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Fiorillo A, Sampogna G, Albert U, Maina G, Perugi G, Pompili M, Rosso G, Sani G, Tortorella A. Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper. Ann Gen Psychiatry 2023; 22:50. [PMID: 38057894 DOI: 10.1186/s12991-023-00481-y] [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] [Received: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Bipolar disorder is one of the most burdensome severe mental disorders, characterized by high levels of personal and social disability. Patients often need an integrated pharmacological and non-pharmacological approach. Lithium is one of the most effective treatments available not only in psychiatry, but in the whole medicine, and its clinical efficacy is superior to that of other mood stabilizers. However, a declining trend on lithium prescriptions has been observed worldwide in the last 20 years, supporting the notion that lithium is a 'forgotten drug' and highlighting that the majority of patients with bipolar disorder are missing out the best available pharmacological option. Based on such premises, a narrative review has been carried out on the most common "misconceptions" and "stereotypes" associated with lithium treatment; we also provide a list of "good reasons" for using lithium in ordinary clinical practice to overcome those false myths. MAIN TEXT A narrative search of the available literature has been performed entering the following keywords: "bipolar disorder", "lithium", "myth", "mythology", "pharmacological treatment", and "misunderstanding". The most common false myths have been critically revised and the following statements have been proposed: (1) Lithium should represent the first choice for the treatment of patients with bipolar disorder; (2) lithium treatment is effective in different patients' groups suffering from bipolar disorder; (3) Drug-drug interaction risk can be easily managed during lithium treatment; (4) The optimal management of lithium treatment includes periodical laboratory tests; (5) Slow-release lithium formulation has advantages compared to immediate release formulation; (6) Lithium treatment has antisuicidal properties; (7) Lithium can be carefully managed during pregnancy. CONCLUSIONS In recent years, a discrepancy between evidence-based recommendations and clinical practice in using lithium treatment for patients with bipolar disorder has been highlighted. It is time to disseminate clear and unbiased information on the clinical efficacy, effectiveness, tolerability and easiness to use of lithium treatment in patients with bipolar disorder. It is necessary to reinvigorate the clinical and academic discussion about the efficacy of lithium, to counteract the decreasing prescription trend of one of the most effective drugs available in the whole medicine.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna delle Grazie, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna delle Grazie, Naples, Italy.
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Maina
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital - Sapienza University of Rome, Rome, Italy
| | - Gianluca Rosso
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Pacholko AG, Bekar LK. Different pharmacokinetics of lithium orotate inform why it is more potent, effective, and less toxic than lithium carbonate in a mouse model of mania. J Psychiatr Res 2023; 164:192-201. [PMID: 37356352 DOI: 10.1016/j.jpsychires.2023.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 05/09/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Abstract
Lithium carbonate (LiCO) is a mainstay therapeutic for the prevention of mood-episode recurrences in bipolar disorder (BD). Unfortunately, its narrow therapeutic index is associated with complications that may lead to treatment non-compliance. Intriguingly, lithium orotate (LiOr) is suggested to possess unique uptake characteristics that would allow for reduced dosing and mitigation of toxicity concerns. We hypothesized that due to differences in pharmacokinetics, LiOr is more potent with reduced adverse effects. Dose responses were established for LiOr and LiCO in male and female mice using an amphetamine-induced hyperlocomotion (AIH) model; AIH captures manic elements of BD and is sensitive to a dose-dependent lithium blockade. LiCO induced a partial block of AIH at doses of 15 mg/kg in males and 20 mg/kg in females. In contrast, LiOr elicited a near complete blockade at concentrations of just 1.5 mg/kg in both sexes, indicating improved efficacy and potency. Prior application of organic anion transport inhibitors, or inhibition of orotate uptake into the pentose pathway, completely blocked the effects of LiOr on AIH while sparing LiCO effects, confirming differences in transport and compartmentalization between the two compounds. Next, the relative toxicities of LiOr and LiCO were contrasted after 14 consecutive daily administrations. LiCO, but not LiOr, elicited polydipsia in both sexes, elevated serum creatinine levels in males, and increased serum TSH expression in females. LiOr demonstrates superior efficacy, potency, and tolerability to LiCO in both male and female mice because of select transport-mediated uptake and pentose pathway incorporation.
