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1.
Encephale ; 46(3S): S126-S127, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32475694
3.
Sci Rep ; 9(1): 17453, 2019 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-31767892

RESUMO

Immune dysfunction is implicated in the etiology of bipolar disorder. The single-nucleotide polymorphism rs17026688 in the gene encoding glutamate decarboxylase-like protein 1 (GADL1) has been found to be associated with lithium response in Han Chinese patients with bipolar I disorder (BDI). However, whether patients with GADL1 polymorphisms have different immunophenotypes is unknown. To address this issue, differences in the immune profiles based on analysis of peripheral blood mononuclear cells (PBMCs) were compared among BDI patients and healthy controls who lack or carry the T allele of rs17026688. BDI patients had significantly higher percentages of total T cells, CD4+ T cells, activated B cells, and monocytes than healthy controls, suggesting that immunologic imbalance might be involved in BDI development or progression. Treatment of BDI patients-derived PBMCs with lithium in vitro increased the percentage of CD14+ monocytes and dendritic cells, suggesting that lithium plays an immunomodulatory role in CD14+ monocytes and dendritic cells. Among BDI patients, non-T carriers had a significantly higher percentage of CD11b+/CD33lo/HLA-DR- myeloid-derived suppressor cells than T carriers. Moreover, only T carriers exhibited differential sensitivity to lithium therapeutic use with respect to the percentage of myeloid cells. These findings suggest that rs17026688 polymorphisms in GADL1 are associated with immune dysfunction in BDI patients.


Assuntos
Antígenos CD/análise , Transtorno Bipolar/imunologia , Carboxiliases/genética , Carbonato de Lítio/uso terapêutico , Subpopulações de Linfócitos/imunologia , Células Supressoras Mieloides/imunologia , Polimorfismo de Nucleotídeo Único , Psicotrópicos/uso terapêutico , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/genética , Grupos Étnicos/genética , Feminino , Humanos , Imunofenotipagem , Carbonato de Lítio/farmacologia , Subpopulações de Linfócitos/química , Subpopulações de Linfócitos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Células Supressoras Mieloides/química , Células Supressoras Mieloides/efeitos dos fármacos , Psicotrópicos/farmacologia
4.
Med Hypotheses ; 131: 109302, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443765

RESUMO

Parkinson's disease (PD) patients have higher rates of melanoma and vice versa, observations suggesting that the two conditions may share common pathogenic pathways. ß-Catenin is a transcriptional cofactor that, when concentrated in the nucleus, upregulates the expression of canonical Wnt target genes, such as Nurr1, many of which are important for neuronal survival. ß-Catenin-mediated activity is decreased in sporadic PD as well as in leucine-rich repeat kinase 2 (LRRK2) and ß-glucosidase (GBA) mutation cellular models of PD, which is the most common genetic cause of and risk for PD, respectively. In addition, ß-catenin expression is significantly decreased in more aggressive and metastatic melanoma. Multiple observational studies have shown smokers to have significantly lower rates of PD as well as melanoma implying that tobacco may contain one or more elements that protect against both conditions. In support, smoker's brains have significantly reduced levels of α-synuclein, a pathological intracellular protein found in PD brain and melanoma cells. Tobacco contains very high lithium levels compared to other plants. Lithium has a broad array of neuroprotective actions, including enhancing autophagy and reducing intracellular α-synuclein levels, and is effective in both neurotoxin and transgenic preclinical PD models. One of lithium's neuroprotective actions is enhancement of ß-catenin-mediated activity leading to increased Nurr1 expression through its ability to inhibit glycogen synthase kinase-3 ß (GSK-3ß). Lithium also has anti-proliferative effects on melanoma cells and the clinical use of lithium is associated with a reduced incidence of melanoma as well as reduced melanoma-associated mortality. This is the first known report hypothesizing that inhaled lithium from smoking may account for the associated reduced rates of both PD and melanoma and that this protection may be mediated, in part, through lithium-induced GSK-3ß inhibition and consequent enhanced ß-catenin-mediated activity. This hypothesis could be directly tested in clinical trials assessing lithium therapy's ability to affect ß-catenin-mediated activity and slow disease progression in patients with PD or melanoma.


