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Shakoor N, Adeel M, Ahmad MA, Zain M, Waheed U, Javaid RA, Haider FU, Azeem I, Zhou P, Li Y, Jilani G, Xu M, Rinklebe J, Rui Y. Reimagining safe lithium applications in the living environment and its impacts on human, animal, and plant system. ENVIRONMENTAL SCIENCE AND ECOTECHNOLOGY 2023; 15:100252. [PMID: 36891261 PMCID: PMC9988428 DOI: 10.1016/j.ese.2023.100252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Lithium's (Li) ubiquitous distribution in the environment is a rising concern due to its rapid proliferation in the modern electronic industry. Li enigmatic entry into the terrestrial food chain raises many questions and uncertainties that may pose a grave threat to living biota. We examined the leverage existing published articles regarding advances in global Li resources, interplay with plants, and possible involvement with living organisms, especially humans and animals. Globally, Li concentration (<10-300 mg kg-1) is detected in agricultural soil, and their pollutant levels vary with space and time. High mobility of Li results in higher accumulation in plants, but the clear mechanisms and specific functions remain unknown. Our assessment reveals the causal relationship between Li level and biota health. For example, lower Li intake (<0.6 mM in serum) leads to mental disorders, while higher intake (>1.5 mM in serum) induces thyroid, stomach, kidney, and reproductive system dysfunctions in humans and animals. However, there is a serious knowledge gap regarding Li regulatory standards in environmental compartments, and mechanistic approaches to unveil its consequences are needed. Furthermore, aggressive efforts are required to define optimum levels of Li for the normal functioning of animals, plants, and humans. This review is designed to revitalize the current status of Li research and identify the key knowledge gaps to fight back against the mountainous challenges of Li during the recent digital revolution. Additionally, we propose pathways to overcome Li problems and develop a strategy for effective, safe, and acceptable applications.
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Affiliation(s)
- Noman Shakoor
- Beijing Key Laboratory of Farmland Soil Pollution Prevention and Remediation and College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
| | - Muhammad Adeel
- BNU-HKUST Laboratory of Green Innovation, Advanced Institute of Natural Sciences, Beijing Normal University at Zhuhai, 18 Jinfeng Road, Tangjiawan, Zhuhai, Guangdong, China
| | - Muhammad Arslan Ahmad
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen, 518060, China
| | - Muhammad Zain
- Department of Botany, University of Lakki Marwat, KP, 28420, Pakistan
| | - Usman Waheed
- Department of Pathobiology, University of Veterinary & Animal Sciences, Jhang-campus, Lahore, 54000, Pakistan
| | - Rana Arsalan Javaid
- Crop Science Institute, National Agriculture Research Center, Islamabad, Pakistan
| | - Fasih Ullah Haider
- Key Laboratory of Vegetation Restoration and Management of Degraded Ecosystems, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China
| | - Imran Azeem
- Beijing Key Laboratory of Farmland Soil Pollution Prevention and Remediation and College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
| | - Pingfan Zhou
- Beijing Key Laboratory of Farmland Soil Pollution Prevention and Remediation and College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
| | - Yuanbo Li
- Beijing Key Laboratory of Farmland Soil Pollution Prevention and Remediation and College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
| | - Ghulam Jilani
- Institute of Soil Science, PMAS Arid Agriculture University, Rawalpindi, 46300, Pakistan
| | - Ming Xu
- BNU-HKUST Laboratory of Green Innovation, Advanced Institute of Natural Sciences, Beijing Normal University at Zhuhai, 18 Jinfeng Road, Tangjiawan, Zhuhai, Guangdong, China
| | - Jörg Rinklebe
- University of Wuppertal, School of Architecture and Civil Engineering, Institute of Foundation Engineering, Water- and Waste Management, Laboratory of Soil- and Groundwater-Management, Pauluskirchstraße 7, 42285, Germany
| | - Yukui Rui
- Beijing Key Laboratory of Farmland Soil Pollution Prevention and Remediation and College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
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Methaneethorn J, Mannie Z, Bell E, Malhi GS. Lithium replacement dose recommendations using Monte Carlo simulations. Bipolar Disord 2022; 24:739-748. [PMID: 35766143 DOI: 10.1111/bdi.13241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Missed medication doses are a common clinical problem, and cause consternation when prescribing lithium because its plasma levels must be kept within a narrow therapeutic window. Therefore, this study set out to determine the potential impact of missed lithium doses on its pharmacokinetics, and to explore the optimal compensatory dosing scheme. This is difficult to determine clinically and in research because of ethical constraints and therefore we modelled the effects using simulations. METHODS Monte Carlo simulations were used to simulate lithium concentrations under different missed dose scenarios. For patients with normal renal function, the optimal replacement dosing scheme was selected based on the lowest percentage of deviation from the full adherence scenario. However, for patients with renal impairment the appropriate dosing schedule was selected based on the lowest number of simulated concentrations above the upper range of 1.2 mEq/L. RESULTS The impact of a missed lithium dose depended on its daily dose. The higher the daily dose, the higher the deviation from full adherence. In patients with normal renal function, replacement with a regular dose was most appropriate. But in patients with renal impairment, replacement with a partial dose appeared to be most suitable. CONCLUSIONS This study has enabled insights into the optimal suitable lithium replacement dosing schemes for patients with normal renal function and renal impairment. These proposed schemes can be used cautiously in clinical practice in conjunction with clinician judgment and can also be used as a basis for future clinical research.
