We report a case of delirium with anticholinergic symptoms in a 19-year-old female patient with schizophrenia. On the day the symptoms emerged, the patient received olanzapine long-acting injection and a higher dose of paliperidone. We observed symptoms ranging from confusion to delirium as well as some anticholinergic symptoms. The delirium lasted 24 hours and was managed by intravenous fluid substitution and oral benzodiazepines. Olanzapine pamoate, paliperidone and cannabis are central nervous system (CNS) depressants, and their combination can increase the risks of CNS depression. In this case report, we review the symptoms of delirium in a case of antipsychotic overdose and provide general guidelines for managing these symptoms. We also review possible complications in combined use of cannabis, olanzapine and paliperidone.

Introduction:Depression and pain symptoms are often comorbid and share common neurobiological and psychological background.Objectives and aimes:To find out the prevalence of painful physical symptoms (PPS) in otherwise healthy patients hospitalized due to recurrent unipolar (UD) and bipolar depression (BD) and to compare socio-demographic and illness related characteristics.Methods:180 somatically healthy patients were recruited in the study. Symptoms of depression were evaluated with standard clinical tools. The presence of somatic illness was excluded. Visual Analogue Scale was used to evaluate the intensity and location of painful symptoms. Sociodemographic, illness and therapy related data, substance use, and suicidality were recorded as well.Results:41 patients met criteria for BD and 139 for UD. The average age was 50 years (75% females). Higher prevalence of PPS in group of UD (72.6%) in comparison to BD (58.5%) was found. The average intensity of painful symptoms was high. Patients with UD+PPS had higher total number of PPS and scored higher on HAM-D21 and Zung Self Rating Depression Scale than patients with BD+PPS. Use of analgesics and anxiolytics was high.Conclusions:The study offers an insight in the high prevalence of PPS in patients with acute severe unipolar and bipolar depression and the results warn of possible over prescribing of analgesics and anxiolytics. Lower prevalence of PPS in BD might be explained with less severe depression symptoms. The results offer new information on PPS in acute bipolar depression since there is very little research data on this topic.

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