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Imaz ML, Torra M, Langohr K, Arca G, Soy D, Hernández AS, García-Esteve L, Vieta E, Martin-Santos R. Peripartum lithium management: Early maternal and neonatal outcomes. J Affect Disord 2024; 366:326-334. [PMID: 39187196 DOI: 10.1016/j.jad.2024.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/02/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND It has been suggested that a 30-50 % lithium dose reduction or lithium discontinuation 24-48 h before delivery could minimize neonatal complications. We investigated the maternal lithemia changes around delivery after a brief discontinuation, the placental transfer of lithium at delivery, and the association between neonatal lithemia at delivery and acute neonatal outcomes. METHODS A retrospective observational cohort study was conducted in a teaching hospital (November/2006-December/2018). Data was extracted from the medical records. We included psychopathologically stable women, with a singleton pregnancy, treated with lithium in late pregnancy, with at least one maternal and neonatal lithemia at delivery. Lithium was discontinued 12 h before a scheduled caesarean section or induction, or at admission day to hospital birth; and restarted 6-12 h post. RESULTS Sixty-six mother-infant pairs were included, and 226 maternal and 66 neonatal lithemias were obtained. We found slight maternal lithemia fluctuations close to 0.20 mEq/L, and early postpartum relapse of 6 %. The mean (SD) umbilical cord/mother intrapartum lithemia ratio was 1.10 (0.17). Fifty-six percent of neonates presented transient acute complications. Neonatal hypotonia was the most frequent outcome (N = 15). Mean lithemia were 0.178 mEq/L higher in those with hypotonia than in those without (p = 0.028). LIMITATIONS It is a retrospective cohort of a moderate sample size of healthy uncomplicated pregnancies and results cannot be generalized to all pregnant treated with lithium. CONCLUSIONS Lithium transfers completely across the placenta. A brief predelivery lithium discontinuation was associated with slight maternal lithemia fluctuations. Neonates exposed intrautero to lithium present frequent but transient acute effects.
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Affiliation(s)
- Maria Luisa Imaz
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
| | - Mercè Torra
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center (CBD), Hospital Clínic, IDIBAPS, Department of Medicine, UB, Barcelona, Spain
| | - Klaus Langohr
- Department of Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona Tech, Barcelona, Spain
| | - Gemma Arca
- Neonatology Service, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Barcelona, Spain
| | - Dolors Soy
- Division of Medicines, Pharmacy Service, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
| | - Ana Sandra Hernández
- Maternal Fetal Medicine Service, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clínic, Barcelona, Spain
| | - Lluïsa García-Esteve
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain; Department of Medicine, Institute of Neuroscience, UB, Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain; Department of Medicine, Institute of Neuroscience, UB, Barcelona, Spain.
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Callovini T, Montanari S, Bardi F, Barbonetti S, Rossi S, Caso R, Mandracchia G, Margoni S, Brugnami A, Paolini M, Manfredi G, Giudice LL, Segatori D, Zanzarri A, Onori L, Calderoni C, Benini E, Marano G, Massetti M, Fiaschè F, Di Segni F, Janiri D, Simonetti A, Moccia L, Grisoni F, Ruggiero S, Bartolucci G, Biscosi M, Ferrara OM, Bernardi E, Monacelli L, Giannico AM, De Berardis D, Battisti G, Ciliberto M, Brisi C, Lisci FM, D’Onofrio AM, Restaino A, Di Benedetto L, Anesini MB, Boggio G, Specogna E, Crupi A, De Chiara E, Caroppo E, Ieritano V, Monti L, Chieffo DPR, Rinaldi L, Camardese G, Cuomo I, Brugnoli R, Kotzalidis GD, Sani G, Mazza M. Obstetric Outcomes in Women on Lithium: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4872. [PMID: 39201016 PMCID: PMC11355283 DOI: 10.3390/jcm13164872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Lithium taken during pregnancy was linked in the past with increased risk for foetal/newborn malformations, but clinicians believe that it is worse for newborn children not to treat the mothers' underlying psychiatric illness. We set to review the available evidence of adverse foetal outcomes in women who received lithium treatment for some time during their pregnancy. Methods: We searched four databases and a register to seek papers reporting neonatal outcomes of women who took lithium during their pregnancy by using the appropriate terms. We adopted the PRISMA statement and used Delphi rounds among all the authors to assess eligibility and the Cochrane Risk-of-Bias tool to evaluate the RoB of the included studies. Results: We found 28 eligible studies, 10 of which met the criteria for inclusion in the meta-analysis. The studies regarded 1402 newborn babies and 2595 women exposed to lithium. Overall, the systematic review found slightly increased adverse pregnancy outcomes for women taking lithium for both the first trimester only and any time during pregnancy, while the meta-analysis found increased odds for cardiac or other malformations, preterm birth, and a large size for gestational age with lithium at any time during pregnancy. Conclusions: Women with BD planning a pregnancy should consider discontinuing lithium when euthymic; lithium use during the first trimester and at any time during pregnancy increases the odds for some adverse pregnancy outcomes. Once the pregnancy has started, there is no reason for discontinuing lithium; close foetal monitoring and regular blood lithium levels may obviate some disadvantages of lithium administration during pregnancy.