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Affiliation(s)
- Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| | - Zola Mannie
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic and Mood-T Service, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia.,Royal North Shore Hospital, NSW Health, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Erica Bell
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic and Mood-T Service, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Gin S Malhi
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic and Mood-T Service, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK
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Bojja SL, Singh N, Kolathur KK, Rao CM. What is the Role of Lithium in Epilepsy? Curr Neuropharmacol 2022; 20:1850-1864. [PMID: 35410603 PMCID: PMC9886805 DOI: 10.2174/1570159x20666220411081728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 11/22/2022] Open
Abstract
Lithium is a well-known FDA-approved treatment for bipolar and mood disorders. Lithium has been an enigmatic drug with multifaceted actions involving various neurotransmitters and intricate cell signalling cascades. Recent studies highlight the neuroprotective and neurotrophic actions of lithium in amyotrophic lateral sclerosis, Alzheimer's disease, intracerebral hemorrhage, and epilepsy. Of note, lithium holds a significant interest in epilepsy, where the past reports expose its non-specific proconvulsant action, followed lately by numerous studies for anti-convulsant action. However, the exact mechanism of action of lithium for any of its effects is still largely unknown. The present review integrates findings from several reports and provides detailed possible mechanisms of how a single molecule exhibits marked pro-epileptogenic as well as anti-convulsant action. This review also provides clarity regarding the safety of lithium therapy in epileptic patients.
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Affiliation(s)
| | | | | | - Chamallamudi Mallikarjuna Rao
- Address correspondence to this author at the Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India; E-mails: ,
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Kakhki S, Ahmadi-Soleimani SM. Experimental data on lithium salts: From neuroprotection to multi-organ complications. Life Sci 2022; 306:120811. [PMID: 35850248 DOI: 10.1016/j.lfs.2022.120811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
Lithium-salts stand on the first line of therapy for the management of specific psychiatric conditions, mainly bipolar mood disorder. It is also known to protect the brain against neurodegenerative processes such as Alzheimer's disease. Despite the mentioned merits, recent studies have revealed that high dose or prolonged lithium intake deteriorate the function of multiple key organs including heart, ovaries, thyroid gland and kidneys. Mechanistically, both positive and negative effects of lithium are mediated through methylation of β-catenin nuclear-binding proteins which is potentiated by lithium-induced inhibition of GSK-3 or inositol monophosphatase. The current study briefly reviews the recent experimental data on lithium therapy considering both positive (i.e., neuroprotective) and negative aspects. In this regard, the question is that whether doses of lithium administered in experimental research are comparable with the therapeutic doses, as currently prescribed in clinical practice. It should be noted that the experimental data on animal studies, as widely reviewed here, could not be directly generalized to clinic. This is mainly because lithium doses applied in animal models are usually higher than therapeutic doses, however, there are evidence indicating that even animal to human translated doses of lithium, cause serious complications and this has been reported by meta-analyses on human studies. Therefore, we suggest the clinicians to use lithium-salts with precaution particularly in pregnancy and precisely adjust lithium concentration considering the patient's general health status to avoid lithium toxicity. Indeed, alternative approaches are recommended when the subject is pregnant, prolonged therapy is required or specific organ dysfunction is diagnosed.
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Affiliation(s)
- Samaneh Kakhki
- Department of Clinical Biochemistry, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - S Mohammad Ahmadi-Soleimani
- Department of Physiology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Neuroscience Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
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Lithium and Atypical Antipsychotics: The Possible WNT/β Pathway Target in Glaucoma. Biomedicines 2021; 9:biomedicines9050473. [PMID: 33925885 PMCID: PMC8146329 DOI: 10.3390/biomedicines9050473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022] Open
Abstract
Glaucoma is a progressive neurodegenerative disease that represents the major cause of irreversible blindness. Recent findings have shown which oxidative stress, inflammation, and glutamatergic pathway have main roles in the causes of glaucoma. Lithium is the major commonly used drug for the therapy of chronic mental illness. Lithium therapeutic mechanisms remain complex, including several pathways and gene expression, such as neurotransmitter and receptors, circadian modulation, ion transport, and signal transduction processes. Recent studies have shown that the benefits of lithium extend beyond just the therapy of mood. Neuroprotection against excitotoxicity or brain damages are other actions of lithium. Moreover, recent findings have investigated the role of lithium in glaucoma. The combination of lithium and atypical antipsychotics (AAPs) has been the main common choice for the treatment of bipolar disorder. Due to the possible side effects gradually introduced in therapy. Currently, no studies have focused on the possible actions of AAPs in glaucoma. Recent studies have shown a down regulation of the WNT/β-catenin pathway in glaucoma, associated with the overactivation of the GSK-3β signaling. The WNT/β-catenin pathway is mainly associated with oxidative stress, inflammation and glutamatergic pathway. Lithium is correlated with upregulation the WNT/β-catenin pathway and downregulation of the GSK-3β activity. Thus, this review focuses on the possible actions of lithium and AAPs, as possible therapeutic strategies, on glaucoma and some of the presumed mechanisms by which these drugs provide their possible benefit properties through the WNT/β-catenin pathway.