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Affiliation(s)
- Anthony G Pacholko
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada.
| | - Lane K Bekar
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada.
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D'Avanzo B, Barbato A, Monzio Compagnoni M, Caggiu G, Allevi L, Carle F, Di Fiandra T, Ferrara L, Gaddini A, Sanza M, Saponaro A, Scondotto S, Tozzi VD, Giordani C, Corrao G, Lora A. The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project. BMC Psychiatry 2023; 23:424. [PMID: 37312076 PMCID: PMC10261835 DOI: 10.1186/s12888-023-04921-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo). METHODS Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions. RESULTS 29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26-1.44): 1.18 (1.07-1.29) in females, 1.60 (1.45-1.77) in males. Heterogeneity across areas was considerable in both cohorts. CONCLUSIONS We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.
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Affiliation(s)
- Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy.
| | - Giulia Caggiu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | | | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Does treatment with autophagy-enhancers and/or ROS-scavengers alleviate behavioral and neurochemical consequences of low-dose rotenone-induced mild mitochondrial dysfunction in mice? Mol Psychiatry 2023; 28:1667-1678. [PMID: 36690794 DOI: 10.1038/s41380-023-01955-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/24/2023]
Abstract
Bipolar-disorder's pathophysiology and the mechanism by which medications exert their beneficial effect is yet unknown, but others' and our data implicate patients' brain mitochondrial-dysfunction and its amendment by mood-stabilizers. We recently designed a novel mouse bipolar-disorder-like model using chronic administration of a low-dose of the oxidative-phosphorylation complex I inhibitor, rotenone. Four and eight weeks rotenone treatment induced manic- and depressive-like behavior, respectively, accompanied by mood-related neurochemical changes. Here we aimed to investigate whether each of the autophagy-enhancers lithium (a mood-stabilizer), trehalose and resveratrol and/or each of the reactive oxygen species (ROS)-scavengers, resveratrol and N-acetylcystein and/or the combinations lithium+resveratrol or trehalose+N-acetylcystein, can ameliorate behavioral and neurochemical consequences of neuronal mild mitochondrial-dysfunction. We observed that lithium, trehalose and N-acetylcystein reversed rotenone-induced manic-like behavior as well as deviations in protein levels of mitochondrial complexes and the autophagy marker LC3-II. This raises the possibility that mild mitochondrial-dysfunction accompanied by impaired autophagy and a very mild increase in ROS levels are related to predisposition to manic-like behavior. On the other hand, although, as expected, most of the drugs tested eliminated the eight weeks rotenone-induced increase in protein levels of all hippocampal mitochondrial complexes, only lithium ubiquitously ameliorated the depressive-like behaviors. We cautiously deduce that aberrant autophagy and/or elevated ROS levels are not involved in predisposition to the depressive phase of bipolar-like behavior. Rather, that amending the depressive-like characteristics requires different mitochondria-related interventions. The latter might be antagonizing N-methyl-D-aspartate receptors (NMDARs), thus protecting from disruption of mitochondrial calcium homeostasis and its detrimental consequences. In conclusion, our findings suggest that by-and-large, among the autophagy-enhancers and ROS-scavengers tested, lithium is the most effective in counteracting rotenone-induced changes. Trehalose and N-acetylcystein may also be effective in attenuating manic-like behavior.