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Affiliation(s)
- Tommaso Callovini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Montanari
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesca Bardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Barbonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Rossi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Romina Caso
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Mandracchia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Stella Margoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Brugnami
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Paolini
- Department of Psychiatry, Università Vita-Salute San Raffaele, 20132 Milan, Italy;
| | - Giovanni Manfredi
- UOC Psichiatria, Sant’Andrea University Hospital, Università La Sapienza of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Luca Lo Giudice
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Daniele Segatori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Zanzarri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Onori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Claudia Calderoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elisabetta Benini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Marano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Massetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Federica Fiaschè
- ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Via Giovanni Martinotti, 20, 00135 Rome, Italy;
| | - Federica Di Segni
- ASL Roma 2, Dipartimento di Salute Mentale, Servizio Per Le Dipendenze Patologiche Distretto 7, Via dei Sestili 7, 00174 Rome, Italy;
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Flavia Grisoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Ruggiero
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Bartolucci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Biscosi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ottavia Marianna Ferrara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Evelina Bernardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Leonardo Monacelli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandro Michele Giannico
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Giulia Battisti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Michele Ciliberto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Caterina Brisi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Maria Lisci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Maria D’Onofrio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Restaino
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Di Benedetto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Benedetta Anesini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluca Boggio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elettra Specogna
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Arianna Crupi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuela De Chiara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Local Health Authority Roma 2, 00159 Rome, Italy;
| | - Valentina Ieritano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
- Department Women Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Lucio Rinaldi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ilaria Cuomo
- ASL RM1, UOC SM Distretto XIII ASL Roma 1, CSM Via Boccea 271271, 00168 Rome, Italy;
| | - Roberto Brugnoli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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Schrijver L, Kamperman AM, Bijma H, van Kamp IL, Wesseloo R, Hoogendijk WJG, Bergink V, Poels EMP. Dose response relationship between lithium serum levels during pregnancy and birth outcomes. Acta Psychiatr Scand 2024; 149:323-331. [PMID: 38238613 DOI: 10.1111/acps.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Lithium use during pregnancy reduces the risk of mood episodes in the perinatal period for women with bipolar disorder. Some previous studies found deleterious effects of intrauterine lithium exposure on birth outcomes, yet little is known about a dose response relationship. The current study investigated the influence of maternal lithium serum levels on birth outcomes. METHODS This retrospective observational cohort study included women with a bipolar spectrum disorder who were referred to a specialized psychiatric and obstetric outpatient clinic from 2003 to 2019 and used lithium during the entire pregnancy. For 101 pregnancies at least one lithium level during pregnancy was available. A weighted average lithium level was calculated for the entire pregnancy, as well as for each trimester. Detailed information on maternal, obstetric and neonatal outcomes were retrieved from the medical records. Linear and logistic regression models were used to investigate the association between weighted average lithium level and pregnancy duration, birth weight percentiles, preterm birth and large for gestational age births (LGA). In subsequent exploratory analyses, we studied the role of thyroid-stimulating hormone (TSH) and thyroxine (T4) as a mediator in the found associations. RESULTS The weighted average lithium serum level during pregnancy was negatively associated with pregnancy duration and positively with preterm birth, but not with birth weight percentile or LGA. In exploratory analyses, TSH and T4 did not mediate the association between average lithium serum level and pregnancy duration. CONCLUSION The results of this cohort study during pregnancy indicate a dose response relationship between maternal lithium serum levels and pregnancy duration.
