Suicides and parasuicides in a high risk patient group on and off lithium long-term treatment

Department of Psychiatry, Free University of Berlin, FRG.
Journal of Affective Disorders (Impact Factor: 3.38). 09/1992; 25(4):261-9. DOI: 10.1016/0165-0327(92)90084-J
Source: PubMed

ABSTRACT 68 patients with affective disorders, and receiving lithium prophylaxis in a specialized lithium clinic were followed up for 8 years on average. Patients were selected for this study according to 2 criteria: They had been given lithium for at least 12 months, and they had attempted suicide at least once before onset of lithium prophylaxis. Outcome was analysed in terms of suicidal and parasuicidal behaviour. 55 patients took their lithium regularly, 13 discontinued or dropped the medication. One third of those patients having discontinued the medication died from suicide. Only one suicide occurred in patients with regular lithium intake and proven compliance during the last check before death. An impressive drop of parasuicides was observed in responders as well as in apparent non-responders. In total, 11 of 13 patients showed suicidal or parasuicidal behaviour 2 weeks-44 months after lithium discontinuation, which in about half of these cases took place on advice or with consent of the treating psychiatrist. It is concluded that lithium may have specific anti-suicidal properties, possibly related to its anti-aggressive effect, and that patients apparently not responding satisfactorily in terms of reduced number of episodes may still be protected against suicide or parasuicide.

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    • "Early detection and adequate treatment of a primary psychiatric disorder is of paramount importance. In psychiatrically ill subjects, lithium,[152–154] clozapine.[155–157] olanzapine,[158] antidepressants,[159] and behavioral interventions such as dialectical behavior therapy, DBT[160] have been shown to have antisuicidal effects. "
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    Indian Journal of Psychiatry 03/2012; 54(4):304-319. DOI:10.4103/0019-5545.104793
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    • "However, post-mortem brain donors with a history of BD are most often suicide completers. The literature provides extensive evidence for the anti-suicidal effects of Li prophylaxis through observational studies [41], [42], randomized controlled studies [43], [44] and meta-analyses [45], [46]. Thus, such a study would be logistically quite challenging. "
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    ABSTRACT: Bipolar disorder (BD) is a debilitating psychiatric condition with a prevalence of 1-2% in the general population that is characterized by severe episodic shifts in mood ranging from depressive to manic episodes. One of the most common treatments is lithium (Li), with successful response in 30-60% of patients. Synapsin II (SYN2) is a neuronal phosphoprotein that we have previously identified as a possible candidate gene for the etiology of BD and/or response to Li treatment in a genome-wide linkage study focusing on BD patients characterized for excellent response to Li prophylaxis. In the present study we investigated the role of this gene in BD, particularly as it pertains to Li treatment. We investigated the effect of lithium treatment on the expression of SYN2 in lymphoblastoid cell lines from patients characterized as excellent Li-responders, non-responders, as well as non-psychiatric controls. Finally, we sought to determine if Li has a cell-type-specific effect on gene expression in neuronal-derived cell lines. In both in vitro models, we found SYN2 to be modulated by the presence of Li. By focusing on Li-responsive BD we have identified a potential mechanism for Li response in some patients.
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