Assuntos
Lítio/farmacologia , Melanoma/prevenção & controle , Modelos Biológicos , Fármacos Neuroprotetores/farmacologia , Doença de Parkinson/prevenção & controle , Fumantes , Tabaco/química , Via de Sinalização Wnt/efeitos dos fármacos , beta Catenina/fisiologia , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/prevenção & controle , Autofagia/efeitos dos fármacos , Química Encefálica/efeitos dos fármacos , Avaliação Pré-Clínica de Medicamentos , Glicogênio Sintase Quinase 3 beta/antagonistas & inibidores , Glicogênio Sintase Quinase 3 beta/fisiologia , Humanos , Incidência , Serina-Treonina Proteína Quinase-2 com Repetições Ricas em Leucina/genética , Serina-Treonina Proteína Quinase-2 com Repetições Ricas em Leucina/metabolismo , Lítio/análise , Lítio/uso terapêutico , Carbonato de Lítio/uso terapêutico , Melanoma/epidemiologia , Mutação , Fármacos Neuroprotetores/análise , Membro 2 do Grupo A da Subfamília 4 de Receptores Nucleares/biossíntese , Membro 2 do Grupo A da Subfamília 4 de Receptores Nucleares/genética , Doença de Parkinson/epidemiologia , Transtornos Parkinsonianos/tratamento farmacológico , Água/química , Via de Sinalização Wnt/fisiologia , alfa-Sinucleína/metabolismo , beta-Glucosidase/genética
5.
Bull Exp Biol Med ; 167(1): 87-90, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31177458

RESUMO

We studied the effect of lithium carbonate on hepatocellular carcinoma-29 cells in CBA male mice after injection in a dose of 20 mM along the tumor periphery. Transmission electron microscopy revealed a decrease in the volume density of the granular endoplasmic reticulum in the cell cytoplasm and an increase in the total numerical and volume density of autophagosomes and autolysosomes and zones of destruction of intracellular organelles. The ability of lithium carbonate to activate intracellular degradation processes in tumor cells and to stimulate cell death can be used to develop new combined strategies in the chemotherapy for hepatocellular carcinoma.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/ultraestrutura , Carbonato de Lítio/uso terapêutico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/ultraestrutura , Animais , Autofagia/efeitos dos fármacos , Carcinoma Hepatocelular/tratamento farmacológico , Linhagem Celular Tumoral , Neoplasias Hepáticas/tratamento farmacológico , Camundongos , Camundongos Endogâmicos CBA , Microscopia Eletrônica de Transmissão
6.
Neuro Endocrinol Lett ; 40(1): 17-21, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31184818

RESUMO

Lithium is widely used in psychiatry to treat bipolar affective disorders since 1970 but little is known about the incidence, clinical course and associated factors of acute lithium intoxication. Moderate and severe cases of lithium intoxication are rare. This case reports a patient with acute lithium intoxication (serum level of 3.7 mmol/L) with neurological symptoms imitating stroke, which affects the differential diagnosis in the pre-hospital and hospital care. Patient was treated with forced diuresis and dismissed 21 days after admission.


Assuntos
Antimaníacos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Overdose de Drogas/diagnóstico , Carbonato de Lítio/efeitos adversos , Acidente Vascular Cerebral/diagnóstico , Idoso , Antimaníacos/uso terapêutico , Diagnóstico Diferencial , Overdose de Drogas/sangue , Feminino , Humanos , Lítio/sangue , Carbonato de Lítio/uso terapêutico
7.
J Affect Disord ; 256: 433-440, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31234022

RESUMO

BACKGROUND: In the last five years, the debate around the comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) has flourished within the international psychiatric community and several studies have been published on therapeutic strategies. METHODS: An update of our previous systematic review was conducted on clinical management of comorbid BD-OCD patients. Relevant papers published from July 1st 2013 to September 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: Fifteen studies were included. In all selected studies BD-OCD patients received mood stabilizers, alone or with second-generation antipsychotics (SGAs). Aripiprazole augmentation demonstrated to be effective as maintenance therapy and for treating obsessive-compulsive symptoms during manic episodes (40% of the studies, 6/15). Addition of antidepressants to mood stabilizers led to clinical remission of both conditions in only one case report. LIMITATIONS: Almost 50% of the selected studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS: Mood stabilization should be the primary goal in treating BD-OCD patients. Aripiprazole augmentation to lithium carbonate seemed to be the best option in treatment-resistance comorbid patients. Addition of SRIs may be needed only in a minority of BD patients with refractory OCD.