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Affiliation(s)
- Lisanne Schrijver
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
- Molemann Mental Health, Amersfoort, The Netherlands
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hilmar Bijma
- Department of Obstetrics and Gynecology, Division Obstetrics and Fetal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Inge L van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Richard Wesseloo
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
- GGZ Delfland, Delft, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eline M P Poels
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hasser C, Ameresekere M, Girgis C, Knapp J, Shah R. Striking the Balance: Bipolar Disorder in the Perinatal Period. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:3-15. [PMID: 38694148 PMCID: PMC11058914 DOI: 10.1176/appi.focus.20230020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The authors reviewed the literature, published between 2018 and 2023, on treating bipolar disorder in the perinatal period in order to summarize current treatment perspectives. Mood episodes occur during pregnancy and there are high rates of both initial onset and recurrence in the postpartum period. Bipolar disorder itself is associated with higher risks of adverse pregnancy outcomes, including gestational hypertension, hemorrhage, cesarean delivery, and small for gestational age infants. A general principle of perinatal treatment includes maintaining psychiatric stability of the pregnant person while reducing medication exposure risk to the fetus. A variety of factors can compromise psychiatric stability, including rapid discontinuation of stabilizing medications, decreased efficacy due to physiologic changes of pregnancy, and exacerbation of underlying psychiatric illness. Psychosocial interventions include optimizing sleep, increasing support, and reducing stress. The American College of Obstetricians and Gynecologists recommends against discontinuing or withholding medications solely due to pregnancy or lactation status. Individualized treatment involves a discussion of the risks of undertreated bipolar disorder weighed against the risks of individual medication choice based on available evidence regarding congenital malformations, adverse neonatal and obstetrical events, and neurodevelopmental outcomes. Valproate is not a first-line treatment due to higher risks. Data are lacking on safety for many newer medications. The authors review current safety data regarding lithium, lamotrigine, and antipsychotics, which are the most commonly used treatments for managing bipolar disorder in the perinatal period. Due to physiologic changes during pregnancy, frequent therapeutic drug monitoring and dose adjustments are required.
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Affiliation(s)
- Caitlin Hasser
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Maithri Ameresekere
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Christina Girgis
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Jacquelyn Knapp
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
| | - Riva Shah
- Department of Psychiatry (Hasser, Knapp, Shah) and Department of Obstetrics and Gynecology (Knapp), School of Medicine, Oregon Health & Science University, Portland, Oregon; Portland VA Health Care System, Portland, Oregon (Hasser, Shah); Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston (Ameresekere); Edward Hines, Jr. VA Hospital, Hines, Illinois (Girgis); Department of Psychiatry, Stritch School of Medicine, Loyola University, Maywood, Illinois (Girgis)
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Reproductive Psychiatry: Postpartum Depression is Only the Tip of the Iceberg. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:77-78. [PMID: 38694164 PMCID: PMC11058928 DOI: 10.1176/appi.focus.23021027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
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Whaites Heinonen E, Tötterman K, Bäck K, Sarman I, Forsberg L, Svedenkrans J. High lithium concentration at delivery is a potential risk factor for adverse outcomes in breastfed infants: a retrospective cohort study. Int J Bipolar Disord 2023; 11:36. [PMID: 38032417 PMCID: PMC10689698 DOI: 10.1186/s40345-023-00317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Neonatal effects of late intrauterine and early postpartum exposure to lithium through mother's own milk are scarcely studied. It is unclear whether described symptoms in breastfed neonates are caused by placental lithium transfer or postnatal exposure to lithium through breastfeeding. We aimed to investigate lithium clearance and neonatal morbidity in breastfed infants with high versus low serum lithium concentrations at birth. METHODS This retrospective study focused on breastfed infants to women treated with lithium during and after pregnancy, born between 2006 and 2021 in Stockholm, Sweden. Information on serum lithium concentrations and adverse neonatal outcomes was obtained from medical records. Neonatal symptoms and lithium clearance were compared between a high exposure group (HEG, lithium concentrations ≥ 0.6 meq/l) and a low exposure group (LEG, < 0.6 meq/l). RESULTS A total of 25 infant-mother dyads were included. Median lithium serum concentration at birth was 0.90 meq/l in the HEG as compared with 0.40 meq/l in the LEG (p < 0.05). The difference was still significant at follow-up (0.20 meq/l vs 0.06 meq/l, p < 0.05), despite reduction in maternal dose. The rate of neonatal symptoms was 85.7% in HEG and 41.2% in LEG (p = 0.08) at birth and 28.6% vs 11.8% at follow-up (p = 0.55). Furthermore, 28.6% of infants in HEG were admitted to neonatal care, vs 5.9% in LEG (p = 0.19). Two infants in the HEG had therapeutic lithium levels at follow-up. All infants with symptoms at follow-up were either in the HEG or exposed to additional psychotropic medication. CONCLUSIONS Neonatal symptoms are common after late intrauterine lithium exposure, however transient, treatable and mostly mild. In this study, a high lithium concentration at birth was a risk factor for an increased lithium level at follow-up. Polypharmacy may constitute an additional risk factor. This study suggests that the late intrauterine exposure to lithium might add to the adverse effects in lithium-exposed, breastfed infants. Consequently we recommend breastfed infants with therapeutic lithium concentrations at birth to be followed up promptly to avoid lithium toxicity.
