Lithium Use Following a Severe Suicide Attempt: A Case Report

Introduction: Psychotic disorders confer a significant risk of suicide attempt and completion.1,2 Lithium is one of the two medications that have demonstrated anti-suicidal benefits.3 We present a case of a patient with psychosis status post severe suicide attempt treated with Lithium, showing significant improvement of symptoms and complete resolution of suicidal ideation. Case Description: Mr S. is a 33 year old Caucasian male, recently homeless with PMH of unspecified psychosis and HIV, who attempted suicide by jumping in front of a vehicle, “because a green alien was telling him to kill himself”. Upon arrival, a CT cervical spine showed left occipital condyle fracture. Patient was placed under a Baker Act, admitted to the ICU, and psychiatry was consulted. Once medically cleared, patient was admitted to inpatient psychiatry. Upon psychiatric evaluation, the patient appeared disheveled, depressed, and exhibited psychomotor retardation. He reported command auditory hallucinations and paranoid delusions along with intermittent cannabis and nicotine use. Patient was started on Lithium 300 mg TID and Haldol 5 mg BID. Over the course of hospitalization, patient showed progressive and marked improvement of mood and decreased auditory hallucinations. Prior to discharge, patient reported complete resolution of suicidal ideation. Discussion: Studies indicate that Lithium has anti-suicide properties in mood disorders. 4,5 This case presents Lithium as an optimal treatment for suicide prevention in a high-risk patient with psychosis and mood symptoms. This case highlights the need for longitudinal studies investigating the use of Lithium for suicide prevention in other psychiatric populations.