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Exacerbation of stuttering in a child: case report A 10-year-old boy developed an exacerbation of stuttering while receiving lithium and risperidone. The boy, who had a history of bipolar disorder, attention deficit hyperactivity disorder (ADHD), conduct disorder, and developmental stuttering, was admitted to a psychiatric hospital due to increased physical aggression and recurrent suicidal ideations. During the third week of his hospitalisation, he began receiving oral lithium 150mg at bedtime for symptoms of mania. He also received oral risperidone since admission, with the dosage increased to 4mg at bedtime 1 week before starting lithium. His other medications included clonidine, melatonin, and famotidine. His lithium dosage was increased to 600mg twice daily over 1 week and this resulted in a lithium serum concentration of 0.62 mEq/L. He still had signs of mania so the dosage of lithium was increased 5 days later to 900mg twice daily. His bipolar symptoms were controlled better at this higher dose but his stutter worsened 2 days after the increase. His lithium serum concentration was 1.24 mEq/L after 5 days of lithium treatment at the increased dose. The boy’s lithium dosage was reduced to 600mg in the morning and 900mg at night. Two days later, his stutter returned to baseline. After 5 days of treatment at this new dosage, his lithium concentration was 0.64 mEq/L. Over time, his bipolar symptoms stabilised on the reduced lithium dosage. He was eventually discharged and remained relatively stable, although still showing disruptive and impulsive behaviours associated with his conduct disorder and ADHD. Author comment: "[I]t is possible that risperidone in combination with lithium was responsible. . . Using the Naranjo probability scale for adverse drug reactions (ADRs), the probability that the patient experienced an ADR in the form of an exacerbated stutter due to lithium was regarded as probable." Gulack BC, et al. Stutter exacerbated by lithium in a pediatric patient with bipolar disorder. Annals of Pharmacotherapy 45: e57, No. 10, Oct 2011. Available from: 803064384 URL: http://dx.doi.org/10.1345/aph.1q140 - USA

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Reactions 17 Dec 2011 No. 1382