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Affiliation(s)
- Essi Whaites Heinonen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Div of Pediatrics, Karolinska Institutet, Blickagången 6A, 14157, Huddinge, Stockholm, Sweden.
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Karin Bäck
- Department of Neonatology, St Goran Hospital, Stockholm, Sweden
| | - Ihsan Sarman
- Department of Clinical Science and Education Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Forsberg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Div of Pediatrics, Karolinska Institutet, Blickagången 6A, 14157, Huddinge, Stockholm, Sweden
| | - Jenny Svedenkrans
- Department of Clinical Science, Intervention and Technology (CLINTEC), Div of Pediatrics, Karolinska Institutet, Blickagången 6A, 14157, Huddinge, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
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Uguz F, Sharma V, Boyce P, Clark CT, Galbally M, Koukopoulos A, Marsh W, Stevens A, Viguera A. Prophylactic Management of Women With Bipolar Disorder During Pregnancy and the Perinatal Period: Clinical Scenario-Based Practical Recommendations From A Group of Perinatal Psychiatry Authors. J Clin Psychopharmacol 2023; 43:434-452. [PMID: 37683233 DOI: 10.1097/jcp.0000000000001740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
ABSTRACT Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients. In light of the available effectiveness and reproductive safety data, the current clinical update based on the opinions of a group of international perinatal psychiatry authors recommends general considerations and specific management strategies for each possible clinical scenario, including mixed features, predominant polarity, diagnosis of subtypes of bipolar disorder, severity of previous episodes, and risk of recurrence of mood episodes.
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Affiliation(s)
- Faruk Uguz
- From the Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Verinder Sharma
- Schulich School of Medicine and Dentistry, The University of Western Ontario; Lawson Health Research Institute; Parkwood Institute Mental Health, Perinatal Mental Health Clinic, London Health Sciences Center, London, Ontario, Canada
| | - Philip Boyce
- Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Crystal T Clark
- Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Megan Galbally
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Alexia Koukopoulos
- University Hospital Policlinico Umberto I, La Sapienza University of Rome; Centro Lucio Bini, Rome, Italy
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA.
| | - Anja Stevens
- Centre for Bipolar Disorders, Dimence Group, Deventer, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Psychiatry, the Netherlands
| | - Adele Viguera
- Cleveland Clinic, Cleveland Clinic Neurological Institute, Cleveland, OH
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Ahmed I, Khan MS, Ma V, Magsi H, Gunawan R, Ilyas AMO, Lashari NUR, Wassan N, Paidi S, Ali Z, Law AWL, Zhang Y, Cho WC, Alda M, Bergink V, Barman I, Lau C. Lithium in breast milk transiently affects the renal electrolytic balance of infants. Bipolar Disord 2023; 25:56-65. [PMID: 36409044 DOI: 10.1111/bdi.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of lithium during breast-feeding has not been comprehensively investigated in humans due to concerns about lithium toxicity. PROCEDURE We analyzed lithium in the kidneys of nursed pups of lithium medicated mothers, using analytical spectroscopy in a novel rat model. The mothers were healthy rats administered lithium via gavage (1000 mg/day Li2 CO3 per 50 kg body weight). RESULTS Lithium was detected in the breast milk, and in the blood of pups (0.08 mM), of lithium-exposed dams at post-natal day 18 (P18), during breast-feeding. No lithium was detected after breast-feeding, at P25 (4 days after cessation of nursing). The lithium pups blood had elevated urea nitrogen at P18 and reduced total T4 at P18 and P25, indicating a longer-term effect on the kidneys and the thyroid gland. Multivariate machine-learning analysis of spectroscopy data collected from the excised kidneys of pups showed elevated potassium in lithium-exposed animals both during- and after breast-feeding. The elevated renal potassium was associated with low nephrin expression in the kidneys measured immunohistochemically during breast-feeding. After lithium exposure is stopped, the filtration of lithium from the kidneys reverses these effects. Our study showed that breastfeeding during lithium use has an effect on the kidneys of the offspring in rats.
