慢性锂中毒临床分析

目的:探讨血锂浓度≥1.0mmol/L的慢性锂中毒患者血锂浓度、中毒症状与治疗之间的关系。方法:查阅150例血锂浓度≥1.0mmol/L的慢性锂中毒患者的病历记录,采集人口学资料及临床特征。结果:高剂量、高龄、女性、合并苯二氮艹卓类药物者血锂浓度较高。中毒症状与血锂浓度密切相关,血锂浓度越高,越容易中毒。血液透析对锂的排除率高于常规治疗。结论:长期服用锂盐的患者应监测血锂浓度,警惕危险因素,临床医生需密切观察中毒症状。     

临床医师应用血锂测定情况调查分析

目的调查临床医师实际应用血锂测定情况。方法自制调查表，内容包括年龄、性别、诊断、病程、测量血锂次数、测量血锂时的碳酸锂剂量、测量血锂时应用锂盐治疗的时间、测量血锂的原因、血锂测量结果、测量血锂前后的血白细胞数，应用SPSS软件包对数据进行统计分析。结果每位患者血锂测量最少1次，最多6次。测量血锂的医嘱绝大多数为常规检查。绝大多数病例血锂浓度值在正常范围内，极少数病例超出正常值。随着治疗时间的延长，测量血锂的意义下降。结论血锂测量绝大多数为常规检查，随治疗时间的延长，测量血锂次数和人数逐渐减少，测量血锂的意义也下降。但愿结合临床观察，随时检查血锂浓度，以防和早期发现锂盐中毒。     

躁狂症患者体液锂浓度与剂量,疗效的关系

本文对11例躁狂症患者体液锂浓度与临床疗效及剂量的关系进行了研究,结果显示:当临床上取得显效时,血锂浓度为1.0±0.4mmol/L,唾液锂浓度为1.67±0.82mmol/L,脑脊液锂浓度为0.42±0.26mmol/L。体液锂浓度与剂量呈正相关,血锂浓度与唾液浓度之比为1∶2.3,且二者相关系数为0.537,脑脊液锂为血锂浓度的37.3—53.4%。中毒时体液浓度可能不变,故在应用碳酸锂时应密切观察临床表现和中毒症状,不能只用体液浓度衡量是否中毒。     

肾上腺皮质及甲状腺功能减退所致精神障碍1例

1病例 患者,女,37岁,因渐起话多,易激惹,睡眠差1周于2007年8月29日入院,体检未见明显异常,诊断心境障碍,躁狂发作。予碳酸锂和奎硫平口服,第3天剂量分别为1．0mg／d和400mg／d。1周后患者症状明显缓解,话不多,情绪稳定,饮食睡眠好。入院第8天,出现进食差,恶心,呕吐,无震颤,血锂浓度2．2mmol／L。考虑急性锂中毒,查肝肾功能、空腹血糖和电解质水平正常,停用碳酸锂,排锂盐治疗。     

碳酸锂治疗的躁狂发作患者血锂浓度与肾小球滤过率的关系

目的探讨锂盐代谢与肾小球滤过率的关系。方法收集52例接受碳酸锂治疗的躁狂发作患者,检测治疗前血肌酐、尿素氮、体表面积、血钠浓度等指标,同时根据肾脏病膳食改善(the modification of diet in renaldisease,MDRD)方程估算肾小球滤过率(estimated glomerular filtration rates,eGFR);在给予口服碳酸锂1.0 g/d 1周后测定稳态血锂浓度。对上述各项指标与血锂浓度进行相关分析。结果患者组的稳态血锂浓度为0.2～1.0 mmoL/L,平均(0.52±0.18)mmoL/L。单因素分析显示,血锂浓度与体表面积、eGFR负相关(r=-0.33,P=0.02;r=-0.30,P=0.03)。多元线性回归分析也显示血锂浓度与体表面积、eGFR间负相关(β=-0.31,P=0.02;β=-0.28,P=0.03),未发现血锂浓度与血肌酐、尿素氮相关(P>0.05)。结论本研究结果提示eGFR可以作为个体代谢锂盐能力的预测指标之一。     

锂与丙戊酸钠合并使用致神经中毒1例报告

病人,男性,19岁,患双相情感性障碍(躁狂相)符合CCMD-2诊断标准。入院前未做任何治疗,入院后,为了控制其躁狂状态,逐渐施以锂盐系统治疗一个月,最高日量2g维持两周,无发生不良反应,血锂浓度1.0mEP/L,单独用锂盐不能控制其精神运动性兴奋症状,因此合并丙戊酸钠0.4/日,分二次给药,3天内发生神经中毒症状,表现步态不稳,全身震颤,共济失调、水平性眼艮球震颤、四肢过度屈曲和肌肉强直,伴有重度意识障碍。体温40.1℃血自细胞26.0×     

唾液与血清锂浓度的比较

唾液与血清锂浓度的比较魏贤玉，程秀然，朱蔼，杨永杰，张长岭，梁立桂，李桂民，王曙光血清理浓度的测定对锂盐剂量的掌握有很大帮助。唾液电解质成份与血清相仿，若能以唾液代替血清测定锂浓度，则较简便易行，我们以正常志愿者与情感性障碍患者各１０例，作两者锂浓度...     

