Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder

Article Abstract:

Treatment of bipolar disorders, more commonly referred to as manic depression, with long-term maintenance doses of lithium has long been recognized as the most effective therapy. Although a commonly accepted therapy, little is known of the dose-response relationship that is involved. Concerns have been voiced over the side effects of the long-term usage of lithium, as some of its complications, such as kidney damage, are potentially serious. Other side effects include tremor, frequent urination, diarrhea, and weight gain. Some recent studies have resulted in the recommendation of lower standardized dosages of lithium for bipolar disorders. An evaluation of 94 patients with bipolar disorder was made where half of the patients received doses of lithium within current standardized ranges and the other half were given lower doses of lithium. Regular periodic measurements of blood concentrations of lithium were taken and symptoms and side effects were noted over a period of approximately two years. The group given the higher doses had a relapse rate of 13 percent, or 6 out of the 47. The relapse in the subjects in the group receiving the lower dosage was 38 percent, affecting three times as many individuals. The risk of relapse in the low dose group was found to be 2.6 times higher than the other group, who overall experienced fewer manic episodes. The group receiving the higher doses also reported a high incidence of side effects but without serious complications. Based on the results of these data, the researchers recommend that average dosages of lithium for bipolar disorder should remain in the 0.8 to 1.0 mmol per liter range, as reduction in dose leads to increased mental instability.

Physiological aspects, Bipolar disorder, Lithium, Lithium (Metal)

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Prospective study of tardive dyskinesia incidence in the elderly

Article Abstract:

Tardive dyskinesia is a condition characterized by involuntary repetitious movements of the muscles; it can be caused by certain antipsychotic drugs such as phenothiazine. Elderly people who are treated with antipsychotic medication are more susceptible to the side effects of this medication, including tardive dyskinesia. The incidence of tardive dyskinesia is three times greater in patients over 40 than in younger patients. A prospective study was undertaken to investigate the incidence of tardive dyskinesia in elderly patients who were beginning anti-psychotic drug treatment, and to identify risk factors for this side effect. Preliminary information is presented for 160 older patients (over 55 years of age) enrolled in the study. Follow-up ranged from 3 to 119 weeks. The average age was 77 years, 72 percent were women, and 87 percent were white. The majority of patients (67 percent) received medication to treat organic brain syndrome (condition involving impaired function of the brain), and 42 percent had a psychiatric diagnosis. The incidence of tardive dyskinesia caused by medication was 31 percent at the end of 43 weeks of drug treatment. Increased vulnerability to tardive dyskinesia was associated with psychiatric diagnosis and the early onset of extrapyramidal signs such as tremors, twitching, slow snake-like movements of the upper body, or facial grimace. These findings should aid in assessing the risks and benefits of using antipsychotic drugs for treating elderly patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Causes of, Complications and side effects, Risk factors, Psychotropic drugs, Geriatric psychiatry, Tardive dyskinesia, Drug-induced dyskinesia

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Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond

Article Abstract:

Future research may pinpoint the physiological changes that occur when patients with depression go into remission. This will give doctors the ability to detect remission precisely. However, until that happens, remission should be based on the patient's symptoms and his or her psychosocial functioning.

Patient outcomes, Depression, Mental, Depression (Mood disorder)

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