Intellectual efficiency in manic-depressive patients treated with lithium

A longitudinal study of 21 non-hospitalized manic-depressive subjects treated with lithium was carried out over a 3-year period: year 1 (Y1), year 2 (Y2), year 3 (Y3). A control group C of 21 subjects matched for age, sex and educational level was compared to Y1, Y2 and Y3 using the Cattell Intelligence Scale, the immediate memory recall test of numbers, the Code Test (WAIS), the 15-Word Test and the Benton Visual Retention Test. The vocabulary test of Binois and Pichot was first applied to C and Y1 to test the homogeneity of intellectual level between these two groups. A strategy of variance analysis followed by non-parametric Mann-Whitney and Wilcoxon tests was applied for statistical analysis of the results. Generally, except for the Cattell test, the patients presented lower scores than the control group. This decrease was not accentuated as time elapsed; the non-verbal were not affected more than the verbal tests. A clinical analysis was carried out relating the importance of the criteria “deterioration” to four other criteria: “age”, “gravity and duration of illness”, “history of E.C.T.” and “insufficient mood stabilization”. The factor “gravity of the illness” was slightly more frequently associated with factor deterioration.     

Autoimmune thyroiditis in manic-depressive patients treated with lithium

To explore whether lithium-induced hypothyroidism is related to an exacerbation of underlying autoimmune processes such as thyroiditis, the authors comprehensively assessed thyroid function in 16 manic-depressive patients. Each of the three patients who showed detectable titers of thyroid microsomal antibodies before treatment manifested a marked increase in antibody titer from 4 to 12 months after lithium treatment was begun. Thus, lithium-induced thyroid dysfunction may not only involve direct effects on the thyroid itself but also involve exacerbation of an underlying indolent autoimmune thyroiditis, possibly by causing shifts in T lymphocyte subpopulations.     

Manic-depressive illness in children: treatment with lithium carbonate

A behavior questionnaire was used retrospectively in 21 manic-depressive children to quantitate manic-depressive behaviors before and after treatment with lithium carbonate. The study children were matched with 21 control children for age, race, sex, and socioeconomic status. The study children had significantly more seizures, relatives with psychotic disorders, allergies, food sensitivities, headaches, and abnormal behaviors in all categories measured. During treatment, manic-depressive children had a statistically significant reduction in disturbed behavior. This behavior, however, was still significantly more disturbed than normal control children.     

Visually stimulated saccadic eye movements in patients treated with lithium

Saccadic eye movements were stimulated with the aid of 11 light spot stimuli, 10 of which were arranged at 3 degrees, 6 degrees, 9 degrees, 12 degrees, and 15 degrees to the left and right of the central stimulus. The parameters average and maximal eye movement velocity and latency were precisely investigated. 19 patients averaging 6.6 years on lithium prophylaxis were compared with 23 healthy controls. Significant differences between the two groups could not be found at this level of function.     

Renal function in 153 manic-depressive patients treated with lithium for more than five years

Renal function was examined in 153 manic-depressive patients treated with lithium for more than 5 years, mean 10 years. No significant change was detectable in plasma creatinine. Glomerular filtration rate (GFR) decreased slightly, but significantly, and not until after 17 years of treatment did the regression line reach the lower confidence limit in the reference material. GFR was generally only moderately decreased. Renal concentrating capacity was significantly reduced during the whole investigation period and did not change with time. GFR was independent of the dosage pattern. The diuresis did not differ markedly in patients given one or three daily doses. In a two-dose group predominantly treated with slow-release tablets, the diuresis was somewhat higher in 75% of the patients but much higher for the rest of the group. Since the prophylactic effect of lithium was the same in the one-dose group (mean dosage 21 mmol/day) as in the two-dose and three-dose groups (mean dosage 27-28 mmol/day), our data indicate that generally employed lithium doses may be reduced somewhat without loss of prophylactic efficacy.     

