Lithium treatment and weight gain.

The problem of lithium maintenance treatment and weight gain was examined in 70 manic-melancholic patients who had been in treatment for 2 to 10 years. Their case records were reviewed and they answered a questionnaire. Out of 70 patients, 45 increased in weight with a mean weight gain of about 10 kg. The patients who increased in weight during the treatment were overweight already before the start and reached a weight about 20% higher than their ideal weight. They nearly all found themselves overweight and took measures to slim. No connection between a history of infant obesity and weight gain was found. Increase in appetite was only found in one third of the patients and had only a weak influence on the degree of weight gain. Nearly all the patients felt an increased thirst, and a very clear correlation between liquid intake and weight gain was found. It is recommended that all patients are repeatedly warned of the risks involved in satisfying their increased thirst on lithium by fluids rich in calories.     

Lithium metabolism and intracellular electrolytes

LIEBERMAN, K. W., P. E. STOKES AND G. VAN DER NOOT.Lithium metabolism and intracellular electrolytes. BRAIN RES. BULL. 3(5) 415–418, 1978.—Lithium chloride was administered orally to swine and two different types of sheep, HK and LK. There was a pre-lithium 16-fold variation in intracellular sodium (LK>HK>swine) and a 6.5-fold variation in the intracellular potassium (swine>HK>LK). Collected plasma and erythrocytes were analyzed for lithium, sodium and potassium. The ratio of erythrocyte lithium/plasma lithium was directly related to the pre-lithium erythrocyte sodium concentration and inversely related to the pre-lithium erythrocyte potassium concentration.     

Lithium and chlorpromazine in psychotic inpatients

A sample of recently hospitalized psychotic patients was assigned to treatment with lithium or chlorpromazine in a double-blind drug trial. Several diagnostic systems were used to characterize the patients. No relationship was found, regardless of criterion system used, between dignosis and differences in drug effectiveness; specifically, the presence of “schizophrenic” symptoms did not predict a poor response to lithium. Among patients with physical overactivity, those treated with lithium terminated earlier and had poorer outcome than those treated with chlorpromazine. In patients who were not overactive, the two drugs were equally effective, and chronically psychotic patients had poorer outcomes regardless of drug. Lithium may be an effective treatment for acutely psychotic patients who are not overactive. The use of a lithium trial as a diagnostic tool may be unwarranted.     

Lithium treatment of chronic hair pulling

Ten patients with chronic hair pulling received trials of lithium carbonate of 2 to 14 months' duration. Eight patients demonstrated decreased hair pulling and mild to marked hair regrowth. Three responders experienced increased hair pulling subsequent to discontinuation of lithium treatment. Lithium's effect on hair pulling may be related to its observed benefits in treating aggressivity, impulsivity, and mood instability.     

Neuron-specific enolase-like immunoreactivity in inner hair cells but not outer hair cells in the guinea pig organ of Corti

Neuron-specific enolase (NSE) has been localized only in neurons and cells with characteristics of neurons. The immunocytochemical localization of NSE was examined in guinea pig cochleae to determine if hair cells, which have some neuronal characteristics, would show NSE-like immunoreactive labeling. NSE-like immunoreactivity was seen in inner hair cells but not in outer hair cells. This is the first report of NSE-like immunoreactivity in a receptor cell. NSE-like immunoreactivity was also seen in efferent fibers and terminals and in both type I and type II spiral ganglion cells. The finding of NSE-like immunoreactivity in inner but not outer cells adds to the number of differences found between them and may be related to differences in function and action.     

Auditory hair cell innervational patterns in lizards

The pattern of afferent and efferent innervation of two to four unidirectional (UHC) and two to nine bidirectional (BHC) hair cells of five different types of lizard auditory papillae was determined by reconstruction of serial TEM sections. The species studies were Crotaphytus wislizeni (iguanid), Podarcis (Lacerta) sicula and P. muralis (lacertids), Ameiva ameiva (teiid), Coleonyx variegatus (gekkonid), and Mabuya multifasciata (scincid). The main object was to determine in which species and in which hair cell types the nerve fibers were innervating only one (exclusive innervation), or two or more hair cells (nonexclusive innervation); how many nerve fibers were supplying each hair cell; how many synapses were made by the innervating fibers; and the total number of synapses on each hair cell. In the species studies, efferent innervation was limited to the UHC, and except for the iguanid, C. wislizeni, it was nonexclusive, each fiber supplying two or more hair cells. Afferent innervation varied both with the species and the hair cell types. In Crotaphytus, both the UHC and the BHC were exclusively innervated. In Podarcis and Ameiva, the UHC were innervated exclusively by some fibers but nonexclusively by others (mixed pattern). In Coleonyx, the UHC were exclusively innervated but the BHC were nonexclusively innervated. In Mabuya, both the UHC and BHC were nonexclusively innervated. The number of afferent nerve fibers and the number of afferent synapses were always larger in the UHC than in the BHC. In Ameiva, Podarcis, and Mabuya, groups of bidirectionally oriented hair cells occur in regions of cytologically distinct UHC, and in Ameiva, unidirectionally oriented hair cells occur in cytologically distinct BHC regions.     

