Abstract
The long-term outcome of lithium prophylaxis was explored in 43 bipolar and 36 unipolar patients who had been classified as complete responders after the first 2 years of treatment. These patients were followed up prospectively for a further period of 5 years (treatment period II), during which their psychopathological state was assessed monthly or bimonthly. Forty-nine patients completed treatment period II, 2 died during this period, 7 did not attend the unit anymore and could not be traced, and 21 definitively interrupted lithium treatment before the end of the period. In 18 cases the decision to stop lithium was taken by the patient. Twenty-five patients relapsed during the treatment period II. Four relapsers had three or more episodes concentrated during the last 2 years of treatment. These results suggest that the predictive value of an initial favourable response to lithium should not be overrated, and that the impact of the drug on the long-term course of major affective disorders in ordinary clinical conditions might be less dramatic than currently believed.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Abou-Saleh MT, Coppen A (1986) Who responds to prophylactic lithium? J Affective Disord 10:115–125
Åsberg M, Perris C, Schalling D, Sedvall G (1978) Comprehensive psychopathological rating scale: CPRS. Acta Psychiatr Scand [Suppl] 27:5–27
Bouman TK, Niemantsverdriet-van Kampen JG, Ormel J, Slooff CJ (1986) The effectiveness of lithium prophylaxis in bipolar and unipolar depressions and schizo-affective disorders. J Affective Disord 11:275–280
Cordess C (1982) Rebound mania after lithium withdrawal? Br J Psychiatry 141:431
Dickson WE, Kendell RE (1986) Does maintenance lithium therapy prevent recurrences of mania under ordinary clinical conditions? Psychol Med 16:521–530
Dotti A, Bernini P (1979) Indagine catamnestica sulle ragioni del-l'interruzione della terapia continuativa con carbonato di litio. Riv Psichiatria 14:293–307
Dunner DL, Fieve RR (1974) Clinical factors in lithium carbonate prophylaxis failure. Arch Gen Psychiatry 30:229–233
Goodnick PJ, Fieve RR, Schlegel A, Baxter N (1987) Predictors of interepisode symptoms and relapse in affective disorder patients treated with lithium carbonate. Am J Psychiatry 144:367–369
Jamison KR, Gerner RG, Goodwin FK (1979) Patient and physician attitudes towards lithium. Arch Gen Psychiatry 36:866–869
Maarbjerg K, Aagaard J, Vestergaard P (1988) Adherence to lithium prophylaxis: I. Clinical predictors and patient's reasons for nonadherence. Pharmacopsychiatry 21:121–125
Maj M, Perris C (1985) An approach to the diagnosis and classification of schizoaffective disorders for research purposes. Acta Psychiatr Scand 72:405–413
Maj M, Arena F, Lovero N, Pirozzi R, Kemali D (1985) Factors associated with response to lithium prophylaxis in DSM III major depression and bipolar disorder. Pharmacopsychiatry 18:309–313
Page C, Benaim S, Lappin F (1987) A long-term retrospective follow-up study of patients treated with prophylactic lithium carbonate. Br J Psychiatry 150:175–179
Perris C, Kemali D, Amati A, Del Vecchio M, Vacca L (1981) CPRS: scala di valutazione psicopatologica globale. Neurol Psichiat Scienze Umane 1:232–276
Polatin P, Fieve RR (1971) Patient rejection of lithium carbonate prophylaxis. JAMA 218:864–866
Prien RJ (1979) Lithium in the prophylactic treatment of affective disorders. Arch Gen Psychiatry 36:847–848
Schou M (1979) Lithium in unipolar affective illness. Arch Gen Psychiatry 36:849–851
Schou M (1986) Lithium treatment: a refresher course. Br J Psychiatry 149:541–547
Symonds RL, Williams P (1981) Lithium and the changing incidence of mania. Psychol Med 11:193–196
Van Putten T (1975) Why do patients with manic depressive illness stop their lithium? Comp Psychiatry 16:179–183
Vestergaard P, Schou M (1988) Prospective studies on a lithium cohort. I. General features. Acta Psychiatr Scand 78:421–426
Vinarova E, Vinar O (1984) Psychotic relapses in lithium responders. Act Nerv Super 26:34–35
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Maj, M., Pirozzi, R. & Kemali, D. Long-term outcome of lithium prophylaxis in patients initially classified as complete responders. Psychopharmacology 98, 535–538 (1989). https://doi.org/10.1007/BF00441955
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00441955