Assuntos
Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Adulto , Antidepressivos/uso terapêutico , Aripiprazol/uso terapêutico , Transtorno Bipolar/psicologia , Comorbidade , Quimioterapia Combinada , Feminino , Humanos , Carbonato de Lítio/uso terapêutico , Masculino , Transtorno Obsessivo-Compulsivo/psicologia , Resultado do Tratamento , Adulto Jovem
8.
Medicine (Baltimore) ; 98(19): e15573, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083231

RESUMO

BACKGROUND: Rapid I-131 turnover Graves' disease patients have low cure rate. We aimed to compare cure percentage at 12 months among 3 treatment doses of I-131 with or without lithium carbonate (LiCO3) in rapid turnover Graves' disease patients. METHODS: Sixty Graves' disease patients referred for radioactive iodine treatment were randomised into three arms of treatment: Group A, 3.7 MBq I-131/g thyroid plus 600 mg/day LiCO3, Group B, 5.55 MBq I-131/g plus 600 mg/day LiCO3, and Group C, 7.4 MBq I-131/g without LiCO3. Data were collected at baseline, 3, 6, 9, and 12 months. The primary endpoint were cure rates (percentage of euthyroid or hypothyroid) at 12 months. Pairwise comparisons were made across 3 groups using an equality of proportions test. The secondary endpoint, the odds of cure over the total follow-up for group B and C versus group A, was analyzed using generalized estimating equation (GEE). Side effects of I-131 and LiCO3 treatment were evaluated at 1 to 2 weeks after treatment. RESULTS: The cure rate at 12 months was 45% (9/20) for group A, 60% (12/20) for group B and 80% (16/20) for group C. The mean difference in proportion cured at 12 months between group C and group A was 35 (7.0 to 66.8)%; P-value = .02. There was a statistically significant difference between cure rates over all follow-up of group C and A after adjustment for sex (adjusted OR = 3.09; 95%CI = 1.32-7.20; P-value = .009), but no significant difference was found between group B and A or C and B in the primary and/or secondary efficacy endpoints. Side effects from the treatment were found in 12% (7/60); 2 in group A, 4 in group B, and 1 in group C. Four of these were likely due to LiCO3 side effects. CONCLUSIONS: Treatment of rapid turnover Graves' disease patients with high dose I-131 (7.4 MBq/g) provides significantly higher cure rates at 12 months, and 3 times odds of cure than 3.7 MBq/g I-131 plus LiCO3 with lesser side effects. We thus recommend 7.4 MBq I-131/g for treatment in these patients.


Assuntos
Doença de Graves/terapia , Radioisótopos do Iodo/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores Enzimáticos/uso terapêutico , Feminino , Seguimentos , Doença de Graves/metabolismo , Humanos , Radioisótopos do Iodo/efeitos adversos , Radioisótopos do Iodo/metabolismo , Carbonato de Lítio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Resultado do Tratamento , Adulto Jovem
9.
Eur Neuropsychopharmacol ; 29(6): 691-700, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31078359

RESUMO

In recent years, the use of atypical antipsychotics and combination therapy for relapse prevention in bipolar disorder has increased substantially. However, real-world data on the comparative effectiveness of these treatment options are largely non-existent. We conducted a population-based cohort study, using data from Swedish national registers. All patients aged 18-75 years who were hospitalized for mania 2006-2014 and filled at least one prescription of lithium, valproate, olanzapine, quetiapine, aripiprazole or any combination of these drugs were included, and followed for up to one year after hospital discharge, generating follow-up data from 5 713 hospitalizations. We used Cox proportional hazard regression models to study time to treatment failure for each individual drug and combination therapy, using lithium as comparator. Treatment failure was defined as treatment discontinuation, switch, or rehospitalization, and the results were adjusted for clinical and sociodemographic factors. We found that treatment failure occurred in 85% of cases and that the majority of combination therapies were associated with lower risks of treatment failure compared to monotherapies. Patients combining lithium + valproate + quetiapine had the lowest risk of treatment failure (adjusted HR [AHR] 0.40, 95% CI 0.30-0.54), followed by patients on lithium + valproate + olanzapine (AHR 0.55, 95% CI 0.45-0.68). In contrast, monotherapies with antipsychotics were associated with significantly higher risks of treatment failure compared to single use of lithium. In conclusion, our results support experimental findings, suggesting that combination therapy is more effective than monotherapy after a manic episode.