Lithium,Inositol and Mitochondria

Our recent DNA-microarray and proteomics studies searching for pathways affected both by chronic lithium treatment and by knockout of each of two genes (IMPA1 or Slc5a3) encoding for proteins related to inositol metabolism, indicated up-regulation of mitochondria-related genes and autophagy-related proteins in the frontal cortex. Differently from previously reported observations of aberrant mitochondrial function in bipolar patients which leave a causality relationship between mitochondrial dysfunction and bipolar disorder an open question, the behavioral results of our recent report following rotenone treatment tempt us to speculate that mitochondrial dysfunction predisposes manic behavior and that drugs targeted to ameliorate mitochondrial function are potential preventers of bursting manic episodes. However, the promiscuity of the involvement of mitochondrial dysfunction and impaired autophagy in the pathophysiology of psychiatric and neurodegenerative disorders raises questions regarding the credibility and relevance of these findings.     

Lithium in children of lithium-responding parents

Six offspring of manic-depressive patients, whose parents were lithium responders, were selected on the basis of their incapacitating psychopathology for treatment with lithium. The children ranged in age from 6 to 12. A double-blind, crossover design was used over 16–18 weeks. Weekly ratings were done, and average evoked potentials (EPs) were measured at each crossover. Two children diagnosed as having a bipolar affective disorder had a clear-cut response to lithium and were strong augmenters on the EP. This, taken together with the similarity of the EP changes on lithium to those occurring in adult patients treated with lithium, supports a physiological parallel between bipolar affective illness in adults and children.     

Lithium and suicide prevention in bipolar disorder

IntroductionBipolar disorder (BD) is a severe and recurrent psychiatric disorder. The severity of prognosis in BD is mainly linked to the high rate of suicide in this population. Indeed, patients with BD commit suicide 20 to 30 times more frequently than the general population, and half of the BD population with an early age of onset have a history of suicide attempt. International therapeutic guidelines recommend lithium (Li) as the first-line treatment in BD for its prophylactic action on depressive or manic episodes. In addition, Li is the only mood stabilizer that has demonstrated efficacy in suicide prevention. This effect of Li is unfortunately often unknown to psychiatrists. Thus, this review aims to highlight evidence about the preventive action of Li on suicide in BD populations.MethodsWe conducted a literature search between April 1968 and August 2014 in PubMed database using the following terms: “lithium” AND “suicide” OR “suicidality” OR “suicide attempt”.ResultsAs confirmed by a recent meta-analysis, many studies show that Li has a significant effect on the reduction of suicide attempts and deaths by suicide in comparison to antidepressants or other mood-stabilisers in BD populations. Studies have demonstrated that long-term treatment with Li reduces suicide attempts by about 10% and deaths by suicide by about 20%. The combination of Li and an antidepressant could reduce suicidal behaviours by reducing suicidal ideation prior to depressive symptoms. It appears crucial for Li efficacy in suicide prevention to maintain the Li blood concentrations in the efficient therapeutic zone and to instate long-term Li treatment. The “impulsive-aggressive” endophenotype is associated with suicide in BD. The specific action of Li on the 5-HT serotoninergic system could explain the specific anti-suicidal effects of Li via the modulation of impulsiveness and aggressiveness. Furthermore, genetic variants of the glycogen synthase kinase 3α/β (GSK3α and β; proteins inhibited by Li) seem to be associated with more impulsiveness in BD populations.ConclusionThe anti-suicidal effect of Li has been very well demonstrated. By its specific action on the serotoninergic system, treatment with Li significantly reduces “impulsive-aggressive” behaviour which is a vulnerability factor common to suicide and BD. Long-term appropriately modulated treatment with Li seems to have considerable impact on the reduction of suicidal behaviours, suicidal ideation and death by suicide in the BD population.     

