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Psychiatric hospital utilisation following lithium discontinuation in patients with bipolar I or II disorder: A mirror-image study based on the lisie retrospective cohort

Published online by Cambridge University Press:  13 August 2021

L. Öhlund*
Affiliation:
Sunderby Research Unit, Department Of Clinical Sciences, Division Of Psychiatry, Umeå University, Umeå, Sweden
M. Ott
Affiliation:
Department Of Public Health And Clinical Medicine, Division Of Medicine, Umeå University, Umeå, Sweden
M. Bergqvist
Affiliation:
Department Of Psychiatry, Piteå Älvdals hospital, Piteå, Sweden
S. Oja
Affiliation:
Sunderby Hospital, Department of Psychiatry, Luleå, Sweden
R. Lundqvist
Affiliation:
Department Of Public Health And Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
M. Sandlund
Affiliation:
Department Of Clinical Sciences, Division Of Psychiatry, Umeå University, Umeå, Sweden
E. Salander Renberg
Affiliation:
Department Of Clinical Sciences, Division Of Psychiatry, Umeå University, Umeå, Sweden
U. Werneke
Affiliation:
Sunderby Research Unit, Department Of Clinical Sciences, Division Of Psychiatry, Umeå University, Umeå, Sweden
*
*Corresponding author.

Abstract

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Introduction

Evidence for lithium as a maintenance treatment for bipolar disorder type II remains limited since most treatment-prevention studies focus on bipolar disorder type I or do not distinguish between types of bipolar disorder.

Objectives

To compare the impact of lithium discontinuation on hospital utilisation in patients with bipolar disorder type I or schizoaffective disorder and patients with bipolar disorder type II or other bipolar disorder.

Methods

Mirror-image study, examining hospital utilisation within two years before and after lithium discontinuation as part of LiSIE, a retrospective cohort study into effects and side-effects of lithium for the maintenance treatment of bipolar disorder as compared to other mood stabilisers.

Results

For the whole sample, the number of admissions increased from 86 to 185 admissions after lithium discontinuation, with the mean number of admissions/patient/review period doubling from 0.44 to 0.95 (p < 0.001). The number of bed days increased from 2218 to 4240, with the mean number of bed days/patient/review period doubling from 11 to 22 (p = 0.025). This increase in admissions and bed days was exclusively attributable to patients with bipolar disorder type I or schizoaffective disorder.

Conclusions

Our findings suggest that due to a higher relapse risk in patients with bipolar disorder type I or schizoaffective disorder there is a need to apply a higher threshold for discontinuing lithium than for patients with bipolar disorder type II or other bipolar disorder.

Disclosure

Michael Ott has been a scientific advisory board member of Astra Zeneca Sweden, Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme 2014–2018 and EAPM 2016, Luleå, Sweden): Astra

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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