The Prevention of Suicide in Patients with Recurrent Mood Disorder

1992 ◽  
Vol 6 (2_suppl) ◽  
pp. 334-339
Author(s):  
Malcolm Peet
Keyword(s):  
Mood Disorder ◽  
Mood Disorders ◽  
Health Workers ◽  
Lithium Treatment ◽  
Term Treatment ◽  
Mental Health Workers ◽  
Long Term Treatment ◽  
Reduced Rate ◽  
Commit Suicide

Recurrent mood disorder carries a risk of suicide of ~ 15%. Patients who do commit suicide have often received inadequate antidepressant or prophylactic lithium treatment. Long-term treatment with lithium normalizes the excess mortality associated with recurrent mood disorders, including that from suicide. A reduced availability of the most lethal methods of suicide may contribute epidemiologically to a reduced rate of suicide, and therefore the differences in overdose toxicity between antidepressants may be pertinent. Education of mental health workers regarding the effective treatment of mood disorders can help to reduce the rate of suicide. Patient education and psychological support can lead to improved compliance with prophylactic medication and early detection of relapse, but more formal psychotherapy does not appear to be helpful. Specialized mood disorder clinics lead to better patient care than is possible in a routine psychiatric out-patient clinic.

Idiopathic Recurrent Catatonia Needs Maintenance Lorazepam: Case Report and Review

2007 ◽  
Vol 41 (7) ◽  
pp. 625-627 ◽  
Author(s):  
Narayana Manjunatha ◽  
Sahoo Saddichha ◽  
Christoday R.-J. Khess
Keyword(s):  
Case Report ◽  
Mood Disorders ◽  
Term Treatment ◽  
Down Regulation ◽  
Gaba A ◽  
Periodic Catatonia ◽  
Long Term Treatment ◽  
History Of ◽  
High Doses

Objectives: Catatonia as a phenomenon has been well described with either a schizophrenic illness, severe mood disorders or periodic catatonia disorder. We aim to report a patient who had recurrent catatonia that responded to and required lorazepam for maintenance. Methods: We describe the case of a 28 year old woman who had a history of recurrent catatonia that was unresponsive to most anti-psychotics, but who responded to high doses of lorazepam and needed long-term lorazepam for maintenance. Results and Conclusion: Our patient met the criteria for a diagnosis of idiopathic catatonic disorder. Response to lorazepam suggests that a certain group of patients may require long-term treatment with lorazepam, especially those who may have down-regulation of GABA-A receptors.

Practical Aspects of Long-Term Treatment with Lithium

1992 ◽  
Vol 6 (2_suppl) ◽  
pp. 330-333 ◽  
Author(s):  
Iain Glen
Keyword(s):  
Lithium Treatment ◽  
Depressive Illness ◽  
Term Treatment ◽  
Term Therapy ◽  
Manic Depressive Illness ◽  
Short Term Treatment ◽  
Manic Depressive ◽  
Long Term Treatment ◽  
Long Term Therapy

There is no increase in the overall mortality of patients undergoing long-term lithium treatment compared with those receiving short-term treatment. Lithium causes a reduction in the incidence of suicide in patients suffering from manic depressive illness. Long-term treatment with lithium is more effective than treatment with imipramine or amitriptyline. Drug interactions may cause problems during long-term therapy with lithium. A reduction in plasma levels of lithium should be considered in stable patients on long-term prophylaxis. Discontinuation of therapy often results in a relapse. The toxicity of lithium is related to its effects on calcium transport.

