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Díaz Ortiz AC, Vargas Upeguí C, Zapata Ospina JP, Aguirre Acevedo DC, Pineda Zapata JA, López Jaramillo CA. Correlation between cognitive performance and structural neuroanatomy in patients with type I bipolar affective disorder treated with and without lithium. Rev Colomb Psiquiatr (Engl Ed) 2022; 51:133-145. [PMID: 35717384 DOI: 10.1016/j.rcpeng.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/05/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Lithium treatment of bipolar disorder (BD) has been associated with less cognitive impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. METHODS Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propensity score, and the Spearman correlation coefficient (ρ) was used to assess the relationship between cognitive performance and neuroanatomical regions. RESULTS Compared to the group without lithium, the group with lithium had fewer perseverative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amygdala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD = .67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (ρ = -0.78), the volume of the right thalamus (ρ = -0.44), and the right amygdala (ρ = 0.6). CONCLUSIONS The lithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.
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Affiliation(s)
- Andrés Camilo Díaz Ortiz
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Cristian Vargas Upeguí
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan Pablo Zapata Ospina
- Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Carlos Alberto López Jaramillo
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Díaz Ortiz AC, Upeguí CV, Ospina JPZ, Acevedo DCA, Pineda Zapata JA, Jaramillo CAL. Correlation Between Cognitive Performance and Structural Neuroanatomy in Patients with Type I Bipolar Affective Disorder Treated with and Without Lithium. Rev Colomb Psiquiatr (Engl Ed) 2021; 51:S0034-7450(20)30094-9. [PMID: 33735049 DOI: 10.1016/j.rcp.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Lithium treatment of bipolar disorder (BD) has been associated with less cognitive impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. METHODS Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propensity score, and the Spearman correlation coefficient (ρ) was used to assess the relationship between cognitive performance and neuroanatomical regions. RESULTS Compared to the group without lithium, the group with lithium had fewer perseverative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amygdala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD=.67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (ρ = -0.78), the volume of the right thalamus (ρ =-0.44), and the right amygdala (ρ = 0.6). CONCLUSIONS The lithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.
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Affiliation(s)
- Andrés Camilo Díaz Ortiz
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Cristian Vargas Upeguí
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan Pablo Zapata Ospina
- Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Carlos Alberto López Jaramillo
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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González-Pinto A, Balanzá-Martínez V, Benabarre Hernández A, Gutiérrez-Rojas L, Montes JM, de Dios Perrino C, Pérez Sola V, Montejo González ÁL, Giménez Palomo A, Crespo JM. Expert consensus on information sheet proposals for patients under treatment with lithium. Rev Psiquiatr Salud Ment (Engl Ed) 2019; 14:27-39. [PMID: 31882351 DOI: 10.1016/j.rpsm.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Lithium is one of the first therapeutic options for bipolar disorder, which is characterized by recurrent mood swings that strongly reduce quality of life. Our purpose was to achieve professional consensus criteria to define the contents of an information sheet for patients with bipolar disorder that are starting treatment with lithium. MATERIAL AND METHODS A modified Delphi method in two rounds was used. The Scientific Committee-made up by nine psychiatrists-created a 20-item questionnaire about the information that must be given to the patient treated with lithium and selected a panel of ambulatory and hospital psychiatric experts to agree on this information. Panelists scored each item based on a Likert scale of 9 points and could add comments in a confidential manner. It was considered consensus in agreement when median scores were within the range of [7-9] and in disagreement within the range of [1-3]. RESULTS A high level of consensus was reached. In the first round, there was agreement on 17 out of 20 items and, after the second round, there was disagreement on just one item containing information about the discovery of lithium. Finally, said item was modified in the Patient's Information Sheet based on the comments suggested by the panelists. CONCLUSIONS This study allowed to create an information sheet for patients with bipolar disorder under treatment with lithium, with information agreed upon by a group of experts from different health care settings.
