The use of lithium in the medically ill

DasGupta, Krishna; Jefferson, James W.

doi:10.1016/0163-8343(90)90019-9

Cited by 34 publications

(21 citation statements)

References 98 publications

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“…In therapeutic doses, lithium probably does not decrease cardiac contractility. However, if CHF symptoms worsen, lithium should be discontinued [42]. Patients with CHF are also at increased risk for orthostatic hypotension, specifically with medications that antagonize alpha-1 receptors [43].…”

Section: Resultsmentioning

confidence: 99%

Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities

McLaren

Marangell

2004

Ann Gen Hosp Psychiatry

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Background: The pharmacological treatment of bipolar disorder has dramatically improved with multiple classes of agents being used as mood-stabilizers, including lithium, anticonvulsants, and atypical antipsychotics. However, the use of these medications is not without risk, particularly when a patient with bipolar disorder also has comorbid medical illness. As the physician who likely has the most contact with patients with bipolar disorder, psychiatrists must have a high index of suspicion for medical illness, as well as a basic knowledge of the risks associated with the use of medications in this patient population.

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Section: Resultsmentioning

confidence: 99%

Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities

McLaren

Marangell

2004

Ann Gen Hosp Psychiatry

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“…These side effects were well tolerated, and Chacko et al concluded that with proper precaution and monitoring, lithium can be safely administered to these patients. However, it should be noted that lithium prophylaxis in this age group perhaps requires a more cautious approach, as well as more frequent evaluation and monitoring due to greater risk of adverse effects and intoxication in older adults [DasGupta and Jefferson, 1990;Lepkifker et al, 1985;Spar et al, 1979]. One has to be aware of factors such as the decline in the glomerular filtration rate, the existence of medical or neurological illness, greater sensitivity to the drug, increased likelihood of adverse drug interactions in view of the frequent use of multiple medications by older adult patients, irregular or inadequate fluid and food intake, poor compliance, and potentially limited family and social support [de Angelis, 1990;Sproule et al, 2000].…”

Section: Discussionmentioning

confidence: 97%

Lithium therapy for unipolar and bipolar depression among the middle-aged and older adult patient subpopulation

et al. 2007

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Affective disorders are a major cause of morbidity and disability among middle-aged and older people. Thus, the prophylaxis of both unipolar depression and bipolar disorder in this patient subpopulation is an important task of psychiatrists and other physicians. Although lithium remains an effective prophylactic and treatment agent in younger individuals with bipolar disorder, its prophylactic efficacy and tolerability has not been thoroughly investigated among middle aged and older people with unipolar depression and bipolar disorder. Our study is based on a mirror-image design that compared the clinical course with lithium treatment and the clinical course prior to lithium treatment based on a retrospective chart review. We examined the results obtained with long-term lithium maintenance in a group of 60 middle-aged and older adult patients (age >60 years) with unipolar depression and bipolar disorder. More specifically, we analyzed changes of frequency, severity, and duration of depressive or manic relapses, rate and duration of hospitalizations and suicidal behavior (thoughts or attempts), and various assessments of outcome. A significant reduction was found on all indices during lithium therapy compared to before lithium treatment, attesting to the prophylactic efficacy of long-term lithium in unipolar depression and bipolar disorder. The range of side effects in our sample was similar to that found in other reports in this age group. The probability of relapse and recurrence in patients with bipolar disorder and with unipolar depression can be significantly decreased by lithium prophylaxis. Further investigation is mandated to confirm these findings under double-blind conditions.

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“…44,67,68 Finally, the use of corticosteroids in HTx recipients can not only trigger manic episodes, 25 but can also alter serum lithium levels by decreasing tubular fractional re-absorption. 69 …”

Section: Lithium and Htxmentioning

confidence: 97%