Twenty-nine bipolar patients were assessed before the start of lithium therapy to study the prognostic criteria of long-term response to therapy. Assessment included clinical and demographic data and laboratory tests administered before and 2–5 days after initiation of therapy. The tests included calcium and magnesium serum levels, and thyroid hormonal status. Patients were followed up for 2 years. None of the single variables predicted the response to lithium therapy, but a combination of clinical and demographic variables, used in a discriminant function analysis, correctly identified 78.9% of responders. Multiple regression analysis predicted 46.2% of the outcome. The strongest univariate predictors were mood quality, illness duration, and substance abuse.
Thyroid function was evaluated in 10 rapid-cycling bipolar patients who had previously responded to lithium treatment. Five patients had grade II and 1 patient had grade III hypothyroidism as determined by thyrotropin-releasing hormone tests. Treatment with thyroxine in addition to lithium significantly decreased the intensity and frequency of rapid cycling episodes.
The renal function was assessed in 51 bipolar patients on multiple-dosage lithium maintenance therapy from 1 to 22 years, after placing them on single (HS) dosage for 12–18 months. Serum lithium levels were maintained constant at a level of 0.8 mg/1. The patients were divided into three groups according to duration of previous multiple doses (b.i.d.–q.i.d.) Li therapy; less than 5 years; 5–10 years; 10–22 years. The improvement in water handling occurred only in the previously shortest multiple-dosage-treated patients and the duration of previous multiple dosage negatively influenced water handling; however, all laboratory analyses remained within normal limits. None of the patients showed clinical worsening or had an affective episode. The separate analyses showed associated gender differences in urinary volume, serum creatinine, and creatinine clearance values. Our findings confirmed the beneficial renal reaction to single-dose posology, as well the female sensitivity to Li therapy in general, and especially with concomitant antipsychotic medication.
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