Lithium has been used for the treatment of mood disorders for over 60 years, yet the exact mechanisms by which it exerts its therapeutic effects remain unclear. Two enzymatic chains or pathways emerge as targets for lithium: inositol monophosphatase within the phosphatidylinositol signalling pathway and the protein kinase glycogen synthase kinase 3. Lithium inhibits these enzymes through displacing the normal cofactor magnesium, a vital regulator of numerous signalling pathways. Here we provide an overview of evidence, supporting a role for the inhibition of glycogen synthase kinase 3 and inositol monophosphatase in the pharmacodynamic actions of lithium. We also explore how inhibition of these enzymes by lithium can lead to downstream effects of clinical relevance, both for mood disorders and neurodegenerative diseases. Establishing a better understanding of lithium's mechanisms of action may allow the development of more effective and more tolerable pharmacological agents for the treatment of a range of mental illnesses, and provide clearer insight into the pathophysiology of such disorders.
Three interacting challenges are facing all aspects of health care in the United Kingdom: financial restraint in the context of a global economic downturn; a move to services being commissioned and decommissioned by primary care Clinical Commissioning Groups; and a need to provide evidence based practice through 'payment by results'. Psychoanalytic psychotherapy faces more difficulty than most services in mental health, with long and frequent criticisms of it being expensive and underresearched; and it is not as well understood by GPs as cognitive behavioural therapy, with which it is frequently unfavourably compared. This review provides an overview of the existing evidence for psychoanalytic psychotherapy, identifying strengths and areas that are under KAYLEIGH M. BROWN BA (Oxon) MSc is an Assistant Psychologist within South London and Maudsley NHS Foundation Trust, London. She works with adults with complex needs and histories of complex trauma, using mentalization and psychodynamic approaches. She has previously worked in forensic settings using CBT interventions, as a tutor for children with autistic spectrum disorders and as an assistant psychologist, working with adults with diagnoses of psychosis. Her research interests include homelessness and psychopharmacology and she has published research in this field. Magnetic Stimulation in the treatment of auditory hallucinations. As well as publishing on these topics, he has written chapters on neuroanatomy, neurophysiology and psychopharmacology for a forthcoming Oxford University Press textbook for trainee psychiatrists, a book chapter of neuropsychiatry, and is currently writing a commissioned book chapter on treatment resistance in schizophrenia.
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