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Kamal ZM, Dutta S, Rahman S, Etando A, Hasan E, Nahar SN, Wan Ahmad Fakuradzi WFS, Sinha S, Haque M, Ahmad R. Therapeutic Application of Lithium in Bipolar Disorders: A Brief Review. Cureus 2022; 14:e29332. [PMID: 36159362 PMCID: PMC9484534 DOI: 10.7759/cureus.29332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
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Crapanzano C, Casolaro I, Amendola C, Damiani S. Lithium and Valproate in Bipolar Disorder: From International Evidence-based Guidelines to Clinical Predictors. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:403-414. [PMID: 35879025 PMCID: PMC9329114 DOI: 10.9758/cpn.2022.20.3.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Calogero Crapanzano
- Azienda Sanitaria Provinciale di Agrigento, Centro Salute Mentale Licata, Licata,Italy
| | - Ilaria Casolaro
- Azienda Socio Sanitaria Territoriale Ovest Milanese, Milano, Italy
| | - Chiara Amendola
- Azienda Unità Sanitaria Locale Toscana Centro, Centro Salute Mentale Scandicci, Firenze, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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7
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Mills J. Lithium: The Oldest-Known Metal in the Universe Can Prevent Suicide, and Nurses Should Be Using It More. Issues Ment Health Nurs 2022; 43:193-197. [PMID: 34797752 DOI: 10.1080/01612840.2021.1990584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Jeremy Mills
- Peninsula, a Division of Parkwest Medical Center, Knoxville, Tennessee, USA
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Rodríguez AM, de Mendiola Etxezarraga XP. Lithium Plus Olanzapine: One of the Most Effective Combinations for Bipolar Disorder. A Case Report and a Concise Review of the Literature. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082218666211221090624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The recurrent nature of Bipolar Disorder (BD) is the main cause of disability associated with the illness. Despite the proliferation of drugs approved for the maintenance phase of BD, the relapse rate is still high. The combination of drugs, especially the potentiation of mood-stabilizers with second-generation antipsychotics, may reduce the risk of relapse and rehospitalization. However, studies on the efficacy of specific combinations are scarce.
Case presentation:
The clinical case of a 28-year-old woman involuntarily admitted to an Acute Psychiatric Unit is presented. She suffers a manic postpartum episode with mixed and psychotic features. During the hospitalization, she is successfully treated with a combination of lithium plus olanzapine. In the discussion, a concise narrative review of the scientific literature on the efficacy of such a combination in BD is made.
Conclusion:
The association of lithium plus olanzapine is one of the combinations with most evidence on its efficacy in BD, especially in mixed-featured episodes. Tolerability concerns should not be an obstacle to its use, although they must be considered
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Affiliation(s)
- Aitzol Miguélez Rodríguez
- Psychiatry Service. OSI Araba. Hospital Universitario Araba. Sede Santiago. Vitoria-Gasteiz, Araba, Basque , Spain
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A survey of Saskatchewan family physicians, psychiatrists and pharmacists assessing barriers in lithium use. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pacholko AG, Bekar LK. Lithium orotate: A superior option for lithium therapy? Brain Behav 2021; 11:e2262. [PMID: 34196467 PMCID: PMC8413749 DOI: 10.1002/brb3.2262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/08/2021] [Indexed: 01/23/2023] Open
Abstract
Bipolar disorder (BD) poses a significant public health concern, with roughly one-quarter of sufferers attempting suicide. BD is characterized by manic and depressive mood cycles, the recurrence of which can be effectively curtailed through lithium therapy. Unfortunately, the most frequently employed lithium salt, lithium carbonate (Li2 CO3 ), is associated with a host of adverse health outcomes following chronic use: these unwanted effects range from relatively minor inconveniences (e.g., polydipsia and polyuria) to potentially major complications (e.g., hypothyroidism and/or renal impairment). As these undesirable effects can limit patient compliance, an alternative lithium compound with a lesser toxicity profile would dramatically improve treatment efficacy and outcomes. Lithium orotate (LiC5 H3 N2 O4 ; henceforth referred to as LiOr), a compound largely abandoned since the late 1970s, may represent such an alternative. LiOr is proposed to cross the blood-brain barrier and enter cells more readily than Li2 CO3 , which will theoretically allow for reduced dosage requirements and ameliorated toxicity concerns. This review addresses the controversial history of LiOr, complete with discussions of experimental and clinical efficacy, putative mechanisms of action, adverse effects, and its potential future in therapy.
