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1.
BMC Musculoskelet Disord ; 20(1): 389, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31470828

RESUMO

BACKGROUND: Lithium, an established psychiatric medication, has recently been shown to enhance new bone formation in preclinical fracture models. Current research is focused on evaluating the efficacy of low-dose, short-term lithium treatment to improve long bone fracture healing through a Phase II randomized clinical trial (LiFT NCT02999022). In working towards future applications of lithium for fracture management, this study aimed to understand the current perceptions of lithium as a psychiatric drug and the potential barriers to its orthopaedic adoption. METHODS: Three questionnaires, evaluating knowledge about lithium and willingness to embrace its use in fracture healing were disseminated among the general population, fracture patients eligible for the LiFT (Lithium for Fracture Treatment) trial and orthopaedic surgeons across Canada. RESULTS: Of the 768 public respondents, 84% were willing to take a medication that would aid fracture healing but only 62.6% if the medication was lithium. Willingness dropped to 44.6% among the 168 respondents who knew about the psychiatric use of lithium. Lack of sufficient knowledge (n = 50) and concerns about side effects including effects on the brain (n = 74) were the main reasons cited by those who were unwilling to use lithium. Of the 29 fracture patients, only 20 patients had previously heard of lithium. Of these, 40% were willing to take lithium for fracture healing with an additional 10% if the dose was low or if the intake duration was short. Only 50% knew that lithium has side effects. Of the 43 orthopaedic surgeons, 38 surgeons knew about clinical use of lithium. Of these, 68% knew that lithium has side effects and 29% knew that it interacts with other drugs. While most agreed that new strategies are needed to improve fracture management, only 68% were willing to prescribe lithium for fractures with an additional 16% if there is scientific evidence and/or a standard dosing protocol. CONCLUSIONS: This study identified a lack of knowledge about uses and side effects of lithium among all three cohorts. A robust educational framework for orthopaedic surgeons, their patients and the members of their clinical care teams will be essential to widespread repurposing of lithium for fracture care.


Assuntos
Competência Clínica/estatística & dados numéricos , Consolidação da Fratura/efeitos dos fármacos , Fraturas Ósseas/terapia , Conhecimentos, Atitudes e Prática em Saúde , Carbonato de Lítio/administração & dosagem , Adolescente , Adulto , Encéfalo/efeitos dos fármacos , Canadá , Relação Dose-Resposta a Droga , Esquema de Medicação , Reposicionamento de Medicamentos , Feminino , Fixação de Fratura , Humanos , Carbonato de Lítio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/psicologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Percepção , Placebos/administração & dosagem , Placebos/efeitos adversos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
2.
J Clin Psychopharmacol ; 39(3): 238-242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932947

RESUMO

BACKGROUND: Lithium in the form of lithium carbonate (Li2CO3) has become one of the most effective and widely prescribed drugs for mood stabilization. However, lithium has adverse effects on renal tubular functions, such as decreased concentrating function of the kidneys, and even occasional symptoms of nephrogenous diabetes insipidus occur with additional evidence of glomerular disruption in lithium-treated patients. METHODS: We assessed the kidney function of patients with bipolar disorder who are under long-term lithium treatment using novel markers of kidney damage such as plasma neutrophil gelatinase-associated lipocalin, cystatin C, albuminuria, estimated glomerular filtration rate, Chronic Kidney Disease-Epidemiology Investigation using creatinine and cystatin C, and serum and urinary osmolality, and compared the results with those of age-matched patients with bipolar disorder not treated with lithium. The study enrolled 120 patients with bipolar disorder, consisting of 80 (30 male and 50 female patients) who have been receiving lithium for 0.5 to 20 (mean, 7) years and 40 (10 male and 30 female patients) who had never been exposed to lithium treatment. RESULTS: Patients treated with lithium had significantly decreased urine osmolality (mean ± SD, 405 ± 164 vs 667 ± 174 mmol/kg) and urine-to-serum osmolality ratio (1.35 ± 0.61 vs 2.25 ± 0.96). No significant difference was found in creatinine, estimated glomerular filtration rate values calculated using the Chronic Kidney Disease-Epidemiology Investigation using creatinine and cystatin C, neutrophil gelatinase-associated lipocalin, cystatin C, and albuminuria between both groups. We found no significant difference in renal biomarkers between patients treated with lithium for 6 to 24 months and those treated for 25 to 240 months. CONCLUSIONS: We found significantly decreased kidney concentrating ability in the long-term lithium-treated patients compared with the control group. Other renal function markers did not indicate any significant signs of renal dysfunction.