红细胞锂、血浆（清）锂与临床安全性的探讨

本文报告单用锂盐治疗的31例情感、分裂情感性精神病人135例次红细胞锂和血浆锂测定结果的相关、回归分析。结果显示：红细胞锂与血浆锂呈正相关（r＝0．8174）。同时结合临床，对二者浓度水平及其比值进行了分析。发现有5例次血浆锂超过1．2mEq/L，同时相应红细胞锂超过1mEq/L，两者比值超过0．8：1，即有4例次出现了中毒症状。提示在临床上，当达到上述标准时，要警惕有出现锂中毒的可能性。     

锂测定方法及其应用

锂是一种碱金属元素,在医学中有其特殊的意义。一方面,碳酸锂可用于精神科治疗,但锂的有效剂量与中毒剂量接近,故监测血锂浓度就显得非常必要。另一方面,用锂作内标亲测定钾、钠,可缩小火焰光度计因燃气或压缩空气及火焰温度等波动所引起的误差。因此,从临床检验工作出发,现将锂测定方法及其应用综述如下。     

锂中毒12例临床分析

近年来,锂盐在精神科领域的使用日益增多,但如使用不当,就会导致中毒。特别是在当前,血锂浓度的测定方法尚未普及,剂量的增减带有一定的盲目性,如果对锂中毒的临床表现认识不足,对剂量的增加规律不熟悉,观察又不细致,必将使锂中毒的可能性大为增加。     

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。     

Reversible choreoathetosis associated with lithium intoxication]

Several reports have been published in the literature of choreoathetosis associated with lithium intoxication, but little is known about choreoathetosis without concurrent antipsychotic treatment. We report a 65-year-old woman with lithium intoxication whose choreoathetosis completely recovered without sequela following decrease of her serum lithium level. She had been treated elsewhere for bipolar II disorder and also for hypertension, chronic hepatitis type C and diabetes mellitus. As she became hypomanic, lithium carbonate at 600 mg/day was commenced, which was increased to 1200 mg/day due to unfavorable therapeutic response. She began to manifest disorientation and abnormal involuntary movement and was therefore referred to our Department of Psychiatry. Her clinical symptoms at admission included consciousness disturbance with marked bilateral symmetrical slow-wave activity in her EEG and choreoathetosis was observed in her face and upper and lower extremities. Cerebellar symptoms were minimal with only mild ataxic gait and finger-to-nose test did not show dysmetria or intention tremor. Her serum lithium level was 3.52 mEq/L, which was clearly in the toxic range. She demonstrated no metabolic abnormalities including hyperglycemia, and was diagnosed with lithium intoxication and treated with water loading and mannitol for forced diuresis. On the 14th day after admission her consciousness disturbance and choreoathetosis resolved, but EEG abnormalities still persisted. On the 23rd day after admission, she was discharged with clinical remission and normal EEG background activity. Although she developed mild renal dysfunction, hemodialysis was not indicated. Hypersensitivity of dopamine receptor in the nigrostriatal pathways may contribute to choreoathetosis in association with the patient's vulnerability. Choreoathetosis can be a sign of lithium intoxication and prompt treatment is required following careful differential diagnosis.     

Deep venous thrombosis of the leg due to psychiatric stupor

Abstract  We report the cases of two patients with psychiatric stupor who developed venous thrombosis. A 29-year-old schizophrenic woman had been hospitalized in psychiatric institutions three times because of stupor associated with auditory hallucinations and thought blocking. These symptoms recurred and she was admitted to our hospital with deep venous thrombosis of her left leg. The other patient was a 67-year-old woman with depression. She had also suffered from insomnia. Following admission to our hospital, she developed a depressive stupor complicated by deep venous thrombosis of her left leg. Both cases were treated with sodium heparin and urokinase, and completely resolved. It is well known that dehydration, infection and decubitus ulcers are important physical complications of psychiatric stupor, but there have been few reports of deep venous thrombosis as a physical complication of stupor.     

A case of Parkinsonism due to lithium intoxication: treatment with Pramipexole.

We report the case of a 72-year-old woman with bipolar disorder treated with lithium for over a year, who suddenly developed disabling Parkinsonism, apparently after a gastroenteric infection. On hospital admission lithium plasma levels were 3.7 mmol/l. After lithium discontinuation, plasma levels decreased to 0.7 mmol/l, but without resolution of neurological symptoms. Biperidene and levodopa-benserazide did not ameliorate her extrapyramidal symptoms. Pramipexole 0.25 mg TID improved dramatically the Parkinsonism and all neurological symptoms resolved in a few days.     

