Personality traits in subtypes of alcoholics.

Earlier studies have identified at least two distinct subgroups of alcoholics: Type II with early onset and high genetic loading and Type I with late onset in which genetic factors seem to be of minor importance. In the present study, type I and type II alcoholics are compared on stable personality traits determined by the Karolinska Scales of Personality. Both groups were found to have high scores on scales that measured somatic anxiety, psychic anxiety, muscular tension, impulsiveness, detachment, psychastenia, suspicion, guilt and inhibition of aggression. Both groups had low scores on the scale that measured socialization. Type II alcoholics had significantly higher scores than type I alcoholics on Somatic Anxiety and Verbal Aggression scales and significantly lower scores on Socialization and Inhibition of Aggression scales. On the Impulsive Sensation-Seeking Psychopathy factor (Impulsiveness + Monotony Avoidance - Socialization), type II alcoholics were significantly differentiated from both type I alcoholics and healthy volunteers. Results of this study were consistent with those of other studies indicating that alcoholism accompanied by antisocial behavior should be kept separate from alcoholism that is unrelated to antisocial behavior.

Long-term lithium treatment. Some clinical, psychological and biological aspects.

The prophylactic effect of lithium was studied prospectively in 63 patients with recurrent affective disorders. Lithium treatment was started at recovery from a current episode of illness when the patients were able to participate in the decision to start long-term treatment. The median treatment time was 23.7 months and the mean serum lithium concentration approx. 0.63 mmol/l. Comparison with equally long control periods before lithium showed that the treatment resulted in statistically significant reductions in number of episodes, number of months ill, and number of months hospitalized. There were 40 (63%) responders (frequency of episodes during lithium lower than before lithium) and 23 (37%) non-responders (frequency of episodes during lithium higher than or the same as before lithium). Females responded slightly better than males. Responders scored significantly higher than non-responders in the psychasthenia and muscle tension subscales of the Karolinska Hospital Personality Inventory. Both responders and non-responders showed falls in CPRS during lithium treatment, the fall was statistically significant in the responders. During the first 4 months of lithium treatment the responders showed a significant rise in serum calcium, while serum calcium remained unaltered in the non-responders. These variables may be predictive of response to long-term lithium treatment. The low numbers of patients who discontinued treatment and the even serum levels of lithium suggest that good compliance to treatment was achieved with the present approach.

ECG changes during lithium therapy. A prospective study.

The influence of long-term lithium treatment on the ECG was investigated in 53 consecutive patients. An ECG was recorded prior to and 4 and 12 months after institution of lithium therapy. The most frequently observed change during treatment was flattening or inversion of the T wave. Heart rate decreased and P-Q interval increased slightly during therapy. There was no change in the S-T segment or the Q-T interval corrected for heart rate. Our data indicate that well monitored lithium treatment of patients with serum lithium concentrations of about 0.6 mmol/l does not cause serious ECG abnormalities. In the absence of symptoms or signs of heart disease, routine monitoring of ECG is not necessary during lithium treatment.

Cortisol changes in long-term lithium therapy.

a.m. and p.m. serum cortisol levels were investigated in a group of 53 patients before the start of long-term lithium therapy (I) and again after 4 months (II) and 12 months (III) on lithium. The patients were assessed by means of the CPRS and scores for 28 depression items were calculated. When 5 patients with manic/hypomanic scores were excluded the remainder (n = 48) showed a significant decrease in a.m. serum cortisol levels after 1 year on lithium. Those patients with the greatest differences between the CPRS scores before lithium and after 12 months on lithium also displayed significant differences between a.m. and p.m. cortisol levels before the start of lithium and after 12 months of lithium therapy.

Long-term lithium treatment and renal functions. A prospective study.

Renal functions were examined in 53 patients before the start of long-term lithium treatment (I) and then after 4 months (II) and 12 months (III) on lithium treatment. The tubular function was studied by means of the DDAVP (Minirin) test and the glomerular filtration rate was measured by creatinine clearance. The mean maximum urine osmolality (+/- SE) on the first occasion (I) was 800 +/- 20 mosm/kg H2O, 702 +/- 20 on the second (II), and on the third (III) 723 +/- 17 mosm/kg H2O. The mean creatinine clearance before the start of lithium treatment (I) was 128 +/- 5 ml/min, after 4 months (II) 106 +/- 4 and after 12 months (III) 114 +/- 5 ml/min. The results of the present study suggest that lithium treatment with serum levels of approximately 0.6 mmol/l causes a decrease in renal concentrating ability and the glomerular filtration rate in the early stages after the start of therapy. This decrease in the renal functions does not seem to progress during the first year of lithium treatment.

Lithium therapy and thyroid function tests. A prospective study.

Thyroid function tests including thyroxine (T4), T3 test, thyroid-stimulating hormone (TSH), free T4 index and antithyroid antibodies were studied in 51 patients before the start of long-term lithium therapy and after 4 and 12 months on lithium. After 4 months on lithium, changes occurred in all laboratory parameters - T4 and T3 test levels decreased and TSH increased. After 12 months T4 and T3 test increased to pretreatment levels and TSH remained higher than before the start of lithium. During 1 year of lithium treatment only 1 patient developed clinical signs of hypothyroidism and started levo-thyroxine substitution therapy.

Memory functions and prophylactic treatment with lithium.

Memory functions were examined in a group of 53 patients with affective disorders before commencing prophylactic lithium therapy and then after 4 and 12 months of lithium treatment. The memory tests administered were the 30 Figure Test, the 30 Word-Pair Test, the 30 Person-Data Test (these tests are included in the Cronholm-Molander test battery) and the 30 Face Test. Three scores were obtained : immediate memory score, delayed memory score and forgetting score. There were no statistical significant differences between these scores before lithium therapy or after 4 and 12 months, except for immediate and delayed memory on the Person-Data Test and the 30 Face Test which showed an increased score of memory functions. The results of this study support the view that long-term lithium treatment with serum levels of about 0.6 mmol/l does not induce memory disturbances.

Lithium and neuroleptic drugs in combination - effect on lithium RBC/plasma ratio.

The lithium RBC/plasma ratio was determined in 59 patients during prophylactic lithium therapy. No relationship was found between the lithium RBC/plasma ratio and sex, age, type of illness, weight, lithium dosage, duration of treatment or lithium plasma level. However, patients taking a combination of lithium and neuroleptic drugs had significantly higher lithium RBC/plasma ratios than patients taking lithium without neuroleptic drugs. The results are in line with earlier in vitro studies and are discussed in relation to the high frequency of neurotoxic and nephrotoxic adverse effects noted in patients taking a combination of lithium and neuroleptic drugs.

Kidney function in patients with affective disorders with and without lithium therapy.

The ability to concentrate the urine was estimated in healthy volunteers, patients with affective disorders who had never received lithium and lithium-treated patients. Patients with affective disorders who had never received lithium were found to have significantly lower concentrating capacity than healthy volunteers. However, lithium-treated patients had still lower concentrating capacity and differed significantly both from healthy volunteers and from patients who had never received lithium. Furthermore, in a subgroup of lithium-treated patients investigated twice with an interval of 6 months, a progressive decrease in concentrating capacity was found, indicating the importance of lithium therapy.