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Affiliation(s)
- Anthony G Pacholko
- Department of Anatomy, Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lane K Bekar
- Department of Anatomy, Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Buoli M, Gattoni E, Collantoni E, Monteleone AM, Solmi M, Longo L, Ribolsi M, Santambrogio J, Bersani FS, Aguglia A, Serafini G, Signorelli MS, Dell'Osso B, Luciano M, Galderisi S. Factors influencing lithium versus valproate prescription preference in the maintenance treatment of bipolar patients: a report from the Italian Early Career Psychiatrists (SOPSI-GG). Int J Psychiatry Clin Pract 2021; 25:82-89. [PMID: 33380246 DOI: 10.1080/13651501.2020.1865405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Objective of the present manuscript is to investigate, among Italian early career psychiatrists (ECPs), prescriber and patient-related factors associated with lithium or valproate preference to treat patients affected by Bipolar Disorder (BD). METHODS An on-line survey was carried out among 252 ECPs, investigating their prescription patterns in relation to lithium and the differences with prescription of valproate. Collected data were compared according to lithium or valproate prescription preference in the long-term treatment of BD by χ2 tests for qualitative variables. RESULTS Over two thirds of ECPs preferred lithium over valproate for the maintenance treatment of BD. Less than half of the sample used lithium as first-line agent for mania or major depression, and less than one third for mixed episodes. Factors associated with lithium preference as first-line maintenance treatment include perception of having a good knowledge of lithium (p < 0.001) and complete satisfaction with education on lithium (p < 0.001). One of the main factors to prefer valproate was the concern about long-term side effects of lithium (p < 0.001). CONCLUSIONS Type of education, source of information, clinical experience and safety concerns influence the choice of lithium versus valproate in the long-term treatment of BD. Present findings may guide educational training of ECPs.KEY POINTSLithium has been less prescribed in the last years for long-term treatment of Bipolar Disorder.Educational and clinical factors seem to influence the attitude to prescribe lithium.Only half of the Italian early career psychiatrists declare to have at least an adequate knowledge of lithium.Residency program in psychiatry should consider the implementation of education on lithium.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Gattoni
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy.,Institute of Psychiatry, Maggiore della Carità Hospital of Novara, Novara, Italy
| | | | - Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, Naples, Italy
| | - Marco Solmi
- Neurosciences Department, University of Padua, Padua, Italy
| | - Luisa Longo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | | | - Jacopo Santambrogio
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | | | - Andrea Aguglia
- 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
| | - 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
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, AOU Policlinico Hospital, University of Catania, Catania, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences, "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics University of Milan, Milan, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, Naples, Italy
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Second Generation Antipsychotics Monotherapy as Maintenance Treatment for Bipolar Disorder: a Systematic Review of Long-Term Studies. Psychiatr Q 2020; 91:1047-1060. [PMID: 32651765 DOI: 10.1007/s11126-020-09753-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Atypical or so called second generation antipsychotics (SGA) are playing a role of increasing importance in treatment of bipolar disorder (BD). This study is aimed towards a systematic review of their efficacy when used as monotherapy in order to prevent relapses in the long term treatment. Publications about this subject were identified after a thorough bibliographic research in Medline, The Cochrane Library and Web of Science, employing the PICO method for the creation of a database search strategy and carrying out a critical read and analysis of the found evidence. 14 studies were found which informed about the results of randomized and controlled clinical trials (RCT) about the efficacy of these SGA in monotherapy for BD, when it comes to prevention of relapse, in adult patients diagnosed with either type I or II BD, with a minimum follow-up time of 6 months. Evidence of the use of SGAs for maintenance treatment in BD is limited. Amongst all antipsychotics assessed only aripiprazole, olanzapine, lurasidone, risperidone and quetiapine have been found to be competent for their use in monotherapy, according to RCT.
