Unlike the now established antipsychotic and antidepressant drugs, however, no reliable predictions based on preclinical pharmacological studies were available about the profile of lithium's clinical activity. This problem of clinical predictability based on current preclinical pharmacological studies is now surfacing with the advent of many newer investigational psychoactive agents.
As in the introduction of other therapeutic modalities in medicine, including psychiatry, serendipity was the midwife for lithium. The use of this ion in psychiatry, from its fortuitous introduction by Cade in to its present-day acceptance as a universal treatment modality in the affective emotional disorders, presents, however, a clear example of a hapless lag between discovery and application.
Product Details Table of Contents. Uses of Lithium. Nonmedical Uses. Medical Uses. Use in Psychiatry. Commercial Production of Lithium. General Properties of Cations. Chemistry of Lithium. Crystal Structures of Simple Lithium Salts. The Hydration of the Lithium Cation. The Solubility of Lithium Salts. The Complex Ion Chemistry of Lithium. Nonaqueous Lithium Chemistry. Partition between Solvent Phases.
Lithium as an Acid Catalyst. The Biochemistry of Lithium. Lithium and Proteins. Lithium and Enzymes. Lithium and Polynucleotides. Lithium in Membranes. Electrolytic Potentials in Biology. Concluding Remarks. Renal Handling. Effect on Body Electrolytes. Basic Studies. Clinical Studies.
Side Effects of Lithium Therapy and Their Treatment
Cyclic AMP. Membrane Transport. Cholinergic Mechanisms. Microelectrode Studies.
- What is the role of lithium in the treatment bipolar affective disorder (manic-depressive illness)?.
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- Lithium Treatment of Women During Pregnancy and in the Post-Delivery Period.
Animal Studies. Human Studies.
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- Side Effects of Lithium Therapy and Their Treatment - W. T. Brown, .
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EKG Studies. EEG Studies. Computer Studies. Summary and Conclusions. Lithium Poisoning. Neurotoxicity with Lithium. Treatment of Lithium Poisoning. General Considerations. Complications of Lithium Treatment. Effects of Lithium on Thyroid Function. Effects of Lithium on Carbohydrate Metabolism. Lithium Carbonate and Growth Hormone. Lithium and Adrenocortical Activity. Leukocytosis Associated with Lithium Treatment. Other Effects of Lithium Treatment.
General Principles. Dosage and Tissue Concentrations. Logistic regression analyses were conducted to explore the contribution of several possible explanatory variables age, gender, ethnicity, psychiatric diagnosis, and care provider to these binary outcomes. The separate effect of each predictor variable upon each outcome was tested in a series of univariable analyses. Subsequently, the joint effect of the variables upon each outcome was examined in multivariable analyses, using a backwards selection procedure to retain only the statistically significant variables.
There's some evidence lithium protects from dementia, but not enough to put it in drinking water
Data were analysed using SPSS, version Four hundred and thirty six clinical teams from 38 mental health Trusts submitted data for 3, patients. These proportions did not differ for the sub-groups of patients who were either younger than 65 years or older than 65 years. The summary results can be compared with those of previous published UK audits in Table 2. Table 3 provides further information on the demographic and clinical characteristics of the subsample of patients who been prescribed lithium for a year or more.
It also indicates the relationship between each these variables and the extent to which the audit standards derived from the NICE guidance were being met. The univariable analyses examined the effect of potentially relevant clinical or demographic factors age, gender, ethnicity, ICD psychiatric diagnosis and type of clinical service providing care, e. The multivariable analyses addressed biochemical monitoring, and revealed that only service type elderly mental health services was associated with meeting the standards for monitoring serum lithium OR 1.
All 38 Trusts returned a completed questionnaire. The main findings were that documented evidence that baseline tests of renal and thyroid function had been conducted was found for just over four-fifths of patients recently commenced on lithium therapy, and for those patients receiving lithium treatment for a year or more, the frequency of monitoring of serum lithium and renal and thyroid function met the standards set by NICE in less than a third to just over a half of patients, depending on the measure.
Previous published audits of the quality of lithium monitoring have tended to be relatively small and locality specific. These factors render it difficult to directly compare our findings with those of the audits conducted earlier in this area, but there is little to suggest a trend for improvement over time. With respect to procedural factors, previous audits have reported incomplete local implementation of monitoring guidelines [ 11 ], poor communication of test results to clinical teams, lack of communication between primary and secondary care [ 12 ] and a lack of dedicated monitoring services and central registers that generate reminders that tests are due [ 10 , 13 ].
Our study corroborates these findings by revealing variable adoption of monitoring guidelines and use of shared care protocols by mental health Trusts, with few clinicians having electronic access to test results. In addition, few Trusts operate designated lithium clinics and only one reported having a local database specifically for lithium that produced automatic prompts when biochemical tests were due. Communication could be improved through the development of local registers of lithium-treated patients with systems for review and recall , and local needs assessment complemented by audit, training and the use of appropriate guidelines [ 12 — 14 ].
Bringing primary and secondary care teams together to agree on a model of shared care suited to local needs may also be important [ 14 ].
Previous studies have identified a number of patient-related factors that may influence monitoring rates. These include variation in the willingness of patients to have blood tests [ 15 , 16 ], and either receiving inadequate information about lithium treatment and the need for regular blood tests or not assimilating the information given [ 8 , 17 , 18 ]. Our findings provide support for the view that many patients are not provided with basic information about their lithium treatment. Patient demographics may plausibly influence the quality of monitoring of psychotropic medication [ 19 ], but to what extent this would be driven by variable engagement with healthcare by patients and the behaviour of clinicians is uncertain.
Our study did not identify any contribution from gender or ethnicity, but found that monitoring practice for patients cared for by older peoples services was generally better than that provided by general adult services. This may reflect that clinicians in elderly services have an increased awareness of lithium monitoring requirements for their patients, who are particularly vulnerable to renal side-effects, and in whom the background prevalence of thyroid problems is higher than in younger adults.
Our audit also revealed slightly superior monitoring of body weight for patients with a diagnosis of a schizophrenia spectrum disorder, which may indicate increased clinician awareness of risk factors for weight gain in such patients [ 20 , 21 ]. With respect to practitioner-related factors, several studies report superior standards of lithium monitoring for patients under the care of a psychiatrist [ 9 , 11 , 22 ] while others report no difference from the quality of monitoring undertaken by general practitioners [ 23 , 24 ]. Some audits also report superior monitoring for those patients in nurse-led, designated lithium clinics [ 10 ] or under pharmacist supervision [ 25 ].
It has been suggested that the large variation in the degree of knowledge about lithium and its monitoring requirements amongst individual professionals may account for these inconsistent findings [ 26 ]. There may also be variation between clinicians in the acceptance of the need for monitoring at the frequency recommended by NICE. In contrast, there are no sanctions for General Practitioners who fail to meet QOF targets, rather a positive benefit in the form of payment when these targets are met.
In our sample, the primary care QOF targets with respect to monitoring of serum lithium was met in over two-thirds of cases, and the target with respect to renal and thyroid function in just over four fifths.