Side-effects of lithium at lower therapeutic levels: the significance of thirst

The prevalence of thirst, subjective polyuria and related side-effects was investigated in 87 patients attending a lithium clinic and in a group of 52 controls. Thirst was surprisingly common, occurring in 67% of patients, in spite of the fact that they had been maintained on relatively low levels of lithium, and was due principally to the lithium rather than to other psychotropic drugs. Urine flow and impaired renal water absorption correlated with the serum lithium level and the length of treatment in the patients, despite the fact that few were clinically polyuric. The pattern of the results confirms previous suggestions that lithium may stimulate the thirst mechanism directly as well as via an increased renal resistance to vasopressin. The possible implications in terms of clinical response are discussed.     

A validation study of three anxiety and depression self-assessment scales

All measuring instruments require further validation both in the setting for which they were designed and in other fields. The Hospital Anxiety and Depression Scale was designed for detection and assessment of those mood disorders in the setting of hospital medical and surgical clinics. Reasons are given for supposing it has advantages over other similar scales. The present study undertakes a further validation of the scale in a general hospital setting. The opportunity is taken to assess the usefulness, in this setting of the Irritability Depression and Anxiety Scale and also of two subscales of the General Health Questionnaire, the one relating to the concept of depression and the other to the concept of anxiety. Score ranges of the latter two subscales are suggested and will require replication for confirmation of their usefulness.