Assuntos
Antimaníacos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Quimioterapia Combinada/métodos , Quimioterapia de Manutenção/métodos , Adolescente , Adulto , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Carbonato de Lítio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Sistema de Registros , Fatores Socioeconômicos , Suécia , Falha de Tratamento , Adulto Jovem
10.
J Affect Disord ; 251: 136-140, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30921597

RESUMO

BACKGROUND: Lithium augmentation (LA) of antidepressants is an effective strategy for treatment-resistant depression (TRD). Nevertheless, it is rarely used in geriatric patients. The purpose of this study was to investigate treatment response of LA in geriatric compared to non-geriatric patients. METHOD: In a prospective multicenter cohort study, severity of depression was measured weekly in 167 patients with unipolar depression (nage≥65years = 22; nage<65years = 145) at baseline and over at least four weeks of LA. RESULTS: Geriatric patients showed a significantly better response to LA compared to non-geriatric patients (Hazard Ratio = 1.91; p = 0.04). LIMITATIONS: An important limitation of our study is the lack of a control group of LA and the missing evaluation of side effects in both groups. CONCLUSIONS: This is the first study investigating the efficacy of LA for TRD in geriatric compared to non-geriatric patients. Our data suggest that LA is an effective treatment option in geriatric patients that clinicians might consider more frequently and earlier on in the course of treatment.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Carbonato de Lítio/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
11.
J Affect Disord ; 249: 15-19, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30743017

RESUMO

BACKGROUND: Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry, but treatment of BD-OCD remains a clinical challenge. Although serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. METHODS: A systematic review was conducted on aripiprazole augmentation in treating comorbid BD-OCD patients. Relevant papers published through August 31st 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: Aripiprazole augmentation to mood stabilizers (lithium carbonate, valproate), even at low doses (10-15 mg/day), helped to achieve significant remission in affective and obsessive-compulsive symptoms. Aripiprazole was generally safe and well tolerated. LIMITATIONS: Most studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS: Keeping in mind scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that aripiprazole augmentation to mood stabilizers, even at low doses, is effective in BD-OCD patients.


Assuntos
Aripiprazol/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Antimaníacos/uso terapêutico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Comorbidade , Humanos , Carbonato de Lítio/uso terapêutico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia
12.
Eur J Drug Metab Pharmacokinet ; 44(3): 329-338, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30536114

RESUMO

BACKGROUND AND OBJECTIVE: Lithium, which is used to treat bipolar disorder, has a narrow therapeutic blood concentration range and quickly reaches clinically toxic levels. We performed a population pharmacokinetic analysis with a lithium tubular reabsorption model including urinary pH and investigated the relationship between blood lithium concentration and tremor as a side effect. METHODS: Routine clinical data, including 389 serum concentrations, were collected from 214 patients orally administered an adjusted amount of lithium carbonate. Pharmacokinetics were described using a one-compartment distribution model with first-order absorption and elimination. The fractions of the MID (Li+ + LiCO3-) and ION (2Li+ + CO32-) forms were calculated using the Henderson-Hasselbalch equation, and the influences of these fractions on clearance (CL) were evaluated. The rate of tremor development was analyzed using a logit model. RESULTS: Oral apparent CL (CL/F) was explained by nonrenal CL and renal CL, and renal CL was varied by the fractions of lithium forms influenced by urinary pH. The contribution of MID to CL was slightly larger than that of ION. The rate of tremor development was estimated to be more than 30% when the trough lithium concentration was greater than 1.26 mEq L-1. CONCLUSION: Renal function and urinary pH are important indices in lithium treatment, so the serum concentration of lithium may be predicted based on the renal function and urinary pH.