Screening and evaluation on predictive factors in lithium carbonate maintenance treatment of manic-depressive disorders

The prophylactic effect of lithium carbonate was studied prospectively in 95 patients with recurrent manic-depressive disorders. Maintenance lithium treatment started at the stage of recovery after previous episodes lasting for 20-24 months. Of all the 95 patients, 55 cases (57.9%) were responders, with no relapse during the follow-up period; whereas the other 40 cases (42.1%) were non-responders, having at least one relapse occurred from 4 to 12 months after the index episode. Of the parameters studied, (1) minor primary episode; (2) higher lithium RBC/plasma ratio (greater than 0.4); (3) increase of plasma calcium level during lithium treatment; (4) extraversion-cycloid personality featured by EPQ have higher predictive sensitivity and specificity (greater than 70%) and maybe used as the core predictive factors for long-term outcome in lithium treatment. The other parameters, the age of unset, frequency of episodes, euphoric and grandiose symptoms, clinical respond of first lithium anti-episode medications and lithium clearance can also be used as corresponding predictive factors in selecting cases for long-term lithium treatment.     

Comparison between saliva and serum lithium concentrations in patients treated with lithium carbonate.

The relation between serum and saliva lithium concentration was studied in patients treated with lithium carbonate. In 23 patients a highly variable saliva/serum ratio was found in simultaneous saliva and serum samples. In five patients studied during a period of 4-8 weeks three patients showed a high fluctuation in saliva/serum lithium ratio. In 20 patients saliva lithium concentrations varied unexpectedly in a second sample produced after 15 min. Although some authors report a high and stable relation between saliva and serum lithium concentration, we consider the saliva lithium level unreliable as a prediction of the serum lithium level in patients treated with lithium carbonate.     

The effect of long-term lithium treatment on the mortality of patients with manic-depressive and schizoaffective illness.

Clinical research centers in Aarhus, Berlin, Hamilton and Vienna collected mortality data for 827 manic-depressive and schizoaffective patients given lithium treatment for more than 6 months. The average duration of the treatment was 81 months and the total time on lithium 5600 patient-years. For each patient, the mortality risk was calculated by entering the appropriate national life tables for the general population. The number of observed deaths was 44; the number of expected deaths was 49.7. The standardized mortality ratio, 0.89, did not differ significantly from 1.0. The mortality of manic-depressive patients is 2-3 times that of the general population. Our data show that the mortality of manic-depressive and schizoaffective patients given long-term lithium treatment does not differ significantly from that of the general population.     

碳酸锂结合氟哌啶醇致恶性综合征(英文)

一名39岁的女性双相障碍患者因再次出现伴精神病性症状的躁狂发作而住院,总病程20年。用常规剂量的碳酸锂和氯氮平治疗。入院3天后,患者出现攻击行为,并拒绝服药,因而停用氯氮平口服,予氟哌啶醇肌注。3天后,患者出现高热以及其他恶性综合征的表现,如大量出汗,肢体肌肉痉挛、震颤,肌强直以及意识障碍。立刻停用氟哌啶醇和锂盐,对症支持治疗,同时用多巴胺激动剂溴隐亭治疗。恶性综合征的症状在3天内缓解,但精神病性症状依然很严重。继而使用丙戊酸钠和奥氮平治疗,未再出现恶性综合征。又治疗1个月后,患者康复出院。过去有若干个病例也与此类似,这些病例提示抗精神病药物合并锂盐治疗引起恶性综合征的风险可能比单用一种抗精神病药物要高。当然病例报告本身无法证实这一点。     

Predictors of interepisode symptoms and relapse in affective disorder patients treated with lithium carbonate

For 98 affective disorder patients receiving lithium prophylaxis for a mean of 45 months, number of interepisode symptoms correlated with relapse rate. Response to prophylaxis appeared highly determined by prelithium frequency of episodes and duration of lithium treatment.