scholarly journals NON PITTING TYPE PEDAL EDEMA WITH LITHIUM: A CASE REPORT

2016 ◽  
Vol 9 (1) ◽  
pp. 323
Author(s):  
Parvathypriya C. ◽  
Jeslyn Mary Philip ◽  
Christeena George ◽  
Lakshmi R.
Keyword(s):  
Affective Disorder ◽  
Dose Escalation ◽  
Lithium Treatment ◽  
Lithium Concentration ◽  
Bipolar Affective Disorder ◽  
Lithium Therapy ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Serum Lithium Concentration ◽  
Pedal Edema

<p><strong>Objective: </strong>To report a case of lithium induced bilateral nonpitting pedal edema.</p><p><strong>Methods: </strong>The clinical data of a bipolar affective disorder patient with current episode of mania and psychotic symptoms who experienced bilateral non pitting pedal edema with lithium.</p><p><strong>Results: </strong>The patient was a 29 yr old female who developed bilateral non-pitting type pedal edema with lithium therapy with normal plasma lithium level (0.72mEq/l). She is a known case of bipolar affective disorder (BPAD) was admitted to psychiatry department with episode of mania with psychotic symptoms. She had history of drug induced hypersensitivity reaction with eosinophilia and systemic symptoms (DRESS) with oxcarbazepine and so the drug was discontinued and was started on tablet lithium 400 mg twice daily. On admission here, the dose of lithium was increased to 1200 mg/day. The patient gradually improved but she developed bilateral non-pitting pedal edema. Serum lithium concentration was normal and there were no other early symptoms of lithium toxicity. But as the patient's distress further increased with increasing pedal edema, it was decided to stop lithium altogether and to maintain the patient on tablet quetiapine 800 mg therapy for BPAD. Within one week of stopping lithium the edema on both her feet decreased significantly. Causality was assessed by naranjo causality assessment scale and a probable relationship was obtained between lithium and pedal edema with a score of 6.</p><p><strong>Conclusion: </strong>This case emphasises that regular physical examination and laboratory investigations are important for patients who are on lithium therapy. Clinicians should always be careful while initiating lithium treatment in a patient with respect to the initial dose and dose escalation even after a period of successful therapy with lithium, as minor dose escalation can cause major changes in the serum lithium concentration and thereby the patient’s tolerability to lithium.</p>

Increased Serum Lithium Concentration Secondary to Treatment with Tiaprofenic Acid and Fosinopril

1996 ◽  
Vol 30 (12) ◽  
pp. 1411-1413 ◽  
Author(s):  
Christopher P Alderman ◽  
Katharine SW Lindsay
Keyword(s):  
Combination Therapy ◽  
Proximal Tubule ◽  
Affective Disorder ◽  
Shoulder Pain ◽  
Lithium Concentration ◽  
Tiaprofenic Acid ◽  
Bipolar Affective Disorder ◽  
Lithium Clearance ◽  
Serum Lithium Concentration ◽  
Case Summary

OBJECTIVE: To describe a patient in whom the administration of tiaprofenic acid and fosinopril was associated with decreased lithium clearance, resulting in increased serum lithium concentrations. CASE SUMMARY: A woman treated with lithium for bipolar affective disorder was concurrently treated with tiaprofenic acid 200 mg tid for shoulder pain. Previously initiated treatment with fosinopril was maintained during this time. The urinary lithium clearance was decreased during this combination therapy, necessitating a reduction in the lithium dosage. DISCUSSION: Lithium is approximately 80% reabsorbed in the proximal tubule, and the addition of tiaprofenic acid may have resulted in enhanced tubular lithium reabsorption. The possible influence of concurrent fosinopril therapy may also have contributed to altered lithium pharmacokinetics in this case. CONCLUSIONS: Serum lithium concentrations should be monitored if patients taking lithium are treated with tiaprofenic acid.

Antinuclear autoantibodies in relation to bipolar affective disorder and lithium therapy

1996 ◽  
Vol 11 (1) ◽  
pp. 50-52 ◽  
Author(s):  
B Spivak ◽  
M Radwan ◽  
P Bartur ◽  
R Mester ◽  
A Weizman
Keyword(s):  
Affective Disorder ◽  
Antinuclear Antibodies ◽  
Lithium Treatment ◽  
Bipolar Affective Disorder ◽  
Lithium Therapy ◽  
Healthy Controls ◽  
Antinuclear Autoantibodies ◽  
Dna Antibodies ◽  
Bipolar Patients ◽  
Drug Free

SummaryWe investigated the presence of antinuclear antibodies (ANA) in 63 drug free and lithium treated bipolar patients as compared to 37 healthy controls. Increased frequency of positive ANA was detected in bipolar patients in comparison to controls (19% vs 5%, respectively, P < 0.05). This finding was unrelated to lithium treatment. No antinative DNA antibodies or antihistone reactive antibodies were detected among the ANA positive subjects.

