcemia. Elevated levels of both calcium and parathyroid hormone (PTH) were noted; 12.0 and 135.5, respectively. Lithium therapy was discontinued, and as calcium and PTH levels normalized, patient began to gradually return to baseline function with improvement of mental status and communication through simple sentences. This case illustrates the importance of recognizing rare clinical presentations of hypercalcemia in patients on chronic lithium therapy. Because the neuropsychiatric manifestations of hypercalcemia are so broad, it is important to understand this phenomenon and be able to distinguish it from primary psychiatric disturbances