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6
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Vallée A, Vallée JN, Lecarpentier Y. Lithium: a potential therapeutic strategy in obsessive-compulsive disorder by targeting the canonical WNT/β pathway. Transl Psychiatry 2021; 11:204. [PMID: 33828076 PMCID: PMC8027628 DOI: 10.1038/s41398-021-01329-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized b-y recurrent and distinctive obsessions and/or compulsions. The etiologies remain unclear. Recent findings have shown that oxidative stress, inflammation, and the glutamatergic pathway play key roles in the causes of OCD. However, first-line therapies include cognitive-behavioral therapy but only 40% of the patients respond to this first-line therapy. Research for a new treatment is mandatory. This review focuses on the potential effects of lithium, as a potential therapeutic strategy, on OCD and some of the presumed mechanisms by which lithium provides its benefit properties. Lithium medication downregulates GSK-3β, the main inhibitor of the WNT/β-catenin pathway. The activation of the WNT/β-catenin could be associated with the control of oxidative stress, inflammation, and glutamatergic pathway. Future prospective clinical trials could focus on lithium and its different and multiple interactions in OCD.
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Affiliation(s)
- Alexandre Vallée
- Department of Clinical Research and Innovation (DRCI), Foch Hospital, 92150, Suresnes, France.
| | - Jean-Noël Vallée
- Centre Hospitalier Universitaire (CHU) Amiens Picardie, Université Picardie Jules Verne, 80054, Amiens, France
| | - Yves Lecarpentier
- Centre de Recherche Clinique, Grand Hôpital de l'Est Francilien (GHEF), 77100, Meaux, France
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Priebe GA, Kanzawa MM. Reducing the progression of Alzheimer's disease in Down syndrome patients with micro-dose lithium. Med Hypotheses 2020; 137:109573. [PMID: 31986471 DOI: 10.1016/j.mehy.2020.109573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/28/2019] [Accepted: 01/15/2020] [Indexed: 11/29/2022]
Abstract
Alzheimer's disease (AD) is a pervasive and progressive neurodegenerative disorder characterized by a gradual decline in memory, leading to significant impairments in cognition, language, and social functioning. An early-onset variant of the disease is a substantial source of morbidity in individuals with trisomy 21, the main cause of Down syndrome (DS), with clinical evidence of the disease seen in roughly one-half of those 50 years and older. Current pharmacologic therapies are limited to a handful of medications that offer only modest improvement in cognition and overall functioning. There is growing consensus in the literature that lithium salts, well-established as efficacious in the treatment of select affective disorders, may also provide neuroprotection from the development and progression of AD by targeting multiple processes implicated in the disease. These include beta-amyloid production, tau hyperphosphorylation, mitochondrial dysfunction, oxidative stress, and neuroinflammation. While complex, inhibition of glycogen synthase kinase 3 (GSK-3) appears to be the primary mechanism by which lithium exerts its disease-modifying effects. Reduced rates of dementia have been described in bipolar patients chronically treated with lithium. Additionally, "micro-dose" lithium (300 µg daily in one study) demonstrated stabilization of cognitive decline in AD patients with mild cognitive impairment. With encouraging data suggesting that lithium confers a clinically significant benefit in AD by impeding accumulation of the aberrant proteins central to the putative pathogenesis, it follows to reason that a population with a genetic predisposition rooted in this disease mechanism may benefit from it. After a thorough review of the literature and currently active clinical trials, no studies have looked at using lithium to slow or prevent the development of Alzheimer's disease in the Down syndrome population. Because those with DS have such reliably high rates of developing AD, many 20-30 years younger than those in the general population, they represent an exemplary subject population to investigate the effect that lithium has on progression to disease. Furthermore, the specific factors that make those with Down syndrome prone to developing AD, including enhanced ability to synthesize beta-amyloid, mitochondrial dysfunction, and elevated oxidative stress, correlate quite well with the model by which lithium is thought to disrupt Alzheimer's pathogenesis, making the DS population ideally suited to study this intervention. Demonstrating reduced progression of Alzheimer's pathology with micro-dose lithium in those with trisomy 21 could function to reinforce our current understanding of the pathogenetic mechanism underlying early-onset AD, and ultimately, establish a preventative treatment for the disease.