Assuntos
Antimaníacos/administração & dosagem , Transtorno Bipolar/tratamento farmacológico , Nefropatias/induzido quimicamente , Carbonato de Lítio/administração & dosagem , Adulto , Idoso , Antimaníacos/efeitos adversos , Biomarcadores/metabolismo , Feminino , Taxa de Filtração Glomerular , Humanos , Nefropatias/epidemiologia , Testes de Função Renal , Carbonato de Lítio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
3.
Clin Drug Investig ; 39(5): 485-489, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30805791

RESUMO

Lithium is a well established therapeutic agent in the treatment of uni- and bipolar affective disorders. Angiotensin-converting enzyme (ACE) inhibitors are the most frequently used class of drugs in the treatment of cardiovascular diseases. Combination therapy with both may be considered in clinical practice on occurrence of arterial hypertension after years of successful lithium therapy, yet an increased risk of lithium intoxication in combination with ACE inhibitors has been described and thus the combination has been warned against. We describe three cases in which enalapril, lisinopril or ramipril was combined with lithium. Either additional co-medication with hydrochlorothiazide or dehydration rather than co-medication with ACE inhibitors could be identified as necessary factors for lithium intoxication. These cases suggest that a combination of lithium with ACE inhibitors is possible when sufficient hydration is ensured and a combination with hydrochlorothiazide is avoided. Lithium concentration should be controlled on a regular level.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Transtorno Bipolar/tratamento farmacológico , Carbonato de Lítio/administração & dosagem , Transtornos Psicóticos/tratamento farmacológico , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/sangue , Transtorno Bipolar/sangue , Transtorno Bipolar/complicações , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/sangue , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Carbonato de Lítio/efeitos adversos , Carbonato de Lítio/sangue , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/sangue , Transtornos Psicóticos/complicações
4.
Eur J Clin Pharmacol ; 75(4): 519-528, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30554270

RESUMO

PURPOSE: Lithium (Li), the first-line treatment of bipolar disorder, was first developed as an immediate-release form with a routine therapeutic drug monitoring 12 h after the last dose. In Europe, the most commonly prescribed form is a sustained release (srLi). Yet no pharmacokinetics (PK) study has been published of srLi, administered once a day, in adults. The present study describes srLi PK in the serum and erythrocytes of bipolar patients. METHODS: To assess srLi PK, we studied prospectively 17 French bipolar patients on a median dose of 1000 mg (600-1600) for at least 2 years. Serum (S), erythrocyte (E) concentrations, and urinary (U) amount were collected over 8 h after 15 days of morning intake using monitoring electronic medical system (MEMs). Population PK parameters were estimated using the SAEM algorithm (MONOLIX 4.3.3 software). RESULTS: Using a population approach, we built a PK population model of srLi including one S compartment (VS = 23.0 L, ClS = 1.21 L h-1), one E compartment (VE = 64.7 L, ClSE = 3.63 L h-1, ClES = 9.46 L h-1), and one U compartment (F = 0.62) and estimate the ratio of concentrations to Li in E over S at 0.38 with 27% between-subject variability. CONCLUSION: This is a PK model of srLi once a day in bipolar patients using a population approach simultaneously describing Li concentrations in serum, erythrocytes, and urine which provide an estimate of the ratio of concentration in erythrocyte over serum and its between-subject variability (BSV).


