The purpose of this study was to evaluate the desired and undesired effects of relapse-preventive lithium treatment given routinely to manic-melancholic patients who had accepted the necessity of a strict tablet regime. The evaluation was based upon case record data and various rating scales, and 76 patients took part in the investigation. Our results showed that in 24% of the patients treatment was discontinued. This was due to side effects in 16% and to insufficient effect in 8% of the cases. The suicide risk was not eliminated, and 29% of the patients were receiving additional antidepressive or antimanic treatment at the test day. On the other hand, 78% of the patients rated the relapse-preventive lithium effect as moderate to excellent. Indirect evidence was obtained in support of a stabilizing effect of lithium on the emotional control in bipolar patients. The most frequent complaints during lithium treatment were tremor and increased thirst.

The problem of lithium maintenance treatment and weight gain was examined in 70 manic-melancholic patients who had been in treatment for 2 to 10 years. Their case records were reviewed and they answered a questionnaire. Out of 70 patients, 45 increased in weight with a mean weight gain of about 10 kg. The patients who increased in weight during the treatment were overweight already before the start and reached a weight about 20% higher than their ideal weight. They nearly all found themselves overweight and took measures to slim. No connection between a history of infant obesity and weight gain was found. Increase in appetite was only found in one third of the patients and had only a weak influence on the degree of weight gain. Nearly all the patients felt an increased thirst, and a very clear correlation between liquid intake and weight gain was found. It is recommended that all patients are repeatedly warned of the risks involved in satisfying their increased thirst on lithium by fluids rich in calories.

The MHFA training was effective in a Danish context.

Cerebrospinal fluid (CSF), thyrotropin releasing hormone (TRH), CSF-vasopressin (AVP), plasma-AVP, CSF-osmolality, plasma-osmolality, CSF-adrenaline (A) and -noradrenaline (NA) were measured in psychiatric patients and controls. Psychiatric patients were classified according to ICD-9 and grouped into endogenous depression, non-endogenous depression, mania and schizophrenia. The depressive groups were classified according to the Newcastle Rating Scale for Depression 1965. Severity of disease was quantified by BRMES, BRMS and BPRS. No difference in CSF-TRH levels was seen among the different diagnostic groups and controls. A positive correlation between CSF-TRH and CSF-A was demonstrated. CSF-AVP concentrations were significantly lowered in both endogenous and non-endogenous depression; no correlation with CSF-A or -NA was seen. Neither did any difference between plasma levels of AVP, plasma-osmolality or CSF-osmolality appear among the groups investigated.

In a double-blind, placebo-controlled, crossover design various side effects (= unwanted effects) during 6 months of therapeutic serum lithium levels (0.7–1.1 mmol/l) to non-psychiatric patients were studied. The side effects were measured by self-rating scales and independent observer rating scales administered every 2–4 weeks throughout the study. After months of treatment, lithium induced hand tremor and thirst/polyuria; however, without any relationship to the serum levels of lithium. The frequency of tremor was highest in patients above the age of 60 years. No initial sedative-like lithium effect was found.