Assuntos
Antimaníacos/efeitos adversos , Antimaníacos/farmacocinética , Túbulos Renais/metabolismo , Carbonato de Lítio/efeitos adversos , Carbonato de Lítio/farmacocinética , Modelos Biológicos , Antimaníacos/uso terapêutico , Feminino , Meia-Vida , Humanos , Testes de Função Renal , Carbonato de Lítio/uso terapêutico , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Tremor/induzido quimicamente
13.
J Clin Psychopharmacol ; 39(1): 67-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30566418

RESUMO

PURPOSE/BACKGROUND: Loss of gray matter after stroke has been associated with cognitive impairment. This pilot study aimed to investigate the therapeutic potential of lithium, a putative neurotrophic agent, in the stroke recovery process within a year of stroke occurrence. METHODS: Twelve stroke patients (mean ± SD age, 71.1 ± 11.9 years) were recruited to the study, and eligible participants were prescribed open-label lithium for 60 days. Magnetic resonance imaging was used to assess global gray matter at baseline and end of treatment; global cognition was assessed using the standardized Mini-Mental State Examination and Montreal Cognitive Assessment, and verbal memory was evaluated using the Hopkins Verbal Learning Test-Revised. FINDINGS/RESULTS: There was no difference in global gray matter volume between baseline and follow-up (t = 1.977, P = 0.074). There was a significant interaction between higher lithium dose and increased global gray matter volume (F = 14.25, P = 0.004) and a correlation between higher lithium dose and improved verbal memory (r = 0.576, P = 0.05). IMPLICATIONS/CONCLUSIONS: Lithium pharmacotherapy may be associated with gray matter volume change and verbal memory improvement in stroke patients, providing a rationale for future trials assessing therapeutic potential of lithium in a poststroke population.


Assuntos
Atrofia/tratamento farmacológico , Transtornos Cognitivos/tratamento farmacológico , Substância Cinzenta/patologia , Carbonato de Lítio/uso terapêutico , Memória/efeitos dos fármacos , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Atrofia/complicações , Transtornos Cognitivos/complicações , Feminino , Humanos , Carbonato de Lítio/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Neuroimagem , Exame Neurológico , Testes Neuropsicológicos , Projetos Piloto , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/patologia , Resultado do Tratamento
14.
IEEE Trans Biomed Eng ; 66(1): 130-137, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29993417

RESUMO

GOAL: Lithium preparations are considered the most reliable mood stabilizers for patients with Bipolar Disorder (BD), and are the most effective at reducing the risk of suicide. However, maintaining blood lithium concentration within the narrow therapeutic range of 0.4-1.2 mEq is crucial but extremely difficult. The aim of this work is to develop a personal lithium blood level analyzer using a novel method of combined optical and electrical impedance spectroscopy to test micro volumes of spiked samples of human blood. RESULTS: Impedance measurements alone showed a limit of detection of less than 0.1 mEq within the therapeutic range, whereas optical measurements could verify the presence of lithium and provide a degree of lithium content. Optical specificity to lithium was further verified in qualitative assessment of lithium spiked blood samples with varying concentrations of sodium. Moreover, analysis of multiple linear regression yielded a prediction model of R2 = 0.322716 and RMSEP = 0.223602 for optical measurements only using feature wavelengths, which were found to appear at minima 560 and 605 nm. Combined with impedance measurements, prediction of lithium concentration in samples with unknown lithium content was significantly increased to R2 = 0.876438 and RMSEP = 0.513554. CONCLUSION: The combination of optical and impedance modalities for determinations of blood lithium resulted in significant improvement to the sensitivity and accuracy of measurement. SIGNIFICANCE: Results are complementary of the proposed opto-impedance method, and future work will now focus on the technical development of an integrated and miniaturized system for measurement of lithium levels in blood with a high level of accuracy and sensitivity.