Assuntos
Transtorno Bipolar/sangue , Transtorno Bipolar/urina , Eritrócitos/metabolismo , Carbonato de Lítio/administração & dosagem , Carbonato de Lítio/farmacocinética , Modelos Biológicos , Adulto , Transtorno Bipolar/tratamento farmacológico , Preparações de Ação Retardada , Feminino , Humanos , Carbonato de Lítio/sangue , Carbonato de Lítio/urina , Masculino
5.
BMJ Case Rep ; 20182018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30317200

RESUMO

A young man previously diagnosed with Kleine-Levin syndrome (KLS) presented with abnormal behaviour over the last 8 days. This included decreased sleeping hours and appetite, hypersexuality, aggressiveness and visual hallucinations. All blood tests and investigations in the emergency department yielded normal results. A preliminary diagnosis of a KLS episode with psychosis was made and the patient was started on a regimen of aripiprazole 10 mg once daily along with lorazepam 2 mg intravenously in two divided doses in the event of agitation or insomnia. On discharge 5 days later, the patient had returned to his premorbid level of functioning and was willing to follow up in the neurology clinic. He was discharged on aripiprazole 10 mg once daily and lorazepam 2 mg two times daily as needed for 2 weeks to help with his agitation and insomnia, as well as lithium carbonate 400 mg at night.


Assuntos
Síndrome de Kleine-Levin/diagnóstico , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Adolescente , Antimaníacos/administração & dosagem , Antimaníacos/uso terapêutico , Diagnóstico Diferencial , Alucinações/etiologia , Humanos , Síndrome de Kleine-Levin/complicações , Síndrome de Kleine-Levin/tratamento farmacológico , Carbonato de Lítio/administração & dosagem , Carbonato de Lítio/uso terapêutico , Masculino , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico
6.
Environ Toxicol Pharmacol ; 61: 79-86, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29852373

RESUMO

Lithium carbonate is an effective drug against bipolar disorders. Direct use of lithium carbonate has been reported to result in lithium toxication and pulmonary complications. With chitosan micro and nanoparticles gaining attention for their protein absorption, drug targeting and improved dissolution rate of sparingly water-soluble drugs, this work has focused on chitosan loaded Li as a possible alternative to Li alone for cellular uptake. Well standardized ionic gelation technique employed in this study resulted in Li loaded chitosan nanoparticles with hydrodynamic diameter below 300 nm and zeta potential of + 30 mV and oval morphology. Through various techniques electrostatic interaction as well as Claritin dependent endocytic pathway is suggested as facilitating 1.3 times increase in cell proliferation in lithium carbonate loaded chitosan nanoparticles treated PC12 cells. A controlled Li release to the extent of less than 50% in 48 h from the nanoparticle was observed. This observation has very high significance as it ensures that the lithium toxicity can be avoided. These results indicated that chitosan is a promising carrier for lithium carbonate and may improve its therapeutic efficacy and also overcome toxicity during its use in the treatment of neuropsychiatric disorders.


Assuntos
Quitosana/administração & dosagem , Portadores de Fármacos/administração & dosagem , Carbonato de Lítio/administração & dosagem , Nanopartículas/administração & dosagem , Animais , Transporte Biológico , Proliferação de Células/efeitos dos fármacos , Quitosana/química , Portadores de Fármacos/química , Liberação Controlada de Fármacos , Carbonato de Lítio/química , Carbonato de Lítio/toxicidade , Nanopartículas/química , Células PC12 , Ratos
7.
Cardiovasc Toxicol ; 18(6): 530-536, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29845450

RESUMO

Lithium is one of the classical drugs that have been widely used for treating bipolar disorder. However, several cardiac side effects including sick sinus syndrome, bundle branch block, ventricular tachycardia/fibrillation, non-specific T-wave abnormalities in addition to Brugada-type electrocardiographic changes have been noticed in patients who were given antidepressant, anticonvulsant, and/or antipsychotic drugs besides lithium. In this study, we assessed cardiohemodynamic and electrophysiological effects of lithium carbonate by itself to begin to analyze onset mechanisms of its cardiovascular side effects. Lithium carbonate in intravenous doses of 0.1, 1, and 10 mg/kg over 10 min was cumulatively administered with an interval of 20 min to the halothane-anesthetized beagle dogs (n = 4), which provided peak plasma Li+ concentrations of 0.02, 0.18, and 1.79 mEq/L, respectively, reflecting sub-therapeutic to toxic concentrations. The low and middle doses prolonged the ventricular effective refractory period at 30 min and for 5-30 min, respectively. The high dose decreased the heart rate for 45-60 min, delayed the intraventricular conduction for 15-20 min and the ventricular repolarization at 45 min, and prolonged the effective refractory period for 5-60 min. No significant change was detected in the other cardiovascular variables. Thus, lithium alone may have a wide safety margin against hemodynamic adverse events; however, it would directly and/or indirectly inhibit Na+ and K+ channels, which may synergistically increase the ventricular refractoriness from the sub-therapeutic concentration and decrease the heart rate at the supra-therapeutic one. These findings may partly explain its clinically observed various types of arrhythmias as well as electrocardiographic changes.