Long-term lithium treatment in the prevention of suicidal behavior in bipolar disorder patients

2009 ◽  
Vol 18 (3) ◽  
pp. 179-183 ◽  
Author(s):  
Leonardo Tondo ◽  
Ross J. Baldessarini
Keyword(s):  
Bipolar Disorder ◽  
Suicidal Behavior ◽  
Antidepressant Treatment ◽  
Lithium Treatment ◽  
Term Treatment ◽  
Mood Stabilizers ◽  
Major Depressive ◽  
Long Term Treatment ◽  
Meta Analyses

AbstractWe reviewed available research findings, including meta-analyses on effects of lithium-treatment associated with rates of suicidal behavior in bipolar disorder or unipolar major depressive disorder patients, and for comparisons of lithium to mood-stabilizing anticonvulsants. Data from meta-analyses consistently indicate marked reductions of suicidal behavior and mortality during long-term treatment with lithium salts in bipolar disorder patients, and possibly also in unipolar, recurrent major depressive, perhaps even more effectively than with anticonvulsants proposed as mood-stabilizers. Suicidal risk is frequently associated with dysphoric-agitated symptoms, anger, aggression, and impulsivity-all of which may respond better to treatment with lithium or other mood-stabilizing medicines than to antidepressants. In these conditions, antidepressant treatment may not provide a beneficial effect on risk of suicidal thoughts and perhaps attempts, particularly in juveniles, whereas, lithium, perhaps even more than anticonvulsants, seems to be remarkably effective in the preventing suicidal behavior. The mechanism of action is not well defined and may be associated with either a prevention of mood recurrences or a more specific “antisuicidal” activity.Declaration of Interest: Dr. Tondo has received research support from Janssen and Eli Lilly Corporations and has served as a consultant to Glaxo-SmithKline and Merck Corporations. Dr. Baldessarini has recently been a consultant or investigator-initiated research collaborator with: AstraZeneca, Auritec, Biotrofix, Janssen, JDS-Noven, Lilly, Luitpold, NeuroHealing, Novartis, Pfizer, and SK-BioPharmaceutical Corporations. Neither author is a member of pharmaceutical speakers’ bureaus, nor do they or any family member hold equity positions in biomedical or pharmaceutical corporations.

Low-Dose Lithium for Long-Term Treatment of Clozapine- Induced Neutropenia: A Case Series

2019 ◽  
Vol 8 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Muhammad R. Baig
Keyword(s):  
Mental Health ◽  
Effective Treatment ◽  
Low Dose ◽  
Lithium Treatment ◽  
Case Series ◽  
Cost Effective ◽  
Term Treatment ◽  
Treatment Resistant ◽  
Long Term Treatment

Background: Treatment-resistant psychosis makes schizophrenia a disabling and costly illness. Clozapine is an effective treatment for treatment-resistant psychosis, though it is underutilized mainly due to prescribing providers’ fear of a serious yet uncommon complication, clozapine-induced neutropenia. Clozapine-induced neutropenia predisposes patients to potentially life-threatening infections leading prescribers to stop use when blood counts start to drop even well above the recommended cut-off point. Colonystimulating factors are effective options for reducing risk and duration of neutropeniarelated events though they add a significant cost burden to the patient and healthcare system. There is a great need for feasible and cost-effective pharmacotherapies in the mental health care setting for the management of clozapine-induced neutropenia. Objective: We evaluated adjunctive use of lithium when prescribed at a low-dose to stabilize dropping blood count in patients receiving clozapine for treatment-resistant psychosis. Methods & Results: A case series analysis of three patients who were followed in a mental health outpatient clinic for the management of schizophrenia. Blood counts of all the patients were stabilized by low-dose lithium treatment and continued to receive long term treatment of clozapine. Conclusion: Results suggest low-dose lithium as a feasible and cost-effective pharmacotherapeutic option enabling the continuation of clozapine, an effective treatment for treatment-resistant psychosis.

scholarly journals Socio-demographic and clinical predictors of outcome to long-term treatment with lithium in bipolar disorders: a systematic review of the contemporary literature and recommendations from the ISBD/IGSLI Task Force on treatment with lithium

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Diane Grillault Laroche ◽  
◽  
Bruno Etain ◽  
Emanuel Severus ◽  
Jan Scott ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Assessment Tool ◽  
Task Force ◽  
Lithium Treatment ◽  
Term Treatment ◽  
Predictors Of Outcome ◽  
Episodic Evolution ◽  
Long Term Treatment ◽  
Lifetime Number