Assuntos
Antimaníacos/sangue , Transtorno Bipolar/tratamento farmacológico , Lítio/sangue , Análise Espectral/métodos , Humanos , Limite de Detecção , Modelos Lineares , Carbonato de Lítio/sangue , Carbonato de Lítio/uso terapêutico , Reprodutibilidade dos Testes
15.
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
16.
Eur Neuropsychopharmacol ; 28(12): 1351-1359, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30243681

RESUMO

To critically examine the effectiveness of lithium in preventing depressive symptoms (mixed and depressive episodes) in real life settings, taking into account adherence to drug treatment and its implications for the clinical costs of the disease. Overall, 72 patients with bipolar disorder initially treated with lithium carbonate were included and followed-up for 10 years. Patients were assessed every 8 weeks for morbidity and alcohol/drug consumption. Patients with good adherence to lithium had fewer episodes with depressive features than poor adherers (B = 2.405, p = 0.046) and also fewer manic and hypomanic episodes (B = 2.572; p < 0.001), after controlling for confounders. Time to relapse into a depressive or mixed episode and into a manic or hypomanic episode was shorter in patients with poor adherence. The costs of the 1.95 ±â€¯2.38 (mean ±â€¯standard deviation) admissions of adherent patients through the 10 years of follow-up were €10,349, while the costs of the 6.25 ±â€¯4.92 admissions of non-adherent patients were €44,547. In clinical practice settings, long-term lithium salts seem to have a preventive effect on depressive symptoms.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Depressão/prevenção & controle , Carbonato de Lítio/uso terapêutico , Adesão à Medicação , Psicotrópicos/uso terapêutico , Adulto , Transtorno Bipolar/economia , Depressão/economia , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Carbonato de Lítio/economia , Masculino , Admissão do Paciente/economia , Psicotrópicos/economia , Recidiva , Análise de Sobrevida , Resultado do Tratamento
17.
East Asian Arch Psychiatry ; 28(3): 80-84, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30146495

RESUMO

OBJECTIVE: This study aimed to compare aripiprazole with lithium for the effectiveness of treating Iranian male patients with acute mania. METHODS: A total of 30 male in-patients with bipolar I disorder who presented with relapse or new emergence of an episode of acute mania were equally randomised to receive 4 weeks of aripiprazole (5 mg uncoated tablets) or lithium carbonate (300 mg uncoated tablets) according to standard practice guidelines and titration protocols. The Manic State Rating Scale (MSRS) was used to determine the severity of manic symptoms at baseline (week 0) and up to week 4. The Bech-Rafaelsen Mania Scale (BRMS), Schedule for Assessment of Insight (SAI), and Clinical Global Impressions-Global Improvement scale (CGI-G) were used to determine the severity of manic symptoms, insight, and overall illness severity, respectively. All outcome measures were recorded by a single experienced psychiatrist. RESULTS: The frequency and intensity of manic symptoms (MSRS score) in both groups decreased significantly from baseline to week 4. In the aripiprazole and lithium groups, the intensity of manic symptoms decreased by ≥25% in 5 and 7 patients and by >50% in 1 and 5 patients, respectively. Between-group analysis showed that lithium was more effective at weeks 3 and 4 in decreasing the frequency and intensity of manic symptoms. The lithium group achieved greater improvement in symptoms than the aripiprazole group in terms of BRMS score, SAI score, and CGI-G. CONCLUSION: Lithium is more effective than aripiprazole in improving manic symptoms.


Assuntos
Aripiprazol/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Carbonato de Lítio/uso terapêutico , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/diagnóstico , Método Duplo-Cego , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
18.
Neuropsychopharmacology ; 43(11): 2256-2263, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29946107