Assuntos
Anestesia Geral/métodos , Anestésicos Inalatórios/farmacologia , Antimaníacos/toxicidade , Arritmias Cardíacas/induzido quimicamente , Halotano/farmacologia , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Carbonato de Lítio/toxicidade , Potenciais de Ação/efeitos dos fármacos , Animais , Antimaníacos/administração & dosagem , Arritmias Cardíacas/fisiopatologia , Cães , Relação Dose-Resposta a Droga , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Infusões Intravenosas , Carbonato de Lítio/administração & dosagem , Modelos Animais , Período Refratário Eletrofisiológico/efeitos dos fármacos , Medição de Risco , Fatores de Tempo
8.
Rev Med Liege ; 73(2): 82-87, 2018 Feb.
Artigo em Francês | MEDLINE | ID: mdl-29517871

RESUMO

Since many years a correlation between neuropsychiatric disorders and eating disorders resulting in obesity is well established. According to different studies, 1.2 - 4 % of patients scheduled for bariatric surgery are taking lithium as a mood stabilizer treatment for bipolar disorder. We are presenting a case of lithium toxicity after vertical sleeve gastrectomy surgery in a 40 years-old female. The patient developed severe neurological and renal signs needing an intensive care unit admission and continuous veno-venous hemodiafiltration. A literature review provides insights into physiological and pharmacokinetics changes that could contribute to lithium poisoning after bariatric surgery. This article illustrates the need for closer monitoring of lithium serum levels following bariatric surgery and presents guidance in managing lithium therapy during perioperative period based on experts' opinion.


Assuntos
Antimaníacos/efeitos adversos , Cirurgia Bariátrica , Transtorno Bipolar/tratamento farmacológico , Carbonato de Lítio/efeitos adversos , Adulto , Antimaníacos/administração & dosagem , Overdose de Drogas/terapia , Feminino , Gastrectomia/métodos , Hemodiafiltração , Humanos , Carbonato de Lítio/administração & dosagem
10.
Cell Death Dis ; 8(6): e2880, 2017 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-28617434

RESUMO

Lithium has been marketed in the United States of America since the 1970s as a treatment for bipolar disorder. More recently, studies have shown that lithium can improve cognitive decline associated with Alzheimer's disease (AD). However, the current United States Food and Drug Administration-approved lithium pharmaceutics (carbonate and citrate chemical forms) have a narrow therapeutic window and unstable pharmacokinetics that, without careful monitoring, can cause serious adverse effects. Here, we investigated the safety profile, pharmacokinetics, and therapeutic efficacy of LISPRO (ionic co-crystal of lithium salicylate and l-proline), lithium salicylate, and lithium carbonate (Li2CO3). We found that LISPRO (8-week oral treatment) reduces ß-amyloid plaques and phosphorylation of tau by reducing neuroinflammation and inactivating glycogen synthase kinase 3ß in transgenic Tg2576 mice. Specifically, cytokine profiles from the brain, plasma, and splenocytes suggested that 8-week oral treatment with LISPRO downregulates pro-inflammatory cytokines, upregulates anti-inflammatory cytokines, and suppresses renal cyclooxygenase 2 expression in transgenic Tg2576 mice. Pharmacokinetic studies indicated that LISPRO provides significantly higher brain lithium levels and more steady plasma lithium levels in both B6129SF2/J (2-week oral treatment) and transgenic Tg2576 (8-week oral treatment) mice compared with Li2CO3. Oral administration of LISPRO for 28 weeks significantly reduced ß-amyloid plaques and tau-phosphorylation. In addition, LISPRO significantly elevated pre-synaptic (synaptophysin) and post-synaptic protein (post synaptic density protein 95) expression in brains from transgenic 3XTg-AD mice. Taken together, our data suggest that LISPRO may be a superior form of lithium with improved safety and efficacy as a potential new disease modifying drug for AD.