Abstract Objective To identify possible socio-demographic and clinical factors associated with Good Outcome (GO) as compared with Poor Outcome (PO) in adult patients diagnosed with Bipolar Disorder (BD) who received long-term treatment with lithium. Methods A comprehensive search of major electronic databases was performed to identify relevant studies that included adults patients (18 years or older) with a diagnosis of BD and reported sociodemographic and/or clinical variables associated with treatment response and/or with illness outcome during long-term treatment to lithium (> = 6 months). The quality of the studies was scored using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Institute of Health. Results Following review, 34 publications (from 31 independent datasets) were eligible for inclusion in this review. Most of them (n = 25) used a retrospective design. Only 11 studies were graded as good or borderline good quality. Forty-three potential predictors of outcome to lithium were identified. Four factors were associated with PO to lithium: alcohol use disorder; personality disorders; higher lifetime number of hospital admissions and rapid cycling pattern. Two factors were associated with GO in patients treated with lithium: good social support and episodic evolution of BD. However, when the synthesis of findings was limited to the highest (good or borderline good) quality studies (11 studies), only higher lifetime number of hospitalization admissions remained associated with PO to lithium and no associations remained for GO to lithium. Conclusion Despite decades of research on lithium and its clinical use, besides lifetime number of hospital admissions, no factor being consistently associated with GO or PO to lithium was identified. Hence, there remains a substantial gap in our understanding of predictors of outcome of lithium treatment indicating there is a need of high quality research on large representative samples.

Lithium treatment and kidney function A SURVEY OF 237 PATIENTS IN LONG-TERM TREATMENT

1979 ◽  
Vol 60 (5) ◽  
pp. 504-520 ◽  
Author(s):  
P. Vestergaard ◽  
A. Amdisen ◽  
H. E. Hansen ◽  
M. Schou
Keyword(s):  
Kidney Function ◽  
Lithium Treatment ◽  
Term Treatment ◽  
Long Term Treatment

Course and prognosis of mood disorders

2012 ◽  
pp. 665-669
Author(s):  
Jules Angst
Keyword(s):  
Mental Disorders ◽  
Mood Disorders ◽  
Age Of Onset ◽  
Term Treatment ◽  
Social Consequences ◽  
Psychiatric Classification ◽  
Residual Symptoms ◽  
The Social ◽  
Long Term Treatment

Ever since Kahlbaum's monograph 1863 the course and outcome of mental disorders have played important roles as criteria and validators of psychiatric classification. The prognosis is fundamental for doctor and patient when deciding whether to start long-term prophylactic medication and, at a later stage, whether to stop a successful long-term treatment. Course is a crucial factor in estimating the social consequences, costs, suicide risk, and mortality associated with mood disorders. The description of course includes the age of onset, episode length, recurrence of episodes, residual symptoms between episodes and outcome (remission, chronicity, death). These aspects are covered in this chapter.

Outcome of Bipolar Disorder on Long-Term Treatment with Lithium

1991 ◽  
Vol 159 (1) ◽  
pp. 123-129 ◽  
Author(s):  
Ralph A. O'Connell ◽  
Julia A. Mayo ◽  
Leslie Flatow ◽  
Beverly Cuthbertson ◽  
Barbara E. O'Brien
Keyword(s):  
Bipolar Disorder ◽  
Treatment Outcome ◽  
Lithium Treatment ◽  
Term Treatment ◽  
Poor Outcome ◽  
Psychiatric Admissions ◽  
Long Term Treatment ◽  
Alcohol And Drug Abuse ◽  
Bipolar Patients

The long-term treatment outcome of 248 bipolar patients in an out-patient lithium programme was assessed. Over half of the patients (138 or 56%) had no affective episodes in the year observed. Patients were divided into outcome groups according to GAS scores: the outcome for 40% of patients was good, for 41% fair, and for 19% poor. More frequent psychiatric admissions before starting lithium treatment was the best predictor of poor outcome, followed by a negative affective style in the family and lower social class. Current alcohol and drug abuse was associated with poor outcome. Although familial and psychosocial factors were significantly associated with outcome, the findings suggest there may be inherent differences in the pathophysiology of bipolar disorder reflected in an increased frequency of episodes which account for a large variance in lithium treatment outcome.

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