RESUMO

The need for treatment response predictive biomarkers is being increasingly recognized in children and adolescents with psychiatric disorders. Structural gray matter abnormalities as a predictor of treatment outcome in pediatric bipolar disorder have not been systematically investigated, especially early in the illness course. With a prospective longitudinal study design, the present study enrolled 52 bipolar adolescents with no history of treatment with mood stabilizers or a therapeutic dose of antipsychotic drugs and 31 healthy controls. Patients were randomly assigned to treatment with quetiapine or lithium after pretreatment data collection. A hierarchical cluster analysis was performed using pretreatment cortical thickness data that identified two discrete patient subgroups. Compared to healthy subjects, patients in subgroup 1 (n = 16) showed widespread greater cortical thickness mainly across heteromodal cortex but also involving some regions of unimodal cortex, while those in subgroup 2 (n = 36) showed regional cortical thinning mainly in superior temporal and superior parietal regions. Patients within subgroup 1 showed a significantly higher response rate to quetiapine than those in subgroup 2 (100% vs 53%). No statistically significant difference was found in lithium response rate between the patient subgroups (63% vs 53%). Pretreatment clinical ratings and neuropsychological data did not differ across subgroups. Our findings suggest the existence of distinct and clinically relevant subgroups of pediatric bipolar patients, as defined by pattern of cortical thickness. These groups appear to differentially respond to antipsychotic treatment-notably with greater cortical thickness relative to controls predicting better treatment response.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/tratamento farmacológico , Córtex Cerebral/diagnóstico por imagem , Carbonato de Lítio/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Adolescente , Antidepressivos/farmacologia , Córtex Cerebral/efeitos dos fármacos , Criança , Feminino , Humanos , Carbonato de Lítio/farmacologia , Imagem por Ressonância Magnética/métodos , Masculino , Tamanho do Órgão , Valor Preditivo dos Testes , Fumarato de Quetiapina/farmacologia , Resultado do Tratamento
19.
Paediatr Drugs ; 20(4): 303-314, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29651656

RESUMO

Lithium has been an intriguing treatment option in psychiatry for over a century. While seemingly just a simple elemental compound, it has powerful treatment effects for both depression and bipolar disorder. The evidence base for treatment of pediatric bipolar disorder is relatively small, but, in recent years, additional clinical trial data have enabled lithium to re-emerge as a valuable and, in many cases, preferred treatment. Pharmacologically, lithium is complex, with varied effects at both intracellular and extracellular levels. As a treatment for bipolar disorder in pediatrics, lithium is challenging, given its narrow therapeutic window and myriad of potential side effects. However, the efficacy of lithium continues to match that of newer pharmacologic agents, and its tolerability has been shown to be comparable with more commonly prescribed medications. Lithium is still one of few drugs that have been proven to reduce the risk of suicidality, and it may have utility in illnesses beyond affective disorders. Practically, as a primary agent or as an adjunct, lithium continues to claim a rightful place in the treatment armamentarium of child psychiatry. New dosing paradigms have improved tolerability and reduced potential side effects. Recent evidence affirms that lithium is effective for pediatric bipolar disorder in multiple phases of the illness.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Carbonato de Lítio/uso terapêutico , Adolescente , Criança , Humanos
20.
Arch. argent. pediatr ; 116(2): 319-321, abr. 2018. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-887478

RESUMO

El tratamiento con litio forma parte de la terapia habitual en las personas que sufren el trastorno bipolar. Habitualmente, aquellas madres que desean dar el pecho a sus hijos son sometidas a la disyuntiva entre modificar el tratamiento o bien administrar lactancia artificial. La administración de litio durante la lactancia materna se ha asociado con diversos efectos adversos en el lactante, tales como alteraciones tiroideas, hipotermia o hipotonía, entre otros. Son pocas las publicaciones en las que no se observan dichas anomalías en los lactantes. A continuación, se presenta el caso de un lactante amamantado por su madre en tratamiento con litio que no presentó alteraciones renales ni tiroideas.


Lithium therapy is currently a cornerstone of treatment for mothers who suffer bipolar disorders. Those who wish to breastfeed their children are often told they have to decide whether modifying the treatment for their disorder or even avoiding lactation. Lithium administration during breastfeeding has been described to produce certain side effects such as thyroid disorders, hypothermia and hypotonia. To our knowledge, there are few publications where infants have no laboratory abnormalities. Here we present the case of an infant without renal or thyroid alteration while he was breastfed.


Assuntos
Humanos , Feminino , Recém-Nascido , Adulto , Transtorno Bipolar/tratamento farmacológico , Aleitamento Materno , Fármacos do Sistema Nervoso Central/uso terapêutico , Carbonato de Lítio/uso terapêutico
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