Patient Selection for Long-term Lithium Treatment in Clinical Practice

Grof, Paul; Angst, J.; Karasek, Mirek; Keitner, Gabor

doi:10.1001/archpsyc.1979.01780080068016

Cited by 23 publications

(4 citation statements)

References 6 publications

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“…34 All these differ from earlier recommendations of prophylaxis for patients either after 3 episodes, or 2 episodes within 2 years. Using actuarial techniques, Grof et al 35 concluded that at least 2 episodes of mania or depression within 2 years was the best criterion, as this correctly classified 61% of patients as having a future recurrence of illness or not (55% of patients were predicted to have a recurrence within 2 years and they did [true positives] and 6% of patients were predicted not to have a recurrence and they did not [true negatives]). 35 The National Institute of Mental Health Consensus Development Panel recommends that having a single manic episode, or both hypomanic and depressed episodes, are grounds for prophylaxis, 36 but factors such as previous suicide attempts, psychotic symptoms, and degree of functional impairment during episodes should also be considered.…”

Section: When To Initiate Long-term Treatment?mentioning

confidence: 99%

Beyond the Guidelines for Bipolar Disorder: Practical Issues in Long-Term Treatment with Lithium

Calkin

Alda

2012

Can J Psychiatry

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Objective: Several treatment guidelines are available for clinicians working with patients with bipolar disorder (BD), but some of the more nuanced aspects of lithium therapy go beyond the scope of such guidelines. Therefore, in this perspective, our objective was to focus on specific practical issues of lithium treatment, including the selection and initiation of long-term treatment, and management and discontinuation (if indicated) of lithium prophylaxis. Method:We conducted a focused review of the relevant literature on the treatment of BD.Results: Consultation requests to a BD specialty service often relate to issues for which there is limited evidence, including when to initiate long-term treatment, whether choice of mood stabilizer is specific, how long to treat acute episodes, whether to switch or add on medication when treatment fails, how long to continue effective treatment, and what medication to use when a lithium-responsive patient must discontinue lithium. Conclusion:Optimal long-term treatment of BD will require more research as well as better alignment of clinical and training programs. W W WObjectif : Plusieurs guides de traitement sont offerts aux cliniciens qui travaillent auprès de patients souffrant du trouble bipolaire (TB), mais certains des aspects plus nuancés de la thérapie par le lithium vont au-delà de la portée de ces guides. Par conséquent, dans cette optique, notre objectif était de mettre l'accent sur des questions pratiques spécifiques du traitement par lithium, notamment la sélection et l'initiation d'un traitement à long terme, et la gestion et l'interruption (si indiqué) d'un traitement préventif par lithium.Méthode : Nous avons mené une revue ciblée de la littérature pertinente sur le traitement du TB.Résultats : Les demandes de consultation à un service spécialisé en TB ont souvent trait aux questions pour lesquelles les données probantes sont limitées, notamment, le moment d'initier un traitement à long terme, si le choix d'un régulateur de l'humeur est spécifique, combien de temps traiter les épisodes aigus, s'il faut changer de médicament ou en ajouter lorsque le traitement échoue, combien de temps continuer un traitement efficace, et quel médicament utiliser quand un patient qui répond bien au lithium doit arrêter le lithium. Conclusion :Le traitement à long terme optimal du TB exigera plus de recherche ainsi qu'une meilleure harmonisation des programmes cliniques et de formation.

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Section: When To Initiate Long-term Treatment?mentioning

confidence: 99%

Beyond the Guidelines for Bipolar Disorder: Practical Issues in Long-Term Treatment with Lithium

Calkin

Alda

2012

Can J Psychiatry

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“…Selection of patients for long-term treatment is difficult. Using actuarial techniques, Grof and Angst [133] concluded that at least two episodes of mania or depression within 2 years was the best criterion, since this correctly classified 61% of patients. The National Institute of Mental Health (NIMH) Consensus Development Panel [132] recommends that having a single manic episode, or both hypomanic and depressed episodes, are grounds for prophylaxis, but factors such as suicide attempts in the past, psychotic symptoms and functional incapacity associated with episodes need to be considered.…”

Section: Prophylaxismentioning

confidence: 99%

Australian and New Zealand Clinical Practice Guidelines for the Treatment of Bipolar Disorder

2004

Aust N Z J Psychiatry

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“…With the occurrence of dysphoric mania, mixed states and especially RC, the response rate of lithium sharply drops [42][43][44][45][46][47]. Historically, the term 'rapid cycling' was created when Dunner and Fieve [1] analysed clinical factors associated with lithium nonresponse in maintenance treatment.…”

Section: Lithiummentioning

confidence: 99%

Clinical Relevance and Treatment Possibilities of Bipolar Rapid Cycling

et al. 2002

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Bipolar rapid cycling (RC) is defined as 4 or more affective episodes within 1 year. It has been postulated that RC is related to a poor response to lithium, to the same extent as mixed episodes or other atypical symptoms of the illness. This article reviews the current status of alternative pharmacological or otherwise supportive therapies of RC. Biological parameters and characteristics of the illness associated with RC like gender prevalence in women, hyperthyroidism, catecholamine-O-methyltransferase allele, the influence of sleep, different subtypes of bipolar disorder and the risk of antidepressantinduced cycling will be discussed in detail.

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Patient Selection for Long-term Lithium Treatment in Clinical Practice

Cited by 23 publications

References 6 publications

Beyond the Guidelines for Bipolar Disorder: Practical Issues in Long-Term Treatment with Lithium

Beyond the Guidelines for Bipolar Disorder: Practical Issues in Long-Term Treatment with Lithium

Australian and New Zealand Clinical Practice Guidelines for the Treatment of Bipolar Disorder

Clinical Relevance and Treatment Possibilities of Bipolar Rapid Cycling

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