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Affiliation(s)
- Ana González-Pinto
- Hospital Universitario de Alava, EHU, BIOARABA, CIBERSAM, Vitoria, España.
| | - Vicent Balanzá-Martínez
- Unidad de Salud Mental de Catarroja, Departament de Medicina, Universitat de València, CIBERSAM, València, España
| | - Antoni Benabarre Hernández
- Unidad de Trastornos Bipolares, Servicio de Psiquiatría, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Luis Gutiérrez-Rojas
- Unidad de Hospitalización de Salud Mental, Hospital Clínico San Cecilio, Granada, España
| | - José Manuel Montes
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, CIBERSAM, IRYCIS, Madrid, España
| | - Consuelo de Dios Perrino
- Servicio de Psiquiatría, Hospital Universitario La Paz, Instituto de Investigación Idipaz, CIBERSAM, Madrid, España
| | - Víctor Pérez Sola
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, CIBERSAM, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, España
| | - Ángel Luis Montejo González
- Universidad de Salamanca, Área de Neurociencias, Instituto de Investigación Biomédica de Salamanca (IBSAL), Servicio de Psiquiatría, Hospital Universitario de Salamanca, Salamanca, España
| | | | - José Manuel Crespo
- Servicio de Psiquiatría, Hospital Universitari de Bellvitge-ICS, IDIBELL, CIBERSAM, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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García-Maldonado G, Castro-García RDJ. Endocrinological Disorders Related to the Medical Use of Lithium. A Narrative Review. Rev Colomb Psiquiatr (Engl Ed) 2019; 48:35-43. [PMID: 30651171 DOI: 10.1016/j.rcp.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022]
Abstract
The prescribing of Lithium is common in psychiatric clinical practice. The aim of this study was to identify the most common endocrine side effects associated with this drug and to clarify the pathophysiological basis. A systematic review was conducted in Psycinfo, Embase, PubMed, and Scopus. A computerised search for information was performed using a PICO (patient, intervention, comparative, outcomes) strategy. The main neuroendocrine alterations were reported in kidneys, thyroid and parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. The pathophysiological mechanisms are diverse, and include the inhibition of the thyroid adenylate cyclase sensitive to the thyroid stimulant hormone (TSH) sensitive adenylate cyclase, which causes hypothyroidism. It also reduces the expression of aquaporin type 2, which is associated with nephrogenic diabetes insipidus, and the loss of the ionic balance of calcium that induces hyperparathyroidism and hypercalcaemia. Other considerations are related to alterations in the hypothalamic-pituitary-adrenal axis and a decrease in the production of catecholamines. Finally, another side-effect is the glycaemic dysregulation caused by the insulin resistance. Periodical clinical and para-clinical evaluations are necessary. The author proposes an evaluation scheme.
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Affiliation(s)
- Gerardo García-Maldonado
- Hospital Psiquiátrico de Tampico, Secretaría de Salud, Tamaulipas, México; Facultad de Medicina Dr. Alberto Romo Caballero, Universidad Autónoma de Tamaulipas, Tamaulipas, México.
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Belfiore C, Curia MV, Farías ME. Characterization of Rhodococcus sp. A5 wh isolated from a high altitude Andean lake to unravel the survival strategy under lithium stress. Rev Argent Microbiol 2017; 50:311-322. [PMID: 29239754 DOI: 10.1016/j.ram.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/19/2017] [Accepted: 07/02/2017] [Indexed: 01/07/2023] Open
Abstract
Lithium (Li) is widely distributed in nature and has several industrial applications. The largest reserves of Li (over 85%) are in the so-called "triangle of lithium" that includes the Salar de Atacama in Chile, Salar de Uyuni in Bolivia and Salar del Hombre Muerto in Argentina. Recently, the use of microorganisms in metal recovery such as copper has increased; however, there is little information about the recovery of lithium. The strain Rhodococcus sp. A5wh used in this work was previously isolated from Laguna Azul. The assays revealed that this strain was able to accumulate Li (39.52% of Li/g microbial cells in 180min) and that it was able to grow in its presence up to 1M. In order to understand the mechanisms implicated in Li tolerance, a proteomic approach was conducted. Comparative proteomic analyses of strain A5wh exposed and unexposed to Li reveal that 17 spots were differentially expressed. The identification of proteins was performed by MALDI-TOF/MS, and the obtained results showed that proteins involved in stress response, transcription, translations, and metabolism were expressed under Li stress. This knowledge constitutes the first proteomic approach to elucidate the strategy followed by Rhodococcus to adapt to Li.