Validation of the Sinhala version of the Morisky Medication Adherence Scale to determine medication adherence in patients with bipolar affective disorder on lithium therapy

2018 ◽  
Vol 6 (1) ◽  
pp. 30
Author(s):  
Uthpali Mannapperuma ◽  
Priyadarshani Galappatthy ◽  
Varuni A De Silva ◽  
Raveen Hanwella ◽  
Raveendra Laal Jayakody ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Internal Consistency ◽  
Lithium Concentration ◽  
Bipolar Affective Disorder ◽  
Lithium Therapy ◽  
Cronbach’S Alpha ◽  
Serum Lithium Concentration ◽  
Cronbach's Alpha ◽  
Morisky Medication Adherence Scale ◽  
Adherence Scale

Rationale, aims and objectives: The Morisky Medication Adherence Scale (MMAS-8) is a self-reported scale used in assessing medication adherence in patients on chronic therapy. Medication adherence is a neglected area of research in Sri Lanka and in this study we have attempted to validate the Sinhala translation of the MMAS-8 to determine medication adherence among patients stabilized on lithium therapy for bipolar disorder (BD).Methods: The MMAS-8 was translated to Sinhala with standard forward and backward translations from English to Sinhala. Patients with BD on stable doses of lithium were administered the Sinhala version of the MMAS-8. During the same visit, the serum lithium concentration was measured. Criterion validity was assessed using therapeutic serum lithium concentrations as the gold standard. Internal consistency was assessed using Cronbach’s alpha and Spearman’s rank correlation was used to assess test-retest reliability.Results: From a sample of 240 patients, 82.1% were considered adherent, with serum lithium concentration >0.4 mmol/L. The mean MMAS-8 score was 6.95±1.3. According to the MMAS-8 scale, 13.3% reported low adherence while 43.3% reported medium and high adherence equally using MMAS cut offs <6, 6 to<8 and 8 respectively. The scale sensitivity to identify adherence at a cut-off score of 6 was 86.3%. The test–retest reliability value was 0.708 (p<0.001). Internal consistency was found with a Cronbach’s alpha value of 0.608 for the 8 items of the scale.Conclusion: The Sinhala version of MMAS-8 can be used as a sensitive instrument to identify medication adherence in patients with bipolar disorders.

scholarly journals Cigarette smoking and psychotic symptoms in bipolar affective disorder

2001 ◽  
Vol 179 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Aiden Corvin ◽  
Ed O'Mahony ◽  
Myra O'Regan ◽  
Claire Comerford ◽  
Robert O'Connell ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Psychotic Symptoms ◽  
Heavy Smoking ◽  
Ordinal Logistic Regression Analysis ◽  
History Of ◽  
Categorical Diagnosis ◽  
The Relationship

BackgroundAn association exists between smoking and schizophrenia, independent of other factors and related to psychotic symptomatology.AimsTo determine whether smoking is associated with psychosis in bipolar affective disorder.MethodSmoking data were collected from 92 unrelated patients with bipolar affective disorder. An ordinal logistic regression analysis tested the relationship between smoking severity and psychotic symptomatology, allowing for potential confounders.ResultsA significant relationship was detected between smoking/heavy smoking and history of psychosis (68.7%, n=44). Smoking was less prevalent in patients who were less symptomatic (56.5%, n=13) than in patients with a more severe psychosis (75.7%, n=31). Prevalence and severity of smoking predicted severity of psychotic symptoms (P=0.001), a relationship independent of other variables (P=0.0272).ConclusionA link between smoking and psychosis exists in bipolar affective disorder and may be independent of categorical diagnosis.

Impact of Lithium Therapy on Core Psychotic Symptoms of Schizophrenia

1984 ◽  
Vol 144 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Frank P. Zemlan ◽  
Jack Hirschowitz ◽  
Frederic J. Sautter ◽  
David L. Garver
Keyword(s):  
Early Identification ◽  
Lithium Treatment ◽  
Lithium Therapy ◽  
Thought Disorder ◽  
Psychotic Symptoms ◽  
Formal Thought Disorder ◽  
The Core ◽  
Schizophrenic Patients ◽  
Core Symptoms

SummaryThe authors have previously reported that a sub-group of schizophrenic-like patients respond favorably to lithium therapy: furthermore, psychotic patients who respond to lithium demonstrate appreciable improvement during the first seven days of treatment. The present study investigated which symptoms of schizophrenia improved quickly during lithium treatment. We found that patients who do respond to lithium show significant improvement in the core symptoms of psychosis—hallucinations, delusions and formal thought disorder—during the first seven days of treatment, thus allowing early identification of 88 per cent of schizophrenic patients who ultimately respond to lithium and 91 per cent of those who do not.

scholarly journals Thyroid Functions and Bipolar Affective Disorder

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Subho Chakrabarti
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Clinical Course ◽  
Lithium Treatment ◽  
Bipolar Affective Disorder ◽  
High Dose ◽  
Careful Monitoring ◽  
Genetic Studies ◽  
Treatment Refractory ◽  
Hpt Axis

Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. Lithium-treatment has potent antithyroid effects and can induce hypothyroidism or exacerbate a preexisting hypothyroid state. Even minor perturbations of the HPT axis may affect the outcome of bipolar disorder, necessitating careful monitoring of thyroid functions of patients on treatment. Supplementation with high dose thyroxine can be considered in some patients with treatment-refractory bipolar disorder. Neurotransmitter, neuroimaging, and genetic studies have begun to provide clues, which could lead to an improved understanding of the thyroid-bipolar disorder connection, and more optimal ways of managing this potentially disabling condition.

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