The relative prophylactic efficacy of lithium against mania and depressive recurrences in bipolar patients
The relative prophylactic efficacy of lithium against manic and depressive recurrences was examined in 61 patients (22 males, 39 females) with bipolar manic-depressive disorders by comparing the number of manic and depressive episodes for each patient during equally long periods before and during lithium treatment. In all the patients, the percentage of depressive episodes during lithium was smaller than that of manic episodes. The better antidepressive than antimanic prophylactic effect of lithium was significant only in male patients, while the reduction of manic episodes during lithium was greater in females. The fraction of patients without depressive episodes on lithium was greater in the male group. The results obtained with this study design indicate that lithium is an effective antidepressive prophylactic agent in bipolar patients. Sex differences are also implicated in response to lithium prophylaxis.
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ABSTRACT: Previous investigations have elucidated an erythrocyte lithium-sodium countertransport (LSC) system as the primary mechanism for extruding lithium from the cell, and this activity has been described in terms of Michaelis-Menten kinetics. In most clinical studies the maximum velocity (Vmax) of the LSC has been measured by estimating the rate of lithium efflux from lithium-loaded cells. To date, few studies have examined whether the affinity (Km) of the LSC for lithium might be altered in patients with affective disorders. In the present study we examined LSC kinetic parameters (Vmax, leak, Km, and in vitro lithium ratio) at baseline in 80 patients with affective disorder and 25 healthy control subjects, and after 6 weeks of lithium administration in 33 of the patients. No differences in Vmax were observed between any patient and control group, although Vmax was significantly lower in unipolar depressed men compared to bipolar men (P = 0.043). The affinity (Km) of the transport 'carrier' for lithium did not differentiate between patient and control groups. Chronic lithium administration caused a decreased Vmax in bipolar men (P = 0.015), an increase in the in vitro lithium ratio in bipolar men (P = 0.002) and bipolar women (P = 0.002), and a marginal increase in Km in bipolar men (P = 0.08) and bipolar women (P = 0.06). Although the present data do not demonstrate an underlying difference for Km between affectively ill patients and controls, they do indicate a decrease in the affinity of the transport 'carrier' for lithium after chronic lithium administration.
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ABSTRACT: Mood-stabilizing pharmacotherapy has become the mainstay of treatment for bipolar disorder (BD). Despite the increasingly biological conceptualization of illness, psychosocial interventions may also have a role to play in the treatment of manic-depressive illness. This article aims to provide a comprehensive and critical review of the literature on the use of psychosocial interventions for BD. The general therapeutic processes underlying the effectiveness of these different psychologically based interventions will also be discussed. All papers listed in Medline and Psychological Abstracts published since 1970 on the use of psychosocial interventions for BD were examined and reviewed with regards to efficacy. The evidence suggests that psychosocial interventions combined with mood-stabilizing medication are associated with superior clinical outcome compared to treatment with mood-stabilizing medication alone. Seven unique therapeutic mechanisms may underlie the effectiveness of these various psycho-social interventions, including: closer monitoring of affective symptomatology, earlier environmental modification, enhanced compliance with medication, enhanced social support, improved familial adjustment, regulation of daily routines, and enhancement of coping strategies. Psychosocial interventions have a beneficial effect on clinical outcome in BD. More rigorous controlled research is needed to replicate these initial outcome studies. What also remains to be clarified is whether psychologically based interventions possess unique therapeutic potency independent of their effects on medication compliance. Depression 2:119-188 (1994/1995). © 1995 Wiley-Liss, Inc.
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