Assuntos
Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Compostos de Lítio/administração & dosagem , Prolina/administração & dosagem , Administração Oral , Doença de Alzheimer/tratamento farmacológico , Animais , Autofagia , Glicogênio Sintase Quinase 3 beta/metabolismo , Células HeLa , Humanos , Inflamação , Carbonato de Lítio/administração & dosagem , Carbonato de Lítio/sangue , Compostos de Lítio/sangue , Compostos de Lítio/química , Masculino , Camundongos , Camundongos Transgênicos , Microglia/metabolismo , Fagocitose , Fosforilação , Prolina/sangue , Prolina/química , Resultado do Tratamento
11.
Clin Pharmacokinet ; 56(1): 77-90, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27393139

RESUMO

BACKGROUND: Lithium is a well-established treatment for bipolar I disorder in adults. However, there is a paucity of information on its pharmacokinetics/pharmacodynamics in children and adolescents. We aimed to develop the first lithium dosage regimens based on population pharmacokinetics/pharmacodynamics for paediatric patients. METHODS: Lithium concentrations, Young Mania Rating Scale (YMRS) and Clinical Global Impressions-Improvement (CGI-I) scores over 24 weeks were available from 61 paediatric patients with bipolar I disorder. The population pharmacokinetics/pharmacodynamics were co-modelled. Concentrations and clinical effects following several dosage regimens were predicted by Monte Carlo simulations. RESULTS: The pharmacokinetics were well characterised by a two compartment model with linear elimination. Including the effect of total body weight (TBW) or lean body weight (LBW) on clearance and volume of distribution decreased the unexplained inter-individual variability by up to 12 %. The population mean (inter-individual variability) clearance was 1.64 L/h/53 kg LBW0.75 (19 %) and central volume of distribution 23.6 L/53 kg LBW (6.8 %). The average lithium concentration over a dosing interval required for a 50 % reduction in YMRS was 0.711 mEq/L (59 %). A maintenance dose of 25 mg/kg TBW/day lithium carbonate in two daily doses was predicted to achieve a ≥50 % reduction in YMRS in 74 % of patients, while ~8 % of patients would be expected to have trough concentrations above the nominal safety threshold of 1.4 mEq/L. Therefore, therapeutic drug monitoring will still be required even with these dosing strategies. CONCLUSIONS: When accounting for body size, the pharmacokinetic parameters in paediatric patients were within the range of estimates from adults. Pharmacokinetic/pharmacodynamic modelling supported development of practical scientifically-based dosage regimens for paediatric patients.


Assuntos
Antimaníacos/farmacocinética , Antimaníacos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Carbonato de Lítio/farmacocinética , Carbonato de Lítio/uso terapêutico , Adolescente , Antimaníacos/administração & dosagem , Antimaníacos/farmacologia , Peso Corporal , Criança , Relação Dose-Resposta a Droga , Feminino , Meia-Vida , Humanos , Carbonato de Lítio/administração & dosagem , Carbonato de Lítio/farmacologia , Masculino , Taxa de Depuração Metabólica , Modelos Biológicos , Método de Monte Carlo
12.
Bipolar Disord ; 18(7): 563-570, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27805299

RESUMO

OBJECTIVE: This study examined the relationship between the number of prior antidepressant treatment trials and step-wise increase in pharmacodynamic tolerance (or progressive loss of effectiveness) in subjects with bipolar II depression. METHODS: Subjects ≥18 years old with bipolar II depression (n=129) were randomized to double-blind venlafaxine or lithium carbonate monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months. RESULTS: After controlling for baseline covariates of prior medications, there was a 25% reduction in the likelihood of response to treatment with each increase in the number of prior antidepressant trials (odds ratio [OR]=0.75, unstandardized coefficient [B]=-0.29, standard error (SE)=0.12; χ2 =5.70, P<.02], as well as a 32% reduction in the likelihood of remission with each prior antidepressant trial (OR=0.68, B=-0.39, SE=0.13; χ2 =9.71, P=.002). This step-wise increase in pharmacodynamic tolerance occurred in both treatment conditions. Prior selective serotonin reuptake inhibitor (SSRI) therapy was specifically associated with a step-wise increase in tolerance, whereas other prior antidepressants or mood stabilizers were not associated with pharmacodynamic tolerance. Neither the number of prior antidepressants, nor the number of prior SSRIs, or mood stabilizers, were associated with an increase in relapse during continuation therapy. CONCLUSIONS: The odds of responding or remitting during venlafaxine or lithium monotherapy were reduced by 25% and 32%, respectively, with each increase in the number of prior antidepressant treatment trials. There was no relationship between prior antidepressant exposure and depressive relapse during continuation therapy of bipolar II disorder.