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Affiliation(s)
- Carolina Belfiore
- Planta Piloto de Procesos Industriales y Microbiológicos (PROIMI), CCT-Tucumán, CONICET, Av. Belgrano y Pasaje Caseros, 4000 S. M. de Tucumán, Argentina.
| | - María V Curia
- Planta Piloto de Procesos Industriales y Microbiológicos (PROIMI), CCT-Tucumán, CONICET, Av. Belgrano y Pasaje Caseros, 4000 S. M. de Tucumán, Argentina
| | - María E Farías
- Planta Piloto de Procesos Industriales y Microbiológicos (PROIMI), CCT-Tucumán, CONICET, Av. Belgrano y Pasaje Caseros, 4000 S. M. de Tucumán, Argentina
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Burguera Vion V, Montes JM, Del Rey JM, Rivera-Gorrín M, Rodao JM, Tenorio M, Saiz-Ruiz J, Liaño F. [Acute lithium poisoning: epidemiology, clinical characteristics, and treatment]. Emergencias 2017; 29:46-48. [PMID: 28825269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lithium continues to be the treatment of choice for bipolar disorder. Acute lithium poisoning is a potentially serious event. We present a retrospective observational significative study of episodes of acute lithium poisoning during a 52- month period. Poisoning was defined by a blood lithium concentration of 1.5 mEq/L or higher. We analyzed treatment and epidemiologic and clinical characteristics of 70 episodes were identified (incidence density among treated patients, 1.76 per 100 patient-years). The most frequent cause of lithium poisoning was a concurrent medical condition (46%). Most poisonings were mild (74.2%), but neurologic involvement was identified in 40.3%. Electrocardiographic abnormalities were found in 8 cases. Acute renal failure, found in 23 patients (37.1%), was mild in most cases, although 11 patients required hemodialysis. We concluded that acute lithium poisoning is an uncommon complication, but risk needs to be lowered. Patients should be warned to avoid dosage errors and to take special care during concurrent illnesses and while taking other medications.
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Affiliation(s)
- Víctor Burguera Vion
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, UAH, REDinREN Madrid, España
| | - José Manuel Montes
- Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, UAH, CIBERSAM, IRYCIS, Madrid, España
| | - José Manuel Del Rey
- Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Maite Rivera-Gorrín
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, UAH, REDinREN Madrid, España
| | - José María Rodao
- Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, UAH, CIBERSAM, IRYCIS, Madrid, España
| | - Maite Tenorio
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, UAH, REDinREN Madrid, España
| | - Jerónimo Saiz-Ruiz
- Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, UAH, CIBERSAM, IRYCIS, Madrid, España
| | - Fernando Liaño
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, UAH, REDinREN Madrid, España
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García de la Orden L, García Carretero R. [Nursing care of a patient with bipolar disorder and lithium-induced nephrogenic diabetes insipidus]. Enferm Clin 2015; 25:92-7. [PMID: 25600576 DOI: 10.1016/j.enfcli.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/23/2014] [Accepted: 12/05/2014] [Indexed: 11/21/2022]
Abstract
Bipolar disorder is one of the most common, severe and persistent mental disorders. The evaluation of all data and variables related to bipolar disorder is a difficult task, because there is no clear agreement on what should be included in this category. One of the traditional treatments for this disease is the lithium metal that is administered in the form of lithium salt. Lithium has a narrow therapeutic window and there is a significant risk of complications arising from its use, mainly neurological and renal. In the case presented, the preparation of a care plan is described for a patient diagnosed with bipolar disorder who suffered a complication with lithium treatment. To do this, it was decided to use a standardized care plan and later completed it with diagnostic, objectives and interventions to the specific needs of the patient, aimed at achieving optimal levels of independence.
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