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Sharpley AL, Williams C, Holder AA, Godlewska BR, Singh N, Shanyinde M, MacDonald O, Cowen PJ. A phase 2a randomised, double-blind, placebo-controlled, parallel-group, add-on clinical trial of ebselen (SPI-1005) as a novel treatment for mania or hypomania. Psychopharmacology (Berl) 2020; 237:3773-3782. [PMID: 32909076 PMCID: PMC7683468 DOI: 10.1007/s00213-020-05654-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE Lithium is an effective prophylactic and anti-manic treatment in bipolar disorder; however, its use is declining through perceived poor tolerance and toxicity. Lithium inhibits inositol monophosphatase (IMPase), a probable key therapeutic mechanism. The anti-inflammatory drug, ebselen, also inhibits IMPase and appears well-tolerated and safe. OBJECTIVES To assess the efficacy of adjunctive ebselen in mania using the Young Mania Rating Scale (YMRS) (primary outcome) and the Altman Self-Rating Mania (ASRM) Scale and Clinical Global Impression-Severity Scale (CGI-S) among the secondary outcomes. METHODS Randomised, double-blind, placebo-controlled, parallel-group trial conducted between October 2017 and June 2019, at Oxford Health NHS Foundation Trust. Pharmacy-controlled randomisation was computer-generated, with full allocation concealment. In/outpatients (n = 68) aged 18-70, experiencing mania or hypomania, were assigned to 3 weeks ebselen (600 mg bd) (n = 33) or placebo (n = 35). Participants received usual clinical care and psychotropic medication. RESULTS Ebselen was numerically, but not statistically, superior to placebo in lowering scores on the YMRS (adjusted mean difference and 95% confidence interval, - 1.71 (- 5.34 to 1.91), p = 0.35) and ASRM (- 1.36 (- 3.75 to 1.17), p = 0.29). However, scores on the CGI-S were significantly lower at week 3 in ebselen-treated participants (adjusted mean difference, - 0.58 (- 1.14 to - 0.03), p = 0.04). A post hoc analysis excluding patients taking concomitant valproate treatment magnified the difference between ebselen and placebo on the YMRS. Adverse events were comparable between groups, and mild. CONCLUSIONS Ebselen merits further investigation where concomitant psychotropic medication is better controlled and participants taking valproate are excluded. If effective, ebselen's superior tolerance and safety could make it a useful alternative to lithium. TRIAL REGISTRATION Trial Registry: www.clinicaltrials.gov , Identifier: NCT03013400.
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Affiliation(s)
- Ann L Sharpley
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Clare Williams
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Adele A Holder
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Beata R Godlewska
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nisha Singh
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Milensu Shanyinde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla MacDonald
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Lithium Prescribing and Therapeutic Drug Monitoring in Bipolar Disorder: A Survey of Current Practices and Perspectives. J Psychiatr Pract 2020; 26:360-366. [PMID: 32936583 DOI: 10.1097/pra.0000000000000493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The goal of this survey study was to assess specific aspects of lithium therapy for bipolar disorder, including psychiatrists' prescribing practices, understanding of therapeutic drug monitoring, and concerns and perspectives regarding lithium therapy. METHODS A 14-item survey was electronically distributed to 225 staff psychiatrists at 8 academic hospitals. RESULTS The survey was completed by 85 psychiatrists (38% of the 225 psychiatrists to whom the survey was distributed), with between 81 and 85 respondents completing the different items. When asked about the agents with which they initiated therapy, 49 (61%) reported initiating therapy with an atypical antipsychotic and 34 (42%) reported starting with lithium therapy in 50% or more of patients newly diagnosed with bipolar disorder. When prescribing lithium, most of the respondents (n=68, 82%) reported that they used once daily dosing, and 67 respondents (79%) indicated that they ordered lithium blood levels 12 hours postdose. When interpreting lithium levels, 46 respondents (55%) reported "always" changing a clinically stable patient's lithium dose when the level was above the therapeutic range, compared with 4 (5%) who reported always changing the dose when the level was below the therapeutic range. When asked about their concerns regarding lithium therapy, more than half of the respondents reported that they were especially concerned about toxicity, organ dysfunction, and other adverse effects, as well as therapeutic drug monitoring. CONCLUSION Shifts in prescribing practices, inconsistent interpretation of lithium levels, and concerns about safety and therapeutic drug monitoring highlight the need for evidence-informed guidelines reflective of current practice.
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15
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Scherf-Clavel M, Treiber S, Deckert J, Unterecker S, Hommers L. Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs. PHARMACOPSYCHIATRY 2020; 53:229-234. [PMID: 32340061 DOI: 10.1055/a-1157-9433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Lithium is the gold standard in treating bipolar affective disorders. As patients become increasingly older, drug-drug interactions leading to decreased excretion of lithium represent a key issue in lithium safety. As no study considered the effect of comedications on lithium serum concentration in combination, we aimed to quantify the impact of drugs affecting renal blood flow and function and thus potentially interacting drugs (diuretics, ACE inhibitors, AT1 antagonists, and non-steroidal anti-inflammatory drugs) on lithium serum levels in addition to age, sex, and sodium and potassium serum levels as well as renal function. METHODS Retrospective data of lithium serum levels were analyzed in 501 psychiatric inpatients (2008-2015) by means of linear regression modelling. RESULTS The number of potentially interacting drugs was significantly associated with increasing serum levels of lithium in addition to the established factors of age, renal function, and sodium concentration. Additionally, absolute lithium levels were dependent on sex, with higher values in females. However, only NSAIDs were identified to increase lithium levels independently. DISCUSSION Routine clinical practice needs to focus on drugs affecting renal blood flow and function, especially on NSAIDs as over-the-counter medication that may lead to an increase in lithium serum concentration. To prevent intoxications, clinicians should carefully monitor the comedications, and they should inform patients about possible intoxications due to NSAIDs.