Sodium-dependent lithium efflux from red cells in affective disorders

Steady state red blood cell/plasma lithium concentration ratios were determined simultaneously with the in vitro sodium-dependent downhill lithium efflux from red cells during maintenance lithium treatment in 22 bipolar depressed patients, 17 unipolar depressed patients, and 28 psychiatric control patients. The values of the sodium-dependent lithium efflux were significantly correlated with the steady-state lithium levels in red blood cells and plasma. A profound difference in sodium-dependent lithium efflux from red cells was found between controls and bipolar patients and to a lesser degree between controls and unipolar patients.     

Delirium syndrome as a side-effect of lithium in normal lithium levels

Lithium is used with great success in the treatment of manic patients and for prophylaxis of bipolar disorders. There are only few reports about neuropsychiatric side effects at therapeutic serum levels. We report on a 38 year old woman with bipolar disorder who was treated with lithium for 20 years without side-effects. Subsequent to a manic episode, she became disoriented at night and showed marked memory deficits. The patient did not show any neurological or gastrointestinal signs of intoxication. Lithium serum-levels were in therapeutic range. The psychiatric symptoms disappeared when lithium was stopped. We interpret these symptoms as delirant syndrome with pseudo-dementia at therapeutic lithium serum levels. This side-effect must be taken into account even in patients on successful longtime lithium therapy.     

Implication of serum concentration monitoring in patients with lithium intoxication

The aim of the present study was to determine the relationships between serum lithium level, duration of lithium intoxication, severity of symptoms, and the outcome of the disease. Subjects with a serum lithium level of >/=1.2 mEq/L were included in the study. Seventy-eight patients with lithium intoxication were identified between 1 July 1999 and 31 December 2002. The demographic characteristics, clinical manifestations, and concomitant medications were recorded. Most patients with acute lithium intoxication had mild symptoms, independent of the serum lithium levels. In patients with chronic lithium intoxication, the frequency of severe symptoms was higher than in those with acute intoxication. None of the 78 intoxicated patients in the present survey died or suffered from persistent neurological sequelae. Patients with concomitant medications, older age, and existing neurological illness may have an increased susceptibility to lithium toxicity. Regular monitoring of serum lithium level is essential for lithium-treated patients. Clinicians should pay attention to patients with pre-existing neurological illness, older age, or receiving medications that may interact with lithium.     

Psychopathology during long-term lithium treatment of patients with major affective disorders. A prospective study

Thirty-seven patients with major affective disorders according to DSM-III and on continuous lithium treatment were followed during a 7-year period. Outcome was assessed by use of the Comprehensive Psychopathological Rating Scale and by the need for additional psychotropic medication and for hospital and outpatient care. Anamnestic variables and patient's attitudes to their lithium medication were also included in the analysis of outcome, as were laboratory data, including lithium parameters. An increase in psychopathology was demonstrated in a significant number of patients and was attributed mainly to an increase in the depressive symptoms, with a significant increase in the rated scores for fatiguability, pessimistic thoughts, reduced sleep, and inner tension. Suicidal thoughts were common, but no suicide attempts were made. A significant number of patients complained of failing memory, but no significant progression was demonstrated during the 7-year study period. The increase in the depressive symptoms was closely correlated with the number of hospital admissions for depressive recurrence and with the number of days in hospital. The following factors showed a significant relationship with the increase in depressive symptoms: serum lithium levels, large increase in the elimination half-life of lithium, low level of social functioning, low TSH values, and need of concomitant administration of antidepressants and benzodiazepines.     

Influence of atypical features on the quality of prophylactic effectiveness of long‐term lithium treatment in bipolar disorders

Pfennig A, Schlattmann P, Alda M, Grof P, Glenn T, Müller‐Oerlinghausen B, Suwalska A, Rybakowski J, Willich SN, Bauer M, Berghöfer A. Influence of atypical features on the quality of prophylactic effectiveness of long‐term lithium treatment in bipolar disorders.
Bipolar Disord 2010: 12: 390–396. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objectives: There is still debate about whether the quality of long‐term efficacy of lithium in patients with bipolar disorders is influenced by atypical features. Extended Cox regression models allow for the use of all follow‐up data on diseases with multiple episodes. The aim of the present analysis was to apply the best suited of these models to analyze the influence of atypical features on the widely used outcome measure of time to recurrence in a large multicenter cohort of lithium responders established by the International Group for the Study of Lithium Treated Patients. Methods: A conditional extended Cox model with a random frailty term was applied to the data of 336 bipolar I and II disorder patients, all of whom were responders to lithium with treatment for up to 30 years. Results: Differences were found in the long‐term outcome, even in patients who have demonstrated a relatively good response to lithium treatment. The hazard for recurrence was negatively influenced by the presence of atypical features, mainly mood‐incongruent psychotic symptoms, interepisodic residual symptomatology, and rapid cycling. Conclusions: As a result of the findings, physicians should regularly reassess the quality of response in bipolar disorder patients with atypical features and, if necessary, modify treatment. Extended Cox regression models are well suited for evaluating long‐term outcome and should be used more extensively to analyze treatment outcome in psychiatric and somatic disorders.