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Identifying predictors for good lithium response – A retrospective analysis of 100 patients with bipolar disorder using a life-charting method

Published online by Cambridge University Press:  16 April 2020

Lena Backlund ,
Anna Ehnvall ,
Jerker Hetta ,
Göran Isacsson  and
Hans Ågren
Lena Backlund*
Affiliation:
Karolinska Institute, Department of Clinical Neuroscience, Section of Psychiatry, Karolinska University Hospital, Huddinge M57, SE-141 86Stockholm, Sweden
Anna Ehnvall
Affiliation:
Institute for Clinical Neuroscience, Gothenburg and Psychiatric Out-patient Clinic, Varberg, Swedan
Jerker Hetta
Affiliation:
Karolinska Institute, Department of Clinical Neuroscience, Section of Psychiatry, Karolinska University Hospital, Huddinge M57, SE-141 86Stockholm, Sweden
Göran Isacsson
Affiliation:
Karolinska Institute, Department of Clinical Neuroscience, Section of Psychiatry, Karolinska University Hospital, Huddinge M57, SE-141 86Stockholm, Sweden
Hans Ågren
Affiliation:
Sahlgrenska Academy at the University of Gothenburg, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Gothenburg, Sweden
*
*Corresponding author. Tel./fax: +46 8 585 857 08. E-mail address: [email protected] (L. Backlund).
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Abstract

Purpose

Our aim was to investigate bipolar patients in order to test the validity of various outcome measures and to identify prognostic predictors for pharmacological treatment.

Material and method

One hundred patients were interviewed using a computerized life-charting program in a descriptive, retrospective analysis. The concept “Burden of illness” was defined as a combination of severity and duration of episodes. Response to treatment was defined as the difference in burden before and after treatment, a low burden during treatment, and freedom of episodes for at least 3 years after insertion of treatment.

Results

The absence of mixed episodes and a high initial burden predicted a good response measured as the difference in burden. If remission for 3 years or a low burden during lithium treatment was used, the absence of rapid cycling and of mixed episodes were the most important predictors. The severity of illness before treatment had no impact.

Discussion and conclusion

We suggest the use of absolute measures of severity during treatment as the most appropriate measure of the outcome. Furthermore, our data provide corroboration that treatment with lithium ameliorates the prognosis of the illness, but that mixed episodes and rapid cycling predict a poorer response to lithium.

Keywords

Bipolar disorderTreatment outcomeLithium
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 3 , April 2009 , pp. 171 - 177
Copyright
Copyright © Elsevier Masson SAS 2009