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Affiliation(s)
- Garrick A Priebe
- Department of Psychiatry, Homer Stryker M.D. School of Medicine, Western Michigan University, 1717 Shaffer St., Suite 010, Kalamazoo, MI 49048-1623, United States.
| | - Mark M Kanzawa
- Department of Psychiatry, Homer Stryker M.D. School of Medicine, Western Michigan University, 1717 Shaffer St., Suite 010, Kalamazoo, MI 49048-1623, United States
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Chang CWL, Ho CSH. Lithium Use in a Patient With Bipolar Disorder and End-Stage Kidney Disease on Hemodialysis: A Case Report. Front Psychiatry 2020; 11:6. [PMID: 32116831 PMCID: PMC7008228 DOI: 10.3389/fpsyt.2020.00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Lithium has been implicated in causing chronic tubulointerstitial nephritis and decline in renal function. However, lithium still plays a role in stabilizing patients with bipolar disorder. We illustrated a case of a bipolar I disorder patient approaching end-stage kidney disease (ESKD) with other medical comorbidities. As her mental state was affecting her compliance with medical treatment, she was mentally and medically unwell. Our patient was hospitalized on two separate occasions, for 5 and 4 months respectively, and failed adequate trials of different psychotropics due to inefficacy or intolerable side effects. A decision was made between the psychiatrist, nephrologist, and cardiologist to use lithium with hemodialysis support, with good treatment response and improved mental state. This case has shown that lithium carbonate can still be prescribed in ESKD patients on hemodialysis. Daily monitoring of lithium levels in the initial phase of lithium and hemodialysis commencement for at least 2 weeks is imperative, reducing to three times per week pre-hemodialysis towards the end of discharge after three consecutive daily serum lithium levels have stabilized. Clinicians can also consider a target serum level of less than 0.6 mEq/L in maintenance treatment for bipolar disorder in patients on hemodialysis.
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Affiliation(s)
- Cheryl W L Chang
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore.,National Psychiatry Residency Programme, National Healthcare Group, Singapore, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
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Kugimiya T, Kohno K, Ishii N, Terao T. Case of drug eruption during treatment with lithium and lamotrigine implicating a possible role of additives in the lithium tablet. Psychiatry Clin Neurosci 2019; 73:285. [PMID: 30821018 PMCID: PMC6850374 DOI: 10.1111/pcn.12834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Tsuyoshi Kugimiya
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Kentaro Kohno
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Nobuyoshi Ishii
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
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A Review of the Pharmacological and Clinical Profile of Newer Atypical Antipsychotics as Treatments for Bipolar Disorder: Considerations for Use in Older Patients. Drugs Aging 2018; 35:887-895. [PMID: 30187288 DOI: 10.1007/s40266-018-0579-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bipolar disorder prevalence rates vary in the older adult population (defined as age ≥ 65 years), ranging from 1% in community dwellers to as high as 8-10% in hospital inpatients. Although older agents, including lithium and valproic acid, offer significant antimanic efficacy, as supported by a recent randomized controlled trial (RCT), there is growing interest in using atypical antipsychotics to treat bipolar disorder in older adults. Newer atypical antipsychotics are of interest based on their tolerability and efficacy in the general adult bipolar population. The aim of this review was to systematically examine efficacy and tolerability of newer atypical antipsychotics for older adult bipolar disorder (OABD). We conducted a systematic search utilizing the MEDLINE, EMBASE, PsycINFO and Cochrane Library electronic databases, with the aim of identifying all RCTs comparing newer atypical antipsychotics approved by the US FDA since 2002 (including brexpiprazole, cariprazine, lurasidone, iloperidone, asenapine, paliperidone, and aripiprazole) with placebo or another comparator, in the treatment of any phase of bipolar disorder (including mania, depression or mixed episodes while used as an acute or maintenance treatment) in older adults (> 65 years). We found no RCT data on any of the examined agents. Hence, we changed our search criteria to include studies with a lower age cut-off (≥ 55 years), as well as the inclusion of post hoc studies. Two post hoc studies on lurasidone suggest its reasonable safety and efficacy profile in the acute and maintenance treatment of OABD; however, there are no pharmacoeconomic data on the use of lurasidone in the treatment of OABD. Research data from open-label studies on oral asenapine and aripiprazole as add-on therapy suggest that these two agents are adequately tolerated and improved symptoms of depression and mania in OABD; hence, there is an urgent need to conduct RCTs on these two agents. Lastly, we found no studies for the treatment of OABD with brexpiprazole, cariprazine, iloperidone, or paliperidone.