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Affiliation(s)
- Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Susanne Treiber
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Leif Hommers
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Würzburg, Germany
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16
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17
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Scott J, Hidalgo-Mazzei D, Strawbridge R, Young A, Resche-Rigon M, Etain B, Andreassen OA, Bauer M, Bennabi D, Blamire AM, Boumezbeur F, Brambilla P, Cattane N, Cattaneo A, Chupin M, Coello K, Cointepas Y, Colom F, Cousins DA, Dubertret C, Duchesnay E, Ferro A, Garcia-Estela A, Goikolea J, Grigis A, Haffen E, Høegh MC, Jakobsen P, Kalman JL, Kessing LV, Klohn-Saghatolislam F, Lagerberg TV, Landén M, Lewitzka U, Lutticke A, Mazer N, Mazzelli M, Mora C, Muller T, Mur-Mila E, Oedegaard KJ, Oltedal L, Pålsson E, Papadopoulos Orfanos D, Papiol S, Perez-Sola V, Reif A, Ritter P, Rossi R, Schulze T, Senner F, Smith FE, Squarcina L, Steen NE, Thelwall PE, Varo C, Vieta E, Vinberg M, Wessa M, Westlye LT, Bellivier F. Prospective cohort study of early biosignatures of response to lithium in bipolar-I-disorders: overview of the H2020-funded R-LiNK initiative. Int J Bipolar Disord 2019; 7:20. [PMID: 31552554 PMCID: PMC6760458 DOI: 10.1186/s40345-019-0156-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/24/2019] [Indexed: 01/01/2023] Open
Abstract
Background Lithium is recommended as a first line treatment for bipolar disorders. However, only 30% of patients show an optimal outcome and variability in lithium response and tolerability is poorly understood. It remains difficult for clinicians to reliably predict which patients will benefit without recourse to a lengthy treatment trial. Greater precision in the early identification of individuals who are likely to respond to lithium is a significant unmet clinical need. Structure The H2020-funded Response to Lithium Network (R-LiNK; http://www.r-link.eu.com/) will undertake a prospective cohort study of over 300 individuals with bipolar-I-disorder who have agreed to commence a trial of lithium treatment following a recommendation by their treating clinician. The study aims to examine the early prediction of lithium response, non-response and tolerability by combining systematic clinical syndrome subtyping with examination of multi-modal biomarkers (or biosignatures), including omics, neuroimaging, and actigraphy, etc. Individuals will be followed up for 24 months and an independent panel will assess and classify each participants’ response to lithium according to predefined criteria that consider evidence of relapse, recurrence, remission, changes in illness activity or treatment failure (e.g. stopping lithium; new prescriptions of other mood stabilizers) and exposure to lithium. Novel elements of this study include the recruitment of a large, multinational, clinically representative sample specifically for the purpose of studying candidate biomarkers and biosignatures; the application of lithium-7 magnetic resonance imaging to explore the distribution of lithium in the brain; development of a digital phenotype (using actigraphy and ecological momentary assessment) to monitor daily variability in symptoms; and economic modelling of the cost-effectiveness of introducing biomarker tests for the customisation of lithium treatment into clinical practice. Also, study participants with sub-optimal medication adherence will be offered brief interventions (which can be delivered via a clinician or smartphone app) to enhance treatment engagement and to minimize confounding of lithium non-response with non-adherence. Conclusions The paper outlines the rationale, design and methodology of the first study being undertaken by the newly established R-LiNK collaboration and describes how the project may help to refine the clinical response phenotype and could translate into the personalization of lithium treatment. Electronic supplementary material The online version of this article (10.1186/s40345-019-0156-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Université Paris Diderot, 75013, Paris, France
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Rebecca Strawbridge
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Allan Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthieu Resche-Rigon
- Université Paris Diderot, 75013, Paris, France.,Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm, UMR 1153, Equipe ECSTRA, Paris, France
| | - Bruno Etain
- Université Paris Diderot, 75013, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, 75475, Paris, France.,Inserm, U1144, Team 1, 75006, Paris, France
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Djamila Bennabi
- Department of Clinical Psychiatry, Inserm CIC 1431, CHU Besançon, 25000, Besançon, France.,Laboratoire de Neurosciences, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Andrew M Blamire
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Fawzi Boumezbeur
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, TX, USA
| | - Nadia Cattane
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Annamaria Cattaneo