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References

Akiskal, H.S.The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol 1996;16:4S–14SCrossRefGoogle ScholarPubMed
Angst, J., Sellaro, R.Historical perspectives and natural history of bipolar disorder. Biol Psychiatry 2000;48:445–457CrossRefGoogle ScholarPubMed
Baethge, C., Smolka, M.N., Gruschka, P., Berghofer, A., Schlattmann, P., Bauer, M.et al.Does prophylaxis-delay in bipolar disorder influence outcome? Results from a long-term study of 147 patients. Acta Psychiatr Scand 2003;107:260–267CrossRefGoogle ScholarPubMed
Baldessarini, R.J., Tondo, L., Baethge, C.J., Lepri, B., Bratti, I.M.Effects of treatment latency on response to maintenance treatment in manic-depressive disorders. Bipolar Disord 2007;9:386–393CrossRefGoogle ScholarPubMed
Baldessarini, R.J., Tondo, L., Hennen, J.Treatment-latency and previous episodes: relationships to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord 2003;5:169–179CrossRefGoogle ScholarPubMed
Baldessarini, R.J., Tondo, L., Viguera, A.C.Discontinuing lithium maintenance treatment in bipolar disorders: risks and implications. Bipolar Disord 1999;1:17–24CrossRefGoogle ScholarPubMed
Berk, M., Hallam, K., Lucas, N., Hasty, M., McNeil, C.A., Conus, P.et al.Early intervention in bipolar disorders: opportunities and pitfalls. Med J Aust 2007;187:S11–S14CrossRefGoogle ScholarPubMed
Bryant-Comstock, L., Stender, M., Devercelli, G.Health care utilization and costs among privately insured patients with bipolar I disorder. Bipolar Disord 2002;4:398–405CrossRefGoogle ScholarPubMed
Denicoff, K.D., Ali, S.O., Sollinger, A.B., Smith-Jackson, E.E., Leverich, G.S.Post RM utility of the daily prospective National Institute of Mental Health Life-Chart Method (NIMH-LCM-p) ratings in clinical trials of bipolar disorder. Depress Anxiety 2002;15:1–9CrossRefGoogle ScholarPubMed
Denicoff, K.D., Leverich, G.S., Nolen, W.A., Rush, A.J., McElroy, S.L., Keck, P.E.et al.Validation of the prospective NIMH-Life-Chart Method (NIMH-LCM-p) for longitudinal assessment of bipolar illness. Psychol Med 2000;30:1391–1397CrossRefGoogle ScholarPubMed
Duffy, A., Grof, P., Robertson, C., Alda, M.The implications of genetics studies of major mood disorders for clinical practice. J Clin Psychiatry 2000;61:630–637CrossRefGoogle ScholarPubMed
Dunayevich, E., Sax, K.W., Keck, P.E. Jr.McElroy, S.L., Sorter, M.T., McConville, B.J.et al.Twelve-month outcome in bipolar patients with and without personality disorders. J Clin Psychiatry 2000;61:134–139CrossRefGoogle ScholarPubMed
Dunayevich, E., Strakowski, S.M., Sax, K.W., Sorter, M.T., Keck, P.E. Jr.McElroy, S.L.et al.Personality disorders in first- and multiple-episode mania. Psychiatry Res 1996;64:69–75CrossRefGoogle ScholarPubMed
Ehnvall, A., Ågren, H.Patterns of sensitisation in the course of affective illness. A life-charting study of treatment-refractory depressed patients. J Affect Disord 2002;70:67–75CrossRefGoogle ScholarPubMed
Ehnvall, A., Sjögren, M., Zachrisson, O.C., Ågren, H.Lifetime burden of mood swings and activation of brain norepinephrine turnover in patients with treatment-refractory depressive illness. J Affect Disord 2003;74:185–189CrossRefGoogle ScholarPubMed
Franchini, L., Zanardi, R., Smeraldi, E., Gasperini, M.Early onset of lithium prophylaxis as a predictor of good long-term outcome. Eur Arch Psychiatry Clin Neurosci 1999;249:227–230CrossRefGoogle ScholarPubMed
Goodwin, F.K., Jamison, K.R.Manic-depressive illness: bipolar disorders and recurrent depression New YorkOxford University Press 2007 p. 120–5Google Scholar
Judd, L.L., Akiskal, H.S., Schettler, P.J., Coryell, W., Endicott, J., Maser, J.D.et al.A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261–269CrossRefGoogle ScholarPubMed
Judd, L.L., Akiskal, H.S., Schettler, P.J., Endicott, J., Maser, J., Solomon, D.A.et al.The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530–537CrossRefGoogle ScholarPubMed
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S.et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8–19CrossRefGoogle ScholarPubMed
Koukopoulos, A., Sani, G., Koukopoulos, A.E., Giraldi, P.Cyclicity and manic-depressive illness DordrechtKluwer Academics 2000 Chapter in a bookGoogle Scholar
Leverich, G.S., Nolen, W.A., Rush, A.J., McElroy, S.L., Keck, P.E., Denicoff, K.D.et al.The Stanley foundation bipolar treatment outcome network. I. Longitudinal methodology. J Affect Disord 2001;67:33–44CrossRefGoogle ScholarPubMed
Maj, M.The impact of lithium prophylaxis on the course of bipolar disorder: a review of the research evidence. Bipolar Disord 2000;2:93–101CrossRefGoogle ScholarPubMed
Marneros, A., Deister, A., Rohde, A.Affective, schizoaffective and schizophrenic psychoses. A comparative long-term study. Monogr Gesamtgeb Psychiatr Psychiatry Ser 1991;65:1–454Google ScholarPubMed
Miklowitz, D.J., Johnson, S.L.The psychopathology and treatment of bipolar disorder. Annu Rev Clin Psychol 2006;2:199–235CrossRefGoogle ScholarPubMed
Ösby, U., Brandt, L., Correia, N., Ekbom, A., Sparén, P.Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58:844–850CrossRefGoogle ScholarPubMed
Regier, D.A., Boyd, J.H., Burke, J.D. Jr.Rae, D.S., Myers, J.K., Kramer, M.et al.One-month prevalence of mental disorders in the United States. Based on five epidemiologic catchment area sites. Arch Gen Psychiatry 1988;45:977–986CrossRefGoogle ScholarPubMed
Rohayem, J., Bayle, J.F., Richa, S.Predictors of prophylactic response to lithium. Encephale 2008;34:394–399CrossRefGoogle ScholarPubMed
Sharma, P., Basu, D., Thapar, S.Latency and outcome of prophylaxis in bipolar disorder: role of severity as a confounding variable?. Acta Psychiatr Scand 2004;109:157 [author reply 158]CrossRefGoogle ScholarPubMed
Sheehan, D.V., Lecrubier, Y., Harnett-Sheehan, K.Reliability and validity of the M.I.N.I International Neuropsychiatric Interview (M.I.N.I.): according to the SCID-P. Eur Psychiatry 1997;12:232–241CrossRefGoogle Scholar
Skeppar, P., Adolfsson, R.Bipolar II and the bipolar spectrum. Nord J Psychiatry 2006;60:7–26CrossRefGoogle ScholarPubMed
Tondo, L., Baldessarini, R.J., Hennen, J., Floris, G.Lithium maintenance treatment of depression and mania in bipolar I and bipolar II disorders. Am J Psychiatry 1998;155:638–645CrossRefGoogle ScholarPubMed
Tondo, L., Baldessarini, R.J., Hennen, J., Minnai, G.P., Salis, P., Scamonatti, L.et al.Suicide attempts in major affective disorder patients with comorbid substance use disorders. J Clin Psychiatry 1999;60(Suppl. 2):63–69 [discussion 75–6, 113–6]Google ScholarPubMed
Tondo, L., Isacsson, G., Baldessarini, R.Suicidal behaviour in bipolar disorder: risk and prevention. CNS Drugs 2003;17:491–511CrossRefGoogle ScholarPubMed
Vieta, E., Pacchiarotti, I., Scott, J., Sanchez-Moreno, J., Di Marzo, S., Colom, F.Evidence-based research on the efficacy of psychological interventions in bipolar disorders: a critical review. Curr Psychiatry Rep 2005;7:449–455CrossRefGoogle Scholar
Winokur, G., Coryell, W., Keller, M., Endicott, J., Akiskal, H.A prospective follow-up of patients with bipolar and primary unipolar affective disorder. Arch Gen Psychiatry 1993;50:457–465CrossRefGoogle ScholarPubMed
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