Adverse Effects in Maintenance Therapy

Ban, Thomas A.

doi:10.1159/000468343

Int Pharmacopsychiatry

1978

DOI: 10.1159/000468343

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Adverse Effects in Maintenance Therapy

Thomas A. Ban¹

Abstract: Adverse effects in maintenance therapy with neuroleptic drugs and lithium salts were reviewed with special emphasis on tardive dyskinesia. The possible teratogenicity of neuroleptics and lithium salts was discussed and the chromosomal abnormalities seen in patients treated with lithium salts described.

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Cited by 4 publications

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A systematic review of existing data on long-term lithium therapy: neuroprotective or neurotoxic?

Fountoulakis

Vieta

Bouras

et al. 2007

Int. J. Neuropsychopharm.

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Lithium is an efficacious agent for the treatment of bipolar disorder, but it is unclear to what extent its long-term use may result in neuroprotective or toxic consequences. Medline was searched with the combination of the word 'Lithium' plus key words that referred to every possible effect on the central nervous system. The papers were further classified into those supporting a neuroprotective effect, those in favour of a neurotoxic effect and those that were neutral. The papers were classified into research in humans, animal and in-vitro research, case reports, and review/opinion articles. Finally, the Natural Standard evidence-based validated grading rationale was used to validate the data. The Medline search returned 970 papers up to February 2006. Inspection of the abstracts supplied 214 papers for further reviewing. Eighty-nine papers supported the neuroprotective effect (6 human research, 58 animal/in vitro, 0 case reports, 25 review/opinion articles). A total of 116 papers supported the neurotoxic effect (17 human research, 23 animal/in vitro, 60 case reports, 16 review/opinion articles). Nine papers supported no hypothesis (5 human research, 3 animal/in vitro, 0 case reports, 1 review/opinion articles). Overall, the grading suggests that the data concerning the effect of lithium therapy is that of level C, that is 'unclear or conflicting scientific evidence' since there is conflicting evidence from uncontrolled non-randomized studies accompanied by conflicting evidence from animal and basic science studies. Although more papers are in favour of the toxic effect, the great difference in the type of papers that support either hypothesis, along with publication bias and methodological issues make conclusions difficult. Lithium remains the 'gold standard' for the prophylaxis of bipolar illness, however, our review suggests that there is a rare possibility of a neurotoxic effect in real-life clinical practice even in closely monitored patients with 'therapeutic' lithium plasma levels. It is desirable to keep lithium blood levels as low as feasible with prophylaxis.

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A systematic review of existing data on long-term lithium therapy: neuroprotective or neurotoxic?

Fountoulakis

Vieta

Bouras

et al. 2007

Int. J. Neuropsychopharm.

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Changing epidemiology of tardive dyskinesia: an overview

1981

AJP

101

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Dyskinesia is found significantly more often among neuroleptic-treated psychiatric patients than among non-neuroleptic-treated patients. The epidemiology of tardive dyskinesia is changing; its reported prevalence among neuroleptic-treated psychiatric inpatients has been progressively rising and has reached 25% during the past five years. The prevalence of persistent tardive dyskinesia that may be attributable to neuroleptics is about 13%. Tardive dyskinesia is not restricted to old, brain-damaged inpatients but also occurs with a noticeable frequency among younger patients, including outpatients, treated neuroleptics. Yet neuroleptics are the most effective available treatment for schizophrenia; hence, any drastic curtailment of their use in the treatment of chronic schizophrenic patients may not be justified. Cautious use of these drugs, along with intensified research on tardive dyskinesia is warranted.

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A Review and Controlled Study of Cutaneous Conditions associated with Lithium Carbonate

Sarantidis¹,

Waters

1983

Br J Psychiatry

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This study compares the incidence of a variety of cutaneous conditions among 91 patients treated with lithium carbonate with the incidence of such conditions among 44 patients treated with other non-neuroleptic, maintenance medications. Data on cutaneous conditions and allergies were obtained using structured interviews, demographic data, medication histories and personal and family histories. A significantly greater proportion of the lithium-treated patients than the comparison patients reported a cutaneous condition which may have been secondary to treatment in that it developed for the first time after the medication or appeared to have been exacerbated by the medication. Among the lithium-treated patients, females were found to be significantly more likely to report a secondary cutaneous condition. This effect was found across the whole range of cutaneous conditions. Male lithium-treated patients on the other hand reported approximately the same rate of secondary cutaneous conditions as both male and female comparison patients. Possible reasons for this sexual effect on incidence are discussed. The literature on cutaneous conditions which have been associated with lithium therapy is also reviewed.

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Adverse Effects in Maintenance Therapy

Cited by 4 publications

References 28 publications

A systematic review of existing data on long-term lithium therapy: neuroprotective or neurotoxic?

A systematic review of existing data on long-term lithium therapy: neuroprotective or neurotoxic?

Changing epidemiology of tardive dyskinesia: an overview

A Review and Controlled Study of Cutaneous Conditions associated with Lithium Carbonate

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