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McCudden CR. Quality, origins and limitations of common therapeutic drug reference intervals. ACTA ACUST UNITED AC 2018; 5:47-61. [PMID: 29794249 DOI: 10.1515/dx-2018-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022]
Abstract
Therapeutic drug monitoring (TDM) is used to manage drugs with a narrow window between effective and toxic concentrations. TDM involves measuring blood concentrations of drugs to ensure effective therapy, avoid toxicity and monitor compliance. Common drugs for which TDM is used include aminoglycosides for infections, anticonvulsants to treat seizures, immunosuppressants for transplant patients and cardiac glycosides to regulate cardiac output and heart rate. An essential element of TDM is the provision of accurate and clinically relevant reference intervals. Unlike most laboratory reference intervals, which are derived from a healthy population, TDM reference intervals need to relate to clinical outcomes in the form of efficacy and toxicity. This makes TDM inherently more difficult to develop as healthy individuals are not on therapy, so there is no "normal value". In addition, many of the aforementioned drugs are old and much of the information regarding reference intervals is based on small trials using methods that have changed. Furthermore, individuals have different pharmacokinetics and drug responses, particularly in the context of combined therapies, which exacerbates the challenge of universal TDM targets. This focused review examines the origins and limitations of existing TDM reference intervals for common drugs, providing targets where possible based on available guidelines.
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Affiliation(s)
- Christopher R McCudden
- Department of Pathology and Laboratory Medicine, Division of Biochemistry, University of Ottawa, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada
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Abstract
BACKGROUND AND OBJECTIVES Even though lithium has been used for the treatment of bipolar disorder for several decades, its toxicities are still being reported. The major limitation in the use of lithium is its narrow therapeutic window. Several methods have been proposed to predict lithium doses essential to attain therapeutic levels. One of the methods used to guide lithium therapy is population pharmacokinetic approach which accounts for inter- and intra-individual variability in predicting lithium doses. Several population pharmacokinetic studies of lithium have been conducted. The objective of this review is to provide information on population pharmacokinetics of lithium focusing on nonlinear mixed effect modeling approach and to summarize significant factors affecting lithium pharmacokinetics. METHODS A literature search was conducted from PubMed database from inception to December, 2016. Studies conducted in humans, using lithium as a study drug, providing population pharmacokinetic analyses of lithium by means of nonlinear mixed effect modeling, were included in this review. RESULTS Twenty-four articles were identified from the database. Seventeen articles were excluded based on the inclusion and exclusion criteria. A total of seven articles were included in this review. Of these, only one study reported a combined population pharmacokinetic-pharmacodynamic model of lithium. Lithium pharmacokinetics were explained using both one- and two-compartment models. The significant predictors of lithium clearance identified in most studies were renal function and body size. One study reported a significant effect of age on lithium clearance. The typical values of lithium clearance ranged from 0.41 to 9.39 L/h. The magnitude of inter-individual variability on lithium clearance ranged from 12.7 to 25.1%. Only two studies evaluated the models using external data sets. CONCLUSIONS Model methodologies in each study are summarized and discussed in this review. For future perspective, a population pharmacokinetic-pharmacodynamic study of lithium is recommended. Moreover, external validation of previously published models should be performed.
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Suwansaksri N, Preechasuk L, Kunavisarut T. Nonthionamide Drugs for the Treatment of Hyperthyroidism: From Present to Future. Int J Endocrinol 2018; 2018:5794054. [PMID: 29849619 PMCID: PMC5937426 DOI: 10.1155/2018/5794054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/11/2018] [Indexed: 12/20/2022] Open
Abstract
Hyperthyroidism is a common endocrine disease. Although thionamide antithyroid drugs are the cornerstone of hyperthyroidism treatment, some patients cannot tolerate this drug class because of its serious side effects including agranulocytosis, hepatotoxicity, and vasculitis. Therefore, nonthionamide antithyroid drugs (NTADs) still have an important role in controlling hyperthyroidism in clinical practice. Furthermore, some situations such as thyroid storm or preoperative preparation require a rapid decrease in thyroid hormone by combination treatment with multiple classes of antithyroid drugs. NTADs include iodine-containing compounds, lithium carbonate, perchlorate, glucocorticoid, and cholestyramine. In this narrative review, we summarize the mechanisms of action, indications, dosages, and side effects of currently used NTADs for the treatment of hyperthyroidism. In addition, we also describe the state-of-the-art in future drugs under development including rituximab, small-molecule ligands (SMLs), and monoclonal antibodies with a thyroid-stimulating hormone receptor (TSHR) antagonist effect.