Assuntos
Transtorno Bipolar , Carbonato de Lítio , Cloridrato de Venlafaxina , Adulto , Antidepressivos/administração & dosagem , Antidepressivos/classificação , Antidepressivos/farmacocinética , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Método Duplo-Cego , Monitoramento de Medicamentos , Quimioterapia Combinada/métodos , Tolerância a Medicamentos , Feminino , Humanos , Carbonato de Lítio/administração & dosagem , Carbonato de Lítio/farmacocinética , Masculino , Indução de Remissão/métodos , Prevenção Secundária/métodos , Resultado do Tratamento , Cloridrato de Venlafaxina/administração & dosagem , Cloridrato de Venlafaxina/farmacocinética
13.
Pan Afr Med J ; 24: 27, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27583091

RESUMO

We report the case of a 47-years old patient, traited with lithium for manic-depressive psychosis over a period of twenty and admitted to hospital with a disorder of consciousness after suicide attempt with lithium overdose (ingestion of 30 tablets of Téralithe(®) LP 400, delayed action galenic forms corresponding to 12 g of lithium carbonate), clinically improved after three hemodialysis sessions. This study illustrates the therapeutic role of hemodialysis in voluntary intoxications with extended release lithium even a week after the ingestion and the therapeutic insufficiency of a single hemodialysis session.


Assuntos
Antimaníacos/envenenamento , Carbonato de Lítio/envenenamento , Diálise Renal/métodos , Antimaníacos/administração & dosagem , Transtorno Bipolar/tratamento farmacológico , Overdose de Drogas , Humanos , Carbonato de Lítio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Tentativa de Suicídio , Resultado do Tratamento
14.
PLoS One ; 11(8): e0160400, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27487121

RESUMO

Patients who seek dental treatment may have bipolar disorder, and lithium carbonate (LC) is the drug of choice used in the treatment of this disorder. Taking into consideration the controversial results found in the literature, and the possible influence of LC on induced tooth movement, the objective was to evaluate tooth movement induced in rats after administration of lithium carbonate. One hundred and ninety-two rats were divided into 3 groups. In the L group, the animals received daily 60mg/kg of LC, they were not subjected to orthodontic movement, and they were euthanized after 33, 37, 44 or 51 days. In the LM group, the LC was administered for 30 days and during the subsequent 3, 7, 14 and 21 days, corresponding to the period of induced tooth movement, and they received a spring that produced a 30cN force. In the SM group, saline solution was applied. Measurements were made of tooth displacement, the numbers of osteoclasts and serum lithium phosphate (PO4), alkaline phosphatase (ALP) and creatinine levels. The tooth displacement was lower in the LM group compared to the SM group at 44 days. A tendency toward reduction in the number of osteoclasts was observed in the LM group compared to the SM group at 44 days. The average lithium were higher in the L and LM groups compared to the SM group. The opposite was observed for the PO4 group. A higher value for the ALP was found in the L group. The average creatinine level was lower in the LM group. LC inhibited tooth movement for 14 days, possibly due to the reduction in the number of osteoclasts.


Assuntos
Antimaníacos/efeitos adversos , Carbonato de Lítio/efeitos adversos , Técnicas de Movimentação Dentária , Dente/efeitos dos fármacos , Animais , Antimaníacos/administração & dosagem , Remodelação Óssea/efeitos dos fármacos , Esquema de Medicação , Carbonato de Lítio/administração & dosagem , Masculino , Aparelhos Ortodônticos , Ratos , Ratos Wistar , Fatores de Tempo , Dente/fisiologia , Mobilidade Dentária/patologia
16.
Yakugaku Zasshi ; 136(3): 517-21, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26935095

