lithium-chloride and Affective-Disorders--Psychotic

Topics: Adult; Affective Disorders, Psychotic; Analysis of Variance; Antidepressive Agents, Tricyclic; Antimanic Agents; Antipsychotic Agents; Drug Therapy, Combination; Female; Humans; Lithium Chloride; Male; Middle Aged

Lithium-associated remission of psychosis has been described in schizophreniform disorders and in psychotic patients with variants of the red blood cell (RBC)/lithium ratio. To determine whether such remissions are the consequence of lithium treatment rather than spontaneous in nature, a double-blind, placebo-controlled study was undertaken in 16 psychotic patients preselected for the variant of RBC/lithium ration and/or DSM-III schizophreniform diagnosis. Essentially full and sustained remission of psychosis began during periods of lithium treatment in 4 of 15 of the study patients. Improvement was significantly greater during lithium treatment periods than in counterbalanced placebo treatment conditions in these four subjects (p less than 0.02). Fifteen of the same 16 study patients failed to initiate sustained improvement either spontaneously or while on placebo during the initial 14-day treatment period. In this preselected psychotic population, sustained response to lithium occurred at a rate at least four times greater than that which could be attributed to spontaneous remission.

Topics: Affective Disorders, Psychotic; Chlorides; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Haloperidol; Humans; Lithium; Lithium Chloride; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia

The aim of this prospective study was to investigate the influence of lithium serum levels on subclinical psychopathological features during the euthymic interval in patients with an affective disorder.. The study included 54 patients with a recurrent affective disorder undergoing a continuous prophylactic lithium treatment (31 unipolar, 23 bipolar). The observation period lasted for 2 years and included 332 visits. Visits consisted of a detailed interview, a continuous measurement of lithium levels and the collection of validated scales including HAMD, YMRS, CGI, VAMS and the SCL-90R. Several correlations between lithium serum levels and different psychopathological features during the euthymic interval were calculated on an individual patient basis and on a group basis to reveal generally occurring correlations.. No generally occurring significant correlations between lithium serum levels and specific psychopathological features were found. Only on a single patient level, 32 significant correlations between lithium level and specific psychopathological features were found, partly indicating a negative and partly indicating a positive influence of higher lithium levels on psychopathological symptoms. Nevertheless, in the group analyses no significant correlations were found.. Higher lithium levels were not associated with an improved psychopathological status, but they were not associated with a worse status (due to a higher burden of side effects) either. According to the literature there is currently no strong evidence to treat patients with a higher lithium level. It is recommended to start with a lower level and to continue with individual adjustments in accordance to prophylactic efficacy and tolerability.

Topics: Adult; Affect; Affective Disorders, Psychotic; Aged; Antimanic Agents; Drug Monitoring; Female; Germany; Hospitals, University; Humans; Lithium; Lithium Chloride; Male; Medical Records; Middle Aged; Outpatient Clinics, Hospital; Prospective Studies; Psychiatric Status Rating Scales; Secondary Prevention; Young Adult