1,721,026 research outputs found
MORTALITY FOLLOW-UP OF PATIENTS SINCE COMMENCING LITHIUM THERAPY
No full textObjectives: To estimate mortality of patients with affective disorder commenced on lithium and followed up for two to 23 years. To estimate the effects of prolonged exposure to lithium and of regular attendance to a specialized facility.
Design: Naturalistic prospective study of a series of consecutively admitted outpatients.
Setting: Outpatient unit for the management of lithium and related treatments.
Participants: All 1411 patients admitted between January 1, 1980 and June 30, 2000 were studied. Vital status on December 31, 2002 or date of death were established for 1394 (99%) participants. Follow-up totaled 18154 patient-years, including 5474 years of controlled lithium treatment (serum concentrations within 0.5-1.0 mmol/L and intervals between visits no longer than four months).
Main outcome measures: The year-by-year mortality of all participants was compared with that of the general Sardinian population, standardized for age, gender and calendar year. Standardized mortality was also analyzed by length of lithium exposure and by regularity of attendance.
Results: Two hundred participants died during the observation period. Overall mortality was twice that of the general population. Controlled treatment with lithium for more than five years reduced mortality to the rates expected for the general population. Death rates doubled again in participants who had dropped out after years of initial regular attendance.
Conclusions: Lithium can protect patients with affective disorders from otherwise high mortality, provided that adherence to prolonged prophylaxis is controlled and encouraged at a specialized facility. Further research of any protective effect by currently available alternatives to lithium is suggested
HETEROZYGOUS BETA-THALASSAEMIA AS A SUSCEPTIBILITY FACTOR IN MOOD DISORDERS: EXCESSIVE PREVALENCE IN BIPOLAR PATIENTS
No full textBIPOLAR DISORDER
No full textThe pharmacological management of bipolar disorder encompasses the acute treatment of mood episodes, the continuation phase after initial response, and the longer term prevention of recurrences. Lithium salts have been the first treatment in the modern era in this field, and still represent the gold standard for the various phases of bipolar disorder 60 years after their introduction in the treatment of mania. Alternatives to lithium have been investigated, often following serendipitous observations. Classical neuroleptics and antidepressants have long been used for the treatment of mania and bipolar depression, respectively, even if relevant controlled trials have been rare. Treatment of acute episodes with antidepressants or neuroleptics has been associated with switch into the opposite phase and with cycle acceleration. After the first description of the effects of valproate in the 1960s, several other anticonvulsants have demonstrated antimanic, antidepressant and mood stabilizing properties in bipolar patients. Several second-generation antipsychotics have already been approved by regulatory authorities from different countries for the acute treatment of mania. On the other hand, acute treatment of bipolar depression has long represented a difficult task, even though current trials of various agents are promising. Controlled trials of prophylactic efficacy of bipolar recurrences are difficult and expensive. The duration of a drug in the market has markedly influenced this field. Discrepancies in the definitions of treatment phases reflect the difficulties of long-term studies. Current trials are designed to investigate maintenance effect of treatments after initial response without a clear separation between prevention of relapse and prevention of recurrence. Long-term outcome can perhaps be investigated by naturalistic studies alone, as effectiveness and efficiency are not addressed by controlled trials. Moreover, bipolar disorder often requires combined treatments. Additional issues can be addressed by naturalistic studies alone, including the potential development of resistance after prolonged treatment or after discontinuation of prophylaxis, and the potential poorer outcome when there is a delay in starting prophylaxis or in the presence of atypical features. Observations from specialized facilities support a potential effect of lithium against the otherwise increased mortality of bipolar patients, especially due to suicide. No similar evidence is available regarding currently prescribed alternatives to lithium
Lithium treatment and thyroid abnormalities
No full textBACKGROUND:
Although the interactions between lithium treatment and thyroid function have long been recognised, their clinical relevance is still controversial. This paper sets out a review of the literature to date, considering that lithium still represents the gold standard among prophylactic treatments of manic-depression several decades after its introduction.