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Affiliation(s)
| | - Lukana Preechasuk
- Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tada Kunavisarut
- Division of Endocrine and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Mezni A, Aoua H, Khazri O, Limam F, Aouani E. Lithium induced oxidative damage and inflammation in the rat's heart: Protective effect of grape seed and skin extract. Biomed Pharmacother 2017; 95:1103-1111. [PMID: 28922729 DOI: 10.1016/j.biopha.2017.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/15/2022] Open
Abstract
Lithium (Li) is a relevant mood stabilizer metal for the treatment of bipolar disorder (BD), as it protects from both depression and mania and reduces the risk of suicide. However, Lihas some clinical concerns as a narrow therapeutic index requiring routine monitoring of the serum level. The present study was designed to analyze the cardio-toxic side effect of Li and the ability of grape seed and skin extract (GSSE) to protect the heart against such toxicity. After 30days of exposure to Li (0, 2, 5 and 100mg/kg bw) and prevention with GSSE (4000mg/kg bw), rats were killed by decapitation and their heart processed for Li-induced oxidative stress. Data mainly showed that Li increased lipoperoxidation and protein carbonylation, it decreased superoxide dismutase and glutathione peroxidase activities, altered acetylcholinesterase (AChE) activity and increased the pro-inflammatory cytokine interleukin 6 (IL-6). Interestingly, GSSE efficiently alleviated all the deleterious effects of Li especially in low therapeutic doses. Based on our results, GSSE could be proposed as a nutritional supplement to mitigate the cardiotoxic side effects of lithium.
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Affiliation(s)
- Ali Mezni
- Laboratoire des Substances Bioactives (LSBA), Centre de Biotechnologie de BorjCedria, BP-901, 2050 Hammam-Lif, Tunisie; Université de Carthage, Faculté des Sciences de Bizerte, 7021 Jarzouna, Tunisie.
| | - Hanène Aoua
- Laboratoire des Substances Bioactives (LSBA), Centre de Biotechnologie de BorjCedria, BP-901, 2050 Hammam-Lif, Tunisie; Université de Carthage, Faculté des Sciences de Bizerte, 7021 Jarzouna, Tunisie
| | - Olfa Khazri
- Laboratoire des Substances Bioactives (LSBA), Centre de Biotechnologie de BorjCedria, BP-901, 2050 Hammam-Lif, Tunisie; Université de Carthage, Faculté des Sciences de Bizerte, 7021 Jarzouna, Tunisie
| | - Ferid Limam
- Laboratoire des Substances Bioactives (LSBA), Centre de Biotechnologie de BorjCedria, BP-901, 2050 Hammam-Lif, Tunisie
| | - Ezzeddine Aouani
- Laboratoire des Substances Bioactives (LSBA), Centre de Biotechnologie de BorjCedria, BP-901, 2050 Hammam-Lif, Tunisie; Université de Carthage, Faculté des Sciences de Bizerte, 7021 Jarzouna, Tunisie
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15
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Fernandes de Lima VM, Hanke W. Extracellular matrix and its role in conveying glial/neural interactions in health and disease. J Integr Neurosci 2017; 16:93-106. [DOI: 10.3233/jin-170012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Vera Maura Fernandes de Lima
- Centro de Biotecnologia, CNEN-IPEN/SP, Av. Lineu Prestes 2242, Campus USP, São Paulo, SP, Brazil, 05508-000
- LIM-26 Faculdade de Medicina da USP-SP, São Paulo, Brazil
| | - Wolfgang Hanke
- Membrane Physiology Division, Institute of Physiology 230, Hohenheim University, Stuttgart, Germany
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Ummar S, Dorai BL, Ramanathan SA. Distressing cutaneous lesion among bipolar affective disorder patients on lithium therapy: A retrospective cross-sectional study. Indian J Psychiatry 2016; 58:383-386. [PMID: 28196994 PMCID: PMC5270262 DOI: 10.4103/0019-5545.196708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To assess the incidence of cutaneous lesion in bipolar affective disorder (BPAD) patients on lithium therapy. To evaluate the relationship between duration of lithium therapy, dosage of lithium, serum lithium level, and cutaneous lesions. To assess whether reduction/stoppage of dose of lithium has any change in the course of cutaneous side effects. To look for a relationship between addition of isotretinoin and the course of mood disorder. METHODOLOGY We retrospectively collected hospital case records of 125 consecutive BPAD patients initiated lithium therapy, assessed with inclusion and exclusion criteria. We follow up them for 2½ years for the assessment of above said aims. RESULTS The prevalence of skin reaction in BPAD patients with lithium therapy was 19.8%. Among patients on lithium therapy, cutaneous lesion emerged in initial 6 months and later after 1 year of treatment. Nearly 55% of patients on higher doses of lithium (1200 mg) had a cutaneous lesion. Patient on therapeutic serum level of lithium had a higher incidence of skin lesion. Out of six patients in whom dosage of lithium was reduced, three of them had reduced lesions (P = 0.6), in two patients, skin lesion increased, and one patient had no change. Among 11 patients treated with isotretinoin, only two patients had emergence of depressive symptoms. CONCLUSION Lithium continues to increase the incidence of multiple cutaneous lesions among BPAD patients on lithium therapy. Incidence of cutaneous side effects directly correlates with the dose of lithium and therapeutic range of serum lithium level. Altering the dose of lithium does not statistically influence the cutaneous lesion.