Lithium carbonate in the treatment of cluster headaches

Summary Twenty-one patients with cluster headaches participated in an open trial to assess the effectiveness of lithium carbonate in the acute treatment and prevention of cluster headaches. Three women and 18 men ranging from 28 to 70 years of age were divided into episodic cluster [8] and chronic cluster [12]. One patient was in his first cluster. The chronic cluster group was further subdivided into primary chronic (5 patients) and secondary chronic (5 patients). In 11 patients there was absolute improvement, in 5 patients there was partial improvement and in 5 patients there was either no response or the improvement was not sustained. Beneficial results were obtained with dosages lower than those used for effective treatment of bipolar illness. It appears that lithium can be a useful drug in the treatment of cluster headaches provided drug levels and renal function are carefully monitored. No serious side effects were noted.     

Lithium therapy in China BRIEF COMMUNICATION

A questionnaire survey among Chinese psychiatrists in June 1980 revealed that lithium treatment is being used in a little over half of the Chinese psychiatric hospitals, mainly for the treatment of mania and schizo-affective illness and only to a limited extent prophylactically. The relatively restricted use of lithium as yet may be due to infrequency of the diagnosis of mania, to fear of toxicity, and to lack of laboratory facilities for monitoring serum lithium levels.     

碳酸锂合并利培酮口服液治疗躁狂发作临床对照研究

目的研究碳酸锂分别合并利培酮口服液与利培酮片治疗躁狂发作的疗效及安全性。方法将72例躁狂发作病人随机分为两组,其中合并利培酮口服液组和合并利培酮片组各36例,进行为期6周的对照研究,采用Bech-Rafaelsen躁狂量表(BRMS)和不良反应症状量表(TESS)评定疗效及安全性。结果合并利培酮口服液组与合并利培酮片组疗效相当(P>0.05),而合并利培酮口服液组治疗躁狂发作起效快,且副作用少。结论碳酸锂合并利培酮口服液是治疗躁狂发作安全有效的药物。     

Innervation patterns of cutaneous hair receptors in cat

Cat hair receptors were studied to determine whether they could be distinguished by the following receptive field characteristics: thickness of innervated guard hairs, distance between innervated follicles and receptive field size. Initially the receptors were classified as G1, GI, G2 or D on the basis of their velocity requirements for excitation, their degree of linear directionality, their vibrational sensitivity, and whether they were activated by movement of down hairs. It was found that the thickest guard hairs on the posterior aspect of a cat's hindleg were usually 4-5 times thicker than the thinnest guard hairs from the same area and that G1, GI and G2 neurons innervated the full range of guard hair thicknesses available. Although there was a tendency for thicker guard hairs to be more heavily innervated, none of the neurons studied innervated thick guard hairs exclusively. While movement of the down hair and most guard hairs within D-mechanoreceptive fields easily evoked activity, a few guard hairs were regularly found for which mechanical displacement did not elicit a discharge even though they were well within the receptive field. Receptive field sizes and nearest neighbor distances between innervated follicles were smaller for D than for G1, GI and G2 receptors and greater for G1 than GI and G2 receptors.     

Biochemical markers in steely hair syndrome

Plasma benzylamine-oxidase activity seemed to be the most significant diagnostic and clinical test in two cases of steely-hair syndrome. These data may be explained by the massive impairment of collagen in this syndrome.

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Sommario In due casi di steely hair syndrome sono stati dosati contemporaneamente i livelli serici di rame e di ceruloplasmina e l'attività della benzilamino-ossidasi. L'attività di quest'ultimo enzima mostra una migliore correlazione con la diagnosi ed il decorso clinico della malattia. Ciò potrebbe essere compreso per la grave collagenopatia presente in questa sindrome.

     