METHOD:
PubMed database was used to search for English-language articles relating to lithium treatment and thyroid function. As the amount of relevant papers totalled several hundreds, this review refers to previous reviews, especially with regard to older literature. Moreover, the authors particularly refer to a series of studies of thyroid function performed in a cohort of patients at different stages of lithium treatment, who were followed up by their group from 1989 onwards.
RESULTS:
The main findings from this review included: a) lithium definitely affects thyroid function as repeatedly shown by studies on cell cultures, experimental animals, volunteers, and patients; b) inhibition of thyroid hormone release is the critical mechanism in the development of hypothyroidism, goitre, and, perhaps, changes in the texture of the gland which are detected by ultrasonic scanning; c) compensatory mechanisms operate and prevent the development of hypothyroidism in the majority of patients; d) when additional risk factors are present, either environmental (such as iodine deficiency) or intrinsic (immunogenetic background), compensatory potential may be reduced and clinically relevant consequences may derive; e) hypothyroidism may develop in particular during the first years of lithium treatment, in middle-aged women, and in the presence of thyroid autoimmunity; f) thyroid autoimmunity is found in excess among patients suffering from affective disorders, irrespective of lithium exposure; g) in patients who have been on lithium for several years, the outcome of hypothyroidism, goitre, and thyroid autoimmunity do not much differ from those observed in the general population; h) hyperthyroidism and thyroid cancer are observed rarely during lithium treatment.
RECOMMENDATIONS:
Thyroid function tests (TSH, free thyroid hormones, specific antibodies, and ultrasonic scanning) should be performed prior to starting lithium prophylaxis. A similar panel should be repeated at one year. Thereafter, annual measurements of TSH may be sufficient to prevent overt hypothyroidism. In the presence of raised TSH or thyroid autoimmunity, shorter intervals between assessments are advisable (4-6 months). Measurement of antibodies and ultrasonic scanning may be repeated at 2-to-3-year intervals. The patient must be referred to the endocrinologist if TSH concentrations are repeatedly abnormal, and/or goitre or nodules are detected. Thyroid function abnormalities should not constitute an outright contraindication to lithium treatment, and lithium should not be stopped if a patient develops thyroid abnormalities. Decisions should be made taking into account the evidence that lithium treatment is perhaps the only efficient means of reducing the excessive mortality which is otherwise associated with affective disorders
The Sardinian puzzle: concentration of major psychoses and suicide in the same sub-regions across one century
Full text linkBackground: Sardinia, the second largest Mediterranean island has long been considered a privileged observatory for the study of several medical conditions. The peculiar epidemiology of mood disorders and suicide across Sardinian sub-regions has long intrigued clinicians and researchers. Objective: The principal aim of the present study was to test whether the geographical distribution of suicides committed in Sardinian over the last three decades are comparable with the geographical origin of patients hospitalized up to half a century ago. Method: The distribution of the municipalities of origin of the patients hospitalized in Sardinia between 1901 and 1964 for schizophrenia, bipolar disorder, and depression was reanalyzed and compared with the distribution of municipalities where suicides were committed between 1980 and 2013. Data were also analyzed by the altitude above the sea level and by the population size of the municipalities. Results: There was a significant variation of hospitalization and suicide rates across Sardinian sub-regions. The sub-regions of origin of the patients hospitalized for schizophrenia and bipolar disorder correlated with each other (P = 0.047). Both hospitalizations and suicides were more incident in municipalities with a higher altitude and a smaller population size. The incidence of hospitalizations and suicides correlated significantly with each other both at the municipality (P = 1.86 x 10-7) and at the sub-region level (P = 1.71 x 10-7). Conclusion: The present study confirms the peculiar geographical distribution of major psychoses and suicide in Sardinia. The two phenomena appear to have been correlated for as long as one century
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