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Affiliation(s)
- Syed Ummar
- Department of Psychiatry, PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu, India
| | - B Lakshmi Dorai
- Department of Psychiatry, Vinayaga Mission's Kirupananda Variyar Medical College, Salem, Tamil Nadu, India
| | - Shree Aarthi Ramanathan
- Department of Psychiatry, PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu, India
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Salimi A, Gholamifar E, Naserzadeh P, Hosseini MJ, Pourahmad J. Toxicity of lithium on isolated heart mitochondria and cardiomyocyte: A justification for its cardiotoxic adverse effect. J Biochem Mol Toxicol 2016; 31. [PMID: 27588890 DOI: 10.1002/jbt.21836] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/24/2016] [Accepted: 08/10/2016] [Indexed: 11/12/2022]
Abstract
Mitochondria play an important role in myocardial tissue homeostasis; therefore, deterioration in mitochondrial function will eventually lead to cardiomyocyte and endothelial cell death and consequently cardiovascular dysfunction. Lithium (Li+ ) is an effective drug for bipolar disorder with known cardiotoxic side effects. This study was designed to investigate the effects of Li+ on mitochondria and cardiomyocytes isolated from the heart of Wistar rat. Results revealed that Li+ induced a concentration- and time-dependent rise in mitochondrial ROS formation, inhibition of respiratory complexes (II), mitochondrial membrane potential (MMP) collapse, mitochondrial swelling, and cytochrome c release in rat heart mitochondria and also induced Caspase 3 activation through mitochondrial pathway, decline of ATP and lipid peroxidation in rat cardiomyocytes. These results indicate that the cardiotoxic effects of Li+ were initiated from mitochondrial dysfunction and oxidative stress, which finally ends in cytochrome c release and cell death signaling heart cardiomyocytes.
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Affiliation(s)
- Ahmad Salimi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Students Research Committee, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Science, Ardabil, Iran
| | - Ehsan Gholamifar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Naserzadeh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Science, Ardabil, Iran
| | - Mir-Jamal Hosseini
- Zanjan Applied Pharmacology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Jalal Pourahmad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gong R, Wang P, Dworkin L. What we need to know about the effect of lithium on the kidney. Am J Physiol Renal Physiol 2016; 311:F1168-F1171. [PMID: 27122541 DOI: 10.1152/ajprenal.00145.2016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/21/2016] [Indexed: 02/03/2023] Open
Abstract
Lithium has been a valuable treatment for bipolar affective disorders for decades. Clinical use of lithium, however, has been problematic due to its narrow therapeutic index and concerns for its toxicity in various organ systems. Renal side effects associated with lithium include polyuria, nephrogenic diabetes insipidus, proteinuria, distal renal tubular acidosis, and reduction in glomerular filtration rate. Histologically, chronic lithium nephrotoxicity is characterized by interstitial nephritis with microcyst formation and occasional focal segmental glomerulosclerosis. Nevertheless, this type of toxicity is uncommon, with the strongest risk factors being high serum levels of lithium and longer time on lithium therapy. In contrast, in experimental models of acute kidney injury and glomerular disease, lithium has antiproteinuric, kidney protective, and reparative effects. This paradox may be partially explained by lower lithium doses and short duration of therapy. While long-term exposure to higher psychiatric doses of lithium may be nephrotoxic, short-term low dose of lithium may be beneficial and ameliorate kidney and podocyte injury. Mechanistically, lithium targets glycogen synthase kinase-3β, a ubiquitously expressed serine/threonine protein kinase implicated in the processes of tissue injury, repair, and regeneration in multiple organ systems, including the kidney. Future studies are warranted to discover the exact "kidney-protective dose" of lithium and test the effects of low-dose lithium on acute and chronic kidney disease in humans.
