Neuroprotective effects of low-dose lithium in individuals at ultra-high risk for psychosis. A longitudinal MRI/MRS study

OBJECTIVES

To investigate if low-dose lithium may counteract the microstructural and metabolic brain changes proposed to occur in individuals at ultra-high risk (UHR) for psychosis.

METHODS

Hippocampal T2 relaxation time (HT2RT) and proton magnetic resonance spectroscopy ((1)H-MRS) measurements were performed prior to initiation and following three months of treatment in 11 UHR patients receiving low-dose lithium and 10 UHR patients receiving treatment as usual (TAU). HT2RT and (1)H-MRS percentage change scores between scans were compared using repeated measures ANOVA and correlated with behavioural change scores.

RESULTS

Low-dose lithium significantly reduced HT2RT compared to TAU (p=0.018). No significant group by time effects was seen for any brain metabolites as measured with (1)H-MRS, although myo-inositol, creatine, choline-containing compounds and NAA increased in the group receiving low-dose lithium and decreased or remained unchanged in subjects receiving TAU.

CONCLUSIONS

This pilot study suggests that low-dose lithium may protect the microstructure of the hippocampus in UHR states as reflected by significantly decreasing HT2RT. Larger scale replication studies in UHR states using T2 relaxation time as a proxy for emerging brain pathology seem a feasible mean to test neuroprotective strategies such as low-dose lithium as potential treatments to delay or even prevent the progression to full-blown disorder.

Uterine activity characteristics in multiple gestations

The frequency of uterine contractions has been shown to be increased during the 24-48 hours before the diagnosis of preterm labor in singleton gestations. Experience has indicated that there is also an increase in baseline uterine activity in twin gestations beyond that seen in women with singleton pregnancies. In this study, patients with twin gestations (39), triplet pregnancies (20), and quadruplets (ten) were monitored in the home daily for uterine activity. The results indicate that uterine activity was increased slightly within 48 hours of the onset of their initial preterm labor episode and significantly increased over baseline during the 24 hours preceding the diagnosis of preterm labor. This uterine activity led to evaluation for preterm labor before advanced dilatation occurred so that the majority of patients continued their pregnancy for more than 48 hours after diagnosis. Tocolytics did not have an effect on the crescendo of uterine activity preceding preterm labor. In this study, the crescendo of uterine activity occurred in multifetal gestations within 24 hours of preterm labor, as has been described for singleton pregnancies.