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Marie Chupin
- CATI Neuroimaging Platform, ICM, Pitié Salpétrière Hospital, 75013, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France.,Inserm, U1127, 75013, Paris, France.,CNRS, UMR 7225, 75013, Paris, France.,Sorbonne Université, 75013, Paris, France
| | - Klara Coello
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Yann Cointepas
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France.,CATI Neuroimaging Platform, ICM, Pitié Salpétrière Hospital, 75013, Paris, France
| | - Francesc Colom
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - David A Cousins
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, NE3 3XT, UK
| | - Caroline Dubertret
- Université Paris Diderot, 75013, Paris, France.,APHP; Psychiatry Department, University Hospital Louis Mourier, Colombes, France.,INSERM U894, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Edouard Duchesnay
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Aitana Garcia-Estela
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Goikolea
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Antoine Grigis
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, Inserm CIC 1431, CHU Besançon, 25000, Besançon, France.,Laboratoire de Neurosciences, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Margrethe C Høegh
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petter Jakobsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Farah Klohn-Saghatolislam
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Trine V Lagerberg
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Mikael Landén
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ashley Lutticke
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Mazer
- APHP; Psychiatry Department, University Hospital Louis Mourier, Colombes, France.,INSERM U894, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Monica Mazzelli
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Cristina Mora
- IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Thorsten Muller
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Estanislao Mur-Mila
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ketil Joachim Oedegaard
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Erik Pålsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Victor Perez-Sola
- Mental Health Research Program, IMIM, Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roberto Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Thomas Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Fiona E Smith
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nils Eiel Steen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pete E Thelwall
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Cristina Varo
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Michele Wessa
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University Mainz, Wallstraße 3, 55122, Mainz, Germany
| | - Lars T Westlye
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Frank Bellivier
- Université Paris Diderot, 75013, Paris, France. .,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, 75475, Paris, France. .,Inserm, U1144, Team 1, 75006, Paris, France.
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18
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Limandri BJ. Treatment-Resistant Depression: Identification and Treatment Strategies. J Psychosoc Nurs Ment Health Serv 2018; 56:11-15. [DOI: 10.3928/02793695-20180808-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Scott J, Etain B, Bellivier F. Can an Integrated Science Approach to Precision Medicine Research Improve Lithium Treatment in Bipolar Disorders? Front Psychiatry 2018; 9:360. [PMID: 30186186 PMCID: PMC6110814 DOI: 10.3389/fpsyt.2018.00360] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/19/2018] [Indexed: 12/20/2022] Open
Abstract
Clinical practice guidelines identify lithium as a first line treatment for mood stabilization and reduction of suicidality in bipolar disorders (BD); however, most individuals show sub-optimal response. Identifying biomarkers for lithium response could enable personalization of treatment and refine criteria for stratification of BD cases into treatment-relevant subgroups. Existing systematic reviews identify potential biomarkers of lithium response, but none directly address the conceptual issues that need to be addressed to enhance translation of research into precision prescribing of lithium. For example, although clinical syndrome subtyping of BD has not led to customized individual treatments, we emphasize the importance of assessing clinical response phenotypes in biomarker research. Also, we highlight the need to give greater consideration to the quality of prospective longitudinal monitoring of illness activity and the differentiation of non-response from partial or non-adherence with medication. It is unlikely that there is a single biomarker for lithium response or tolerability, so this review argues that more research should be directed toward the exploration of biosignatures. Importantly, we emphasize that an integrative science approach may improve the likelihood of discovering the optimal combination of clinical factors and multimodal biomarkers (e.g., blood omics, neuroimaging, and actigraphy derived-markers). This strategy could uncover a valid lithium response phenotype and facilitate development of a composite prediction algorithm. Lastly, this narrative review discusses how these strategies could improve eligibility criteria for lithium treatment in BD, and highlights barriers to translation to clinical practice including the often-overlooked issue of the cost-effectiveness of introducing biomarker tests in psychiatry.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Faculté de Médecine, Université Paris Diderot, Paris, France