RESUMO

To avoid fluctuation of the serum lithium concentration (CLi), sodium chloride (NaCl) intake was regulated in oral alimentation. A 62-year-old woman was hospitalized and orally administered 400 mg of lithium carbonate a day to treat her mania. Her CLi was found to be 0.75-0.81 mEq/L. Vomiting made it difficult for the patient to ingest meals orally, and therefore parenteral nutrition with additional oral intake of protein-fortified food was initiated. On day 22, parenteral nutrition was switched to oral alimentation to enable oral intake of food. The total NaCl equivalent amount was decreased to 1.2 g/d, and the CLi increased to 1.15 mEq/L on day 26. Oral alimentation with semi-solid food blended in a mixer was immediately initiated. Although the total NaCl equivalent amount was increased to 4.5-5.0 g/d, her CLi remained high at 1.14-1.17 mEq/L on days 33 and 49, respectively. We investigated oral administration of NaCl (1.8 g/d) on day 52. The total NaCl equivalent amount was increased to 6.3-6.8 g/d, and the CLi decreased to 1.08-0.97 mEq/L on days 63 and 104, respectively. After the start of the orally administered NaCl, her diet was changed to a completely blended diet on day 125. The total NaCl equivalent amount was increased to 9.0-14.5 g/d, and the CLi decreased to 0.53 mEq/L on day 152; therefore, the oral administration of NaCl was discontinued on day 166. The CLi was found to be 0.70-0.85 mEq/L on days 176 and 220.


Assuntos
Antimaníacos/administração & dosagem , Overdose de Drogas/prevenção & controle , Carbonato de Lítio/administração & dosagem , Lítio/sangue , Cloreto de Sódio na Dieta/administração & dosagem , Antimaníacos/efeitos adversos , Biomarcadores/sangue , Transtorno Bipolar/sangue , Transtorno Bipolar/tratamento farmacológico , Monitoramento de Medicamentos , Overdose de Drogas/sangue , Overdose de Drogas/diagnóstico , Nutrição Enteral , Feminino , Humanos , Carbonato de Lítio/efeitos adversos , Pessoa de Meia-Idade , Nutrição Parenteral
17.
Arch Womens Ment Health ; 19(2): 429-32, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26790685

RESUMO

The aim of this study was to evaluate the efficacy of lithium prophylaxis during the peripartum period in women with lithium-responsive bipolar I disorder. Seventeen lithium-treated patients were selected and underwent preconception counseling that included both a psychiatric and an obstetric evaluation. Treatment was continued with flexible-doses of lithium combined with supportive psychotherapy throughout the pregnancy and the postpartum period. The results support the prophylaxis efficacy of lithium in lithium-responder bipolar women who have a high risk of severe peripartum recurrences.


Assuntos
Antimaníacos/administração & dosagem , Transtorno Bipolar/prevenção & controle , Depressão Pós-Parto/prevenção & controle , Carbonato de Lítio/administração & dosagem , Complicações na Gravidez/fisiopatologia , Adulto , Antimaníacos/uso terapêutico , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Carbonato de Lítio/uso terapêutico , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
18.
Acta Psychiatr Scand ; 133(6): 459-69, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26803764

RESUMO

OBJECTIVE: To examine the safety and effectiveness of antidepressant versus mood stabilizer monotherapy in rapid versus non-rapid cycling bipolar II disorder. METHOD: Subjects ≥18 years old with bipolar II depression (n = 129) were randomized to double-blind venlafaxine or lithium carbonate monotherapy for 12 weeks. Responders (n = 59) received continuation monotherapy for six additional months. RESULTS: Rapid cycling did not affect frequency of response or change over time in depressive symptoms. Rapid cycling status did not affect frequency of depressive relapse or sustained treatment response. Rapid cyclers were more likely to experience hypomanic symptoms (P = 0.005) during continuation monotherapy; however, rates were similar in venlafaxine (17.6%) and lithium (42.9%) (P = 0.31). CONCLUSION: Rapid cycling status may not be associated with an increased risk of diminished response or greater depressive relapse during venlafaxine, relative to lithium monotherapy, in bipolar II subjects. Additional randomized studies are needed to confirm these findings.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Carbonato de Lítio/administração & dosagem , Cloridrato de Venlafaxina/administração & dosagem , Adulto , Antidepressivos de Segunda Geração/administração & dosagem , Antidepressivos de Segunda Geração/efeitos adversos , Antimaníacos/administração & dosagem , Antimaníacos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Carbonato de Lítio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Cloridrato de Venlafaxina/efeitos adversos
19.
Biol Trace Elem Res ; 169(2): 279-84, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26162622