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Affiliation(s)
- Rujun Gong
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island; and
| | - Pei Wang
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island; and.,Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lance Dworkin
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island; and
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Ware K, Tillery E, Linder L. General pharmacokinetic/pharmacodynamic concepts of mood stabilizers in the treatment of bipolar disorder. Ment Health Clin 2016; 6:54-61. [PMID: 29955448 PMCID: PMC6009247 DOI: 10.9740/mhc.2016.01.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Mood stabilizers are the recommended treatment for patients who receive a diagnosis of bipolar disorder. Because of the necessity of mood stabilizer treatment in patients with bipolar disorder and the extent of pharmacokinetic and pharmacodynamic principles involved, the purpose of this review is to summarize the pharmacokinetic principles of lithium in addition to the pharmacodynamics of lithium, carbamazepine, lamotrigine, and valproic acid/valproate. Methods: Practice guidelines, review articles, and clinical trials were located using online databases PubMed, CINAHL, IDIS, and Medline. Search terms included at least one of the following: bipolar disorder, carbamazepine, lamotrigine, lithium, mood stabilizers, pharmacokinetics, pharmacodynamics, valproate, and valproic acid. Online clinical databases Dynamed® and Lexicomp® were also used in the study. Results: Mood stabilizers collectively possess distinct qualities that are closely regarded before, during, and after therapeutic initiation. Individual patient characteristics, coupled with these observed traits, add to the complexity of selecting the most optimal neurologic agent. Each medication discussed uniquely contributes to both the maintenance and restoration of overall patient well-being. Discussion: Introduction of mood stabilizers into drug regimens is often done in the presence of an array of mitigating factors. Safety and efficacy measures are commonly used to gauge desired results. Careful monitoring of patients' responses to selected therapies is paramount for arriving at appropriate clinical outcomes.
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Affiliation(s)
- Kenric Ware
- Assistant Professor of Pharmacy Practice, South University School of Pharmacy, Columbia, South Carolina,
| | - Erika Tillery
- Assistant Professor of Pharmacy Practice and Clinical Pharmacist, South University School of Pharmacy, Columbia, South Carolina
| | - Lauren Linder
- PGY-1 Pharmacy Practice Resident, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana
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Shah VC, Kayathi P, Singh G, Lippmann S. Enhance Your Understanding of Lithium Neurotoxicity. Prim Care Companion CNS Disord 2015; 17:14l01767. [PMID: 26644952 DOI: 10.4088/pcc.14l01767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Vivek C Shah
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky
| | - Pramod Kayathi
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky
| | - Gurpreet Singh
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky
| | - Steven Lippmann
- Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky
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Oruch R, Elderbi MA, Khattab HA, Pryme IF, Lund A. Lithium: A review of pharmacology, clinical uses, and toxicity. Eur J Pharmacol 2014; 740:464-73. [DOI: 10.1016/j.ejphar.2014.06.042] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 01/10/2023]
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Abstract
This review has been done after careful research of articles published in indian journal of psychiatry with the search words of manic depressive psychosis and bipolar mood disorder. Many articles in the following areas are included: 1) ETIOLOGY: genetic studies: 2) ETIOLOGY - neuro psychological impairment: 3) Adult bipolar disorder 4) Epidemological 5) Clinical picture - phenomenology: 6) Course of bipolar mood disorder: 7) Juvenile onset bipolar affective disorder 8) Secondary mania: 9) Clinical variables and mood disorders: 10) Disability: 11) Comorbidity: 12) TREATMENT: biological 13) Recent evidence: 14) Pharmacological evidence in special population. Though there seems to be significant contribution, there are still lot of areas which need careful intervention. The findings in various studies from the indian point of view are reviewed.
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Affiliation(s)
- Prasad G Rao
- Department of Psychiatry, Schizophrenia and Psychopharmacology Division, Asha Hospital, Banjara Hills, Hyderabad, India
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Varma S, Sareen H, Trivedi JK. The geriatric population and psychiatric medication. Mens Sana Monogr 2010; 8:30-51. [PMID: 21327169 PMCID: PMC3031932 DOI: 10.4103/0973-1229.58818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 12/22/2009] [Accepted: 12/23/2009] [Indexed: 12/16/2022] Open
Abstract
With improvement in medical services in the last few years, there has been a constant rise in the geriatric population throughout the world, more so in the developing countries. The elderly are highly prone to develop psychiatric disorders, probably because of age related changes in the brain, concomitant physical disorders, as well as increased stress in later life. Psychiatric disorders in this population may have a different presentation than in other groups and some of psychopathologies might be mistaken for normal age related changes by an unwary clinician. Therefore the need of the day is to train psychiatrists and physicians to better recognize and manage mental disorders in this age group.
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Affiliation(s)
- Sannidhya Varma
- Pursuing Master's degree in Psychiatry from Department of Psychiatry, CSM Medical University, Lucknow, India
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Rao TSS, Asha MR, Ramesh BN, Rao KSJ. Understanding nutrition, depression and mental illnesses. Indian J Psychiatry 2008; 50:77-82. [PMID: 19742217 PMCID: PMC2738337 DOI: 10.4103/0019-5545.42391] [Citation(s) in RCA: 218] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - M. R. Asha
- Department of Sensory Science, Central Food Technological Research Institute, Mysore - 570020, India
| | - B. N. Ramesh
- Department of Biochemistry and Nutrition, Central Food Technological Research Institute, Mysore - 570020, India
| | - K. S. Jagannatha Rao
- Department of Biochemistry and Nutrition, Central Food Technological Research Institute, Mysore - 570020, India
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