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Affiliation(s)
- Irfan Ahmed
- Department of Physics, City University of Hong Kong, Hong Kong SAR, China.,Department of Electrical Engineering, Sukkur IBA University, Sukkur, Pakistan
| | | | - Victor Ma
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Hina Magsi
- Department of Electrical Engineering, Sukkur IBA University, Sukkur, Pakistan
| | - Renardi Gunawan
- Department of Biomedical Sciences, and Tung Biomedical Sciences Centre, City University of Hong Kong, Hong Kong SAR, China
| | - Abdul-Mojeed Olabisi Ilyas
- Department of Physics, City University of Hong Kong, Hong Kong SAR, China.,Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong SAR, China.,Department of Physics, Federal University Oye-Ekiti, Ekiti State, Nigeria
| | - Najeeb Ur Rehman Lashari
- Institute for Advanced Study, Shenzhen University, Shenzhen, China.,Department of Chemistry Physics and Atmospheric Sciences, Jackson State University, Jackson, Mississippi, USA
| | - Naveed Wassan
- Department of Business Administration, Sukkur IBA University, Sukkur, Pakistan
| | - Santosh Paidi
- Johns Hopkins University, Department of Mechanical Engineering, Baltimore, Massachusetts, USA.,School of Optometry, University of California, Berkeley, California, USA
| | - Zulfiqar Ali
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Alan W L Law
- Department of Physics, City University of Hong Kong, Hong Kong SAR, China
| | - Yanpeng Zhang
- Key Laboratory for Physical Electronics and Devices of the Ministry of Education & Shaanxi Key Lab of Information Photonic Technique, Xi'an Jiaotong University, Xi'an, China
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada.,National Institute of Mental Health, Klecany, Czech Republic
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ishan Barman
- Johns Hopkins University, Department of Mechanical Engineering, Baltimore, Massachusetts, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Massachusetts, USA.,Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Massachusetts, USA
| | - Condon Lau
- Department of Physics, City University of Hong Kong, Hong Kong SAR, China
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Sampogna G, Janiri D, Albert U, Caraci F, Martinotti G, Serafini G, Tortorella A, Zuddas A, Sani G, Fiorillo A. Why lithium should be used in patients with bipolar disorder? A scoping review and an expert opinion paper. Expert Rev Neurother 2022; 22:923-934. [PMID: 36562412 DOI: 10.1080/14737175.2022.2161895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lithium treatment is considered the gold standard for the long-term management of bipolar disorder and recurrent unipolar depression. It is also extremely effective in other psychiatric conditions characterized by impulsivity and aggression, and for the prevention of suicidal behaviours. AREAS COVERED This paper provides a scoping review and an expert commentary regarding the use of lithium in adult patients. Available information about efficacy, tolerability, dosing, and switching is analyzed, and the strategies that may be most useful in real-world clinical settings are highlighted. EXPERT OPINION Lithium is effective on different domains of bipolar disorder, including the long-term prevention of recurrences of affective episodes, management of acute mania as well as in the prophylaxis of all affective episodes. Lithium has been defined a 'forgotten drug,' since its use in routine clinical practice has been declined over the last 20 or 30 years. Reasons for this trend include lack of adequate training on the management of lithium side effects. Considering its efficacy, use of lithium in ordinary clinical practice should be promoted. Several strategies, such as using slow-release formulations, can be easily implemented in order to minimize lithium side effects and improve its tolerability profile.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Psychiatry and Neurology, Sapienza University of Rome, Rome, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy. Azienda Sanitaria Integrata Giuliano-Isontina - ASUGI, UCO Clinica Psichiatrica, Trieste, Italy
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, Catania, Italy; Unit of Neuropharmacology and Translational Neurosciences, Oasi Research Institute - IRCCS, Troina, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, Chieti, Italy; Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Alessandro Zuddas
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Gabriele Sani