| | - Bruno Etain
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Faculté de Médecine, Université Paris Diderot, Paris, France
- AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Paris, France
- INSERM, Unité UMR-S 1144, Variabilité de Réponse aux Psychotropes, Université Paris Descartes-Paris Diderot, Paris, France
- AP-HP, Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, Créteil, France
- INSERM, Unité 955, IMRB, Equipe de Psychiatrie Translationnelle, Créteil, France
| | - Frank Bellivier
- Faculté de Médecine, Université Paris Diderot, Paris, France
- AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Paris, France
- INSERM, Unité UMR-S 1144, Variabilité de Réponse aux Psychotropes, Université Paris Descartes-Paris Diderot, Paris, France
- AP-HP, Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, Créteil, France
- INSERM, Unité 955, IMRB, Equipe de Psychiatrie Translationnelle, Créteil, France
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20
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Nederlof M, Heerdink ER, Egberts ACG, Wilting I, Stoker LJ, Hoekstra R, Kupka RW. Monitoring of patients treated with lithium for bipolar disorder: an international survey. Int J Bipolar Disord 2018; 6:12. [PMID: 29654479 PMCID: PMC6161983 DOI: 10.1186/s40345-018-0120-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/27/2018] [Indexed: 02/08/2023] Open
Abstract
Background Adequate monitoring of patients using lithium is needed for optimal dosing and for early identification of patients with (potential) ADEs. The objective was to internationally assess how health care professionals monitor patients treated with lithium for bipolar disorder. Methods Using networks of various professional organizations, an anonymous online survey was conducted among health care professionals prescribing lithium. Target lithium serum levels and frequency of monitoring was assessed together with monitoring of physical and laboratory parameters. Reasons to and not to monitor and use of guidelines and institutional protocols, and local monitoring systems were investigated. Results The survey was completed by 117 health care professionals incorporating responses from twenty-four countries. All prescribers reported to monitor lithium serum levels on a regular basis, with varying target ranges. Almost all (> 97%) monitored thyroid and renal function before start and during maintenance treatment. Reported monitoring of other laboratory and physical parameters was variable. The majority of respondents (74%) used guidelines or institutional protocols for monitoring. In general, the prescriber was responsible for monitoring, had to request every monitoring parameter separately and only a minority of patients was automatically invited. Conclusions Lithium serum levels, renal and thyroid function were monitored by (almost) all physicians. However, there was considerable variation in other monitoring parameters. Our results help to understand why prescribers of lithium monitor patients and what their main reasons are not to monitor patients using lithium. Electronic supplementary material The online version of this article (10.1186/s40345-018-0120-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Nederlof
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508 TB, Utrecht, The Netherlands.,Brocacef Ziekenhuisfarmacie, 3600 AB, Maarssen, The Netherlands
| | - E R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508 TB, Utrecht, The Netherlands. .,Research Group Innovation of Pharmaceutical Care, University of Applied Sciences Utrecht, 3508 AD, Utrecht, The Netherlands. .,Department of Clinical Pharmacy, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
| | - A C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508 TB, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands
| | - I Wilting
- Department of Clinical Pharmacy, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands
| | - L J Stoker
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508 TB, Utrecht, The Netherlands
| | - R Hoekstra
- Antes, Delta Psychiatric Center, 3709 DZ, Rotterdam, The Netherlands
| | - R W Kupka
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands
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21
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Gitlin M. Lithium: Classic? Yes; First line? … Only sometimes. Aust N Z J Psychiatry 2017; 51:938-939. [PMID: 28194996 DOI: 10.1177/0004867417692884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Gitlin
- Department of Psychiatry, Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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