RESUMO

Present study was planned to determine possible dose-dependent effects of lithium (Li) on oxidant-antioxidant status and histomorphological changes in liver and kidney tissues. For this purpose, twenty-four Wistar male rats were equally divided into three groups: the rats in group I served as controls, drinking tap water without lithium. Groups II and III received 0.1 and 0.2 % lithium carbonate (Li2CO3) through their drinking water, respectively, for 30 days. At the end of the experimental period, lithium concentrations, levels of malondialdehyde (MDA) and glutathione (GSH) and superoxide dismutase (SOD) activities were measured in considered tissues. Histomorphological study was also performed on liver and kidney tissues. Compared to controls, MDA was significantly higher but GSH level lower in groups II and III. SOD activity was higher in group III, but no difference was determined in group II in liver tissue. In kidney tissue, there was no difference determined in MDA and GSH levels between control and experimental groups but SOD activity in groups II and III was significantly higher. In histologic sections of both experimental liver and kidney tissues, specific degenerations were observed. The results of the present study show that treatment with lithium carbonate may result in liver and kidney tissue abnormalities and oxidative damage.


Assuntos
Antidepressivos/efeitos adversos , Rim/efeitos dos fármacos , Peroxidação de Lipídeos/efeitos dos fármacos , Carbonato de Lítio/efeitos adversos , Fígado/efeitos dos fármacos , Animais , Antidepressivos/administração & dosagem , Antidepressivos/farmacocinética , Relação Dose-Resposta a Droga , Rim/metabolismo , Rim/patologia , Carbonato de Lítio/administração & dosagem , Carbonato de Lítio/farmacocinética , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/metabolismo , Cirrose Hepática/patologia , Masculino , Ratos Wistar
20.
Rev. psiquiatr. infanto-juv ; 33(1): 38-42, 2016.
Artigo em Espanhol | IBECS | ID: ibc-185809

RESUMO

El síndrome de Prader-Willi (SPW) es un conocido trastorno del neurodesarrollo de origen genético secundario a la falta de expresión de los genes de la región 15q11-q13 del alelo de procedencia paterna, con una prevalencia estimada de 1:25000 nacimientos. Se caracteriza por la presencia de dismorfia, talla baja, hipogonadismo, sobrepeso, y un fenotipo conductual consistente en problemas de aprendizaje, retraso mental variable, rituales, estereotipias y comportamientos compulsivos, dermatilomanía, rabietas frecuentes, irritabilidad, e hiperfagia. El SPW también se asocia con un mayor riesgo de problemas psiquiátricos, entre los que destacan por su gravedad las psicosis y los trastornos afectivos. Se presenta el caso clínico de un varón de 12 años afecto de SPW en el que aparece de forma brusca un cuadro psicótico atípico de carácter recurrente, discutiéndose tanto su filiación diagnóstica como la intervención terapéutica a la luz de la literatura científica publicada


Prader-Willi syndrome (PWS) is a known neurodevelopmental genetic disorder secondary to lack of expression of the genes of the 15q11-q13 region allele of paternal origin, with an estimated prevalence of 1:25000 births. It is characterized by the presence of dysmorphia, short stature, hypogonadism, overweight, and a behavioral phenotype with learning disabilities, mental retardation, rituals, stereotypies and compulsive behaviors, skin-picking, frequent tantrums, irritability, and hyperphagia. The SPW is also associated with an increased risk of psychiatric symptoms, most notably by its severity psychoses and affective disorders. It is presented the case of a 12-years-old male diagnosed with SPW in which suddenly appears an atypical psychotic episode, discussing both its diagnosis and therapeutic intervention in the light of the published scientific literatur


Assuntos
Humanos , Masculino , Criança , Síndrome de Prader-Willi/complicações , Síndrome de Prader-Willi/tratamento farmacológico , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Antipsicóticos/administração & dosagem , Carbonato de Lítio/administração & dosagem , Aripiprazol/administração & dosagem , Topiramato/administração & dosagem
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