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Torfs M, Hompes T, Ceulemans M, Van Calsteren K, Vanhole C, Smits A. Early Postnatal Outcome and Care after in Utero Exposure to Lithium: A Single Center Analysis of a Belgian Tertiary University Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10111. [PMID: 36011745 PMCID: PMC9407712 DOI: 10.3390/ijerph191610111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Knowledge of the impact of in utero exposure to lithium during the postnatal period is limited. Besides a possible teratogenic effect during the first trimester, exposure during the second and third trimesters might lead to neonatal effects. Uniform guidelines for postnatal management of these neonates are lacking. The aim was to retrospectively describe all neonates admitted to the University Hospitals Leuven after in utero exposure to lithium (January 2010 to April 2020), and to propose a postnatal care protocol. Descriptive statistics were performed. For continuous parameters with serial measurements, median population values were calculated. In total, 10 mother-neonate pairs were included. The median gestational age was 37 (interquartile range, IQR, 36-39) weeks. Neonatal plasma lithium concentration at birth was 0.65 (IQR 0.56-0.83) mmol/L with a median neonate/mother ratio of 1.02 (IQR 0.87-1.08). Three neonates needed respiratory support, 7/10 started full enteral (formula) feeding on day 1. The median length of neonatal stay was 8.5 (IQR 8-12) days. One neonate developed nephrogenic diabetes insipidus. This study reported in detail the postnatal characteristics and short-term neonatal outcomes. A postnatal care protocol was proposed, to enhance the quality of care for future neonates, and to guide parental counselling. Future prospective protocol evaluation is needed.
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Affiliation(s)
- Marlien Torfs
- Department of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Titia Hompes
- Mind-Body Research Unit, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
- Adult Psychiatry UPC, KU Leuven, 3000 Leuven, Belgium
- L-C&Y, Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
| | - Michael Ceulemans
- L-C&Y, Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- Teratology Information Service, Netherlands Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands
| | - Kristel Van Calsteren
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Christine Vanhole
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Anne Smits
- L-C&Y, Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium
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Molenaar NM, Poels EMP, Robakis T, Wesseloo R, Bergink V. Management of lithium dosing around delivery: An observational study. Bipolar Disord 2021; 23:49-54. [PMID: 32526071 PMCID: PMC7891390 DOI: 10.1111/bdi.12955] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Recommendations on lithium dosing around delivery vary, with several guidelines suggesting that lithium should be discontinued prior to delivery. We aimed to evaluate the validity of these recommendations by investigating 1) maternal lithium blood level changes following delivery, and 2) the association between neonatal lithium blood levels at delivery and neonatal outcomes. METHODS In this retrospective observational cohort study, we included women with at least one lithium blood level measurement during the final week of pregnancy and the first postpartum week. For aim 2, we included a subcohort of women with neonates for whom neonatal lithium blood levels (obtained from the umbilical cord or a neonatal vein puncture within 24 hours of delivery) were available. RESULTS There were a total of 233 maternal lithium blood level measurements; 55 (23.6%) in the week before delivery and 178 (76.4%) in the week after. There was no association between time and lithium blood level/dose ratio (Pearson correlation coefficient -0.03, P = .63). Additionally, we included a total of 29 neonates for whom a lithium measurement was performed within 24 hours postpartum. Maternal and neonatal lithium blood levels were strongly correlated. We observed no associations between neonatal lithium blood levels at delivery and neonatal outcomes. CONCLUSION Based on our findings, we do not recommend lowering the dosage or discontinuation of lithium prior to delivery. Stable dosing can prevent subtherapeutic lithium serum levels, which is especially important in the postpartum period when relapse risks are highest.
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Affiliation(s)
- Nina M. Molenaar
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA,Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands
| | - Eline M. P. Poels
- Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands
| | - Thalia Robakis
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Richard Wesseloo
- Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands,Department of PsychiatryGGZ DelftlandDelftThe Netherlands
| | - Veerle Bergink
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA,Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands,Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
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12
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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