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Does maintenance lithium therapy prevent recurrences of mania under ordinary clinical conditions?

Published online by Cambridge University Press:  09 July 2009

W. E. Dickson*
Affiliation:
University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh
R. E. Kendell
Affiliation:
University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh
*
1Address for correspondence: Dr W. E. Dickson, Stratheden Hospital, Cupar, Fife K Y 15 5RR.

Synopsis

Mental-hospital admission rates in Edinburgh for mania, schizophrenia and psychotic depression were studied from 1970 to 1981, a 12-year period during which long-term lithium therapy was increasingly employed in affective illnesses. If this treatment had been effective admission and readmission rates for mania, and perhaps also for depression, should have fallen progressively. In fact, they rose steadily, while the admission rate for schizophrenia fell. These changes could not easily be attributed to changing diagnostic criteria, to the admission of milder affective illnesses, or to poor and deteriorating lithium surveillance. Their explanation is uncertain, but they cast some doubt on the efficacy of lithium prophylaxis in ordinary clinical practice.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1986

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References

Baastrup, P. C., Poulson, J. C., Schou, M., Thomsen, K. & Amdisen, A. (1970). Prophylactic lithium: double-blind discontinuation in manic-depressive disorders. Lancet ii, 326330.Google Scholar
Beigel, A. & Murphy, D. L. (1971). Assessing clinical characteristics of the manic state. American Journal of Psychiatry 128, 688694.CrossRefGoogle ScholarPubMed
Blackburn, I. M., Loudon, J. B. & Ashworth, C. M. (1977). A new scale for measuring mania. Psychological Medicine 7, 453458.CrossRefGoogle ScholarPubMed
Christodoulou, G. N. & Lykouras, E. P. (1982). Abrupt lithium discontinuation in manic-depressive patients. Acta Psychiatrica Scandinavica 65, 310314.Google Scholar
Coppen, A., Noguera, R., Bailey, J., Burns, B. H., Swam, M. S., Hare, E. H., Gardner, R. & Maggs, R. (1971). Prophylactic lithium in affective disorders: a controlled trial. Lancet ii, 275279.CrossRefGoogle Scholar
Cordess, C. (1982). Rebound mania after lithium withdrawal? British Journal of Psychiatry 141, 431.Google Scholar
Eagles, J. M. & Whalley, L. J. (1985). Decline in the diagnosis of schizophrenia among first admissions to Scottish mental hospitals from 1969–1978. British Journal of Psychiatry 146, 151154.Google Scholar
Hestbech, J., Hansen, H. E., Amdisen, A. & Olsen, S. (1977). Chronic renal lesions following long-term treatment with lithium. Kidney International 12, 205213.CrossRefGoogle ScholarPubMed
Horgan, D. (1981). Change of diagnosis to manic-depressive illness. Psychological Medicine 11, 517523.Google Scholar
Hullin, R. P. (1979). Minimum effective plasma levels for long-term preventive treatment of recurrent affective disorders. In Lithium: Controversies and Unresolved Issues (ed. Cooper, T. B., Gershon, S., Kline, N. J. and Schou, M.). Excerpta Medica: Amsterdam.Google Scholar
Klein, H. E., Broucek, B. & Greil, W. (1981). Lithium withdrawal triggers psychotic states. British Journal of Psychiatry 139, 255256.CrossRefGoogle ScholarPubMed
Lapierre, Y. D., Gagnon, A. & Kokkinidis, L. (1980). Rapid recurrence of mania following lithium withdrawal. Biological Psychiatry 15, 859864.Google Scholar
Mander, A. J. (1986). Is there a lithium withdrawal syndrome? British Journal of Psychiatry (in the press).CrossRefGoogle Scholar
Margo, A. & McMahon, P. (1982). Lithium withdrawal triggers psychosis. British Journal of Psychiatry 141, 407410.CrossRefGoogle ScholarPubMed
Melia, P. I. (1970). Prophylactic lithium: a double-blind trial in recurrent affective disorders. British Journal of Psychiatry 116, 621624.Google Scholar
Parker, G., O'Donnell, M. & Walter, S. (1985). Changes in the diagnoses of the functional psychoses associated with the introduction of lithium. British Journal of Psychiatry 146, 377382.Google Scholar
Prien, R. F., Klett, J. & Caffey, E. M. (1973). Lithium carbonate and imipramine in prevention of affective episodes. Archives of General Psychiatry 29, 420425.CrossRefGoogle ScholarPubMed
Prien, R. F., Kupfer, D. J., Mansky, P. A., Small, J. G., Tuason, V. B., Voss, C. B. & Johnson, W. E. (1984). Drug therapy in the prevention of recurrences in unipolar and bipolar disorders. Archives of General Psychiatry 41, 10961104.Google Scholar
Sashidharan, S. P. & McGuire, R. J. (1983). Recurrence of affective illness after withdrawal of long-term lithium treatment. Acta Psychiatrica Scandinavica 68, 126133.Google Scholar
Small, J. G., Small, I. F. & Moore, D. F. (1971). Experimental withdrawal of lithium in recovered manic depressive patients: a report of five cases. American Journal of Psychiatry 127, 15551558.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1975). Research Diagnostic Criteria. Biometrics Research Division, New York State Psychiatric Institute: New York.Google Scholar
Symonds, R. L. & Williams, P. (1981). Lithium and the changing incidence of mania. Psychological Medicine 11, 193196.CrossRefGoogle ScholarPubMed