Lithium augmentation in geriatric depressed outpatients: A clinical report

Lithium augmentation of antidepressant therapy in elderly outpatients has not been systematically assessed. A prospective, practice-based observational study of 44 patients comparing an antidepressant monotherapy group (N = 23) with a lithium augmentation group (N = 21) was conducted in a geriatric psychiatry, outpatient clinic. The severity of depression was evaluated with the Montgomery–Asberg Depression Rating Scale (MADRS), the DSM-III-R Global Assessment of Functioning (GAF), a treatment effectiveness rating (ER) and the Geriatric Depression Scale (GDS). Patient-reported adverse events were systematically collected. The mean age for the group was 76.5 ± 6.0 years, 81.8% were female and the most common principal diagnosis was major depression (88.6%). Doxepin was the most commonly prescribed antidepressant (29.5%), followed by nortriptyline (27.2%) and phenelzine (15.9%). Patients receiving lithium augmentation were less depressed and functioning better than those in the antidepressant alone treatment group—MADRS: 8.5 ± 8.8 vs 13.9 ± 9.0 (p < 0.05); GAF: 77.9 ± 8.3 vs 68.5 ± 10.5 (p < 0.01); ER: X² = 4.5 (p < 0.05); GDS: 4.0 ± 2.7 vs 5.9 ± 4.3 (NS). Patients in the lithium group tended to report fewer adverse events (3.7 ± 2.1 vs 5.0 ± 3.0 (NS)). Results suggest that lithium augmented patients are less depressed and report fewer adverse events than those on antidepressants alone. Lithium appears to be a safe and effective addition to antidepressant pharmacotherapy in the elderly.     

Intracellular calcium and outer hair cell electromotility

The influence of increased intracellular calcium level on outer hair cell (OHC) electromotility was examined by means of transcellular electrical stimulation in a partitioning microchamber. Electromotile activity was measured before and after application of the calcium ionophore ionomycin, which promotes the inflow of extracellular calcium, as well as its release from intracellular calcium stores. The ionomycin solvent, dimethyl sulphoxide (DMSO), by itself elicited a significant decrease in the magnitude of OHC electromotility. The DMSO effect was counteracted by 10 microM ionomycin and was reversed by 50 microM ionomycin. The increase in electromotility is partially mediated by a calmodulin-dependent mechanism, since W7, a calmodulin antagonist, attenuated the 50 microM ionomycin-induced motility increase. Our results suggest that the electromotility magnitude increase in isolated OHCs due to ionomycin is a calcium/calmodulin-dependent phenomenon.     

Acute Effects of Lithium on Hippocampal Kindled Seizures

The effects of lithium chloride on seizure activity generated by stimulation of hippocampal kindled rats were studied. Acute administration of 0, 0.25, 0.50, 1.5, 3.0, and 5.0 mEq/kg i.p. resulted in serum levels ranging from clinically subtherapeutic to toxic during the subsequent 4 h. Afterdischarge threshold and seizure severity were unchanged by these levels of lithium. Afterdischarge duration was somewhat prolonged, reaching a significant level only for the 3.0-mEq/kg dose. It is concluded that lithium shows a minor proconvulsant effect after acute administration in the kindled hippocampal seizure model.     

Lithium ratio in psychiatric patients: A caveat

We divided bipolar patients samples into two groups: Group I (off lithium 10 days to 2 weeks, n=14)and group II (off lithium 3 weeks or longer, n=13). Only group I was significantly different from controls. The mean for group II was significantly different from that for group I but not that for controls. Previous reports may have exaggerated the number of “high ratio” patients due to a treatment artifact. We recommend that patients be tested only after having been withdrawn from lithium treatment for 3 weeks or more. Otherwise spurious differences between patients and controls may result.     

Lithium augmentation in the treatment of refractory depression in old age

A retrospective study of treatment and outcome is described in 59 consecutive referrals to a catchment psychogeriatric service meeting ICD9 criteria for manic depressive illness or depressive neurosis. Of 22 who failed to respond to tricyclic antidepressants, nine (of whom four had also failed to respond to ECT) were treated by lithium augmentation. Systematic comparisons between lithium-treated subjects, tricyclic responders and others failing to respond to tricyclics revealed no significant demographic differences. Lithium augmentation was successful in 6/9 subjects. Two ‘lithium failures’ were treated with tranylcypromine to good effect. At follow-up (median six months, range 3–20 months) 7/9 subjects in the lithium-treated group were well. This was similar to the follow-up status in tricyclic responders and significantly better than outcome in the other tricyclic non-responders. Lithium augmentation appears to be a relatively well-tolerated treatment manoeuvre in refractory depression in old age, with treatment response similar to that reported in younger subjects, and may be of particular use where ECT has failed.     

Lithium for the Treatment of Acute Mania in Adolescents

This paper discusses issues around the diagnosis of mania and its acute treatment in adolescence. We review three cases of acute mania treated on an adolescent unit, highlighting some of the diagnostic difficulties. Each of these patients proved resistant to treatment with neuroleptics but responded to the addition of lithium carbonate. The clinical impression of a good response was supported by the use of the Children's Global Assessment Scale. We conclude that lithium carbonate can be useful in the treatment of acute mania in adolescence. It is an illness of which child psychiatrists need to be aware as one third of cases present in adolescence.