A lithium clinic for bipolar patients: 2-year outcome of the first 148 patients

OBJECTIVE

This paper describes the outcome for the first 148 patients referred to a lithium clinic.

METHOD

Two-year follow-up data from treatment charts are reported for all patients entering a lithium clinic in the study period.

RESULTS

Lithium was given as the only mood stabilizer in 132 (89.2%) of the cases. Thirty-two (21.6%) patients were readmitted with a new affective disorder episode. Twenty-nine (19.6%) patients discontinued treatment prematurely. Variables predicting the recurrence of new affective disorder episodes as well as premature discontinuation of treatment were identified.

CONCLUSION

The majority of bipolar patients received lithium for prophylaxis against recurrent affective disorder episodes. The outcome was moderate but comparable to the 30-40% improvement usually reported in follow-up studies of bipolar patients given long-term prophylactic treatment with lithium. Better long-term treatment results for bipolar patients depend on both the development of more effective mood stabilizing drugs or drug combinations and the improvement of patients' adherence to treatment.

[Mortality in patients with affective disorder who commenced treatment with lithium. A 16-year follow-up]

INTRODUCTION

Lithium treatment is claimed to reduce mortality in patients with affective disorder, but the evidence is conflicting. The aim of this study was to estimate mortality rates from a cohort of such patients, who commenced treatment with lithium, over an observation period of 16 years.

MATERIAL AND METHODS

The mortality rates of affectively ill patients, who commenced lithium treatment, were compared with the mortality rates in the general Danish population, standardised for age, sex, and a time to death from all causes, suicide, and cardiovascular death. Comparison of the time from a two-year follow-up to death from any cause between patients compliant and non-compliant with two years of lithium treatment was performed with the Cox regression analysis.

RESULTS

Forty of the 133 patients who participated in the study died during the 16-year observational period; 11 from suicide. Mortality in the patients was twice that of the background population. This statistically significantly higher mortality was predominantly caused by the number of suicides, whereas mortality from all other causes was similar to the background population. Thirty-two patients died after the first two years of observation and were included in the analysis of association between death and two years of compliance with lithium. Suicide occurred more frequently in the lithium non-compliant patients than in the lithium compliant patients.

DISCUSSION

Mortality, particularly death from suicide, was significantly increased in unselected affective disorder patients, who commenced lithium treatment, as compared with the background population.

A lithium clinic for bipolar patients: 2-year outcome of the first 148 patients

OBJECTIVE

This paper describes the outcome for the first 148 patients referred to a lithium clinic.

METHOD

Two-year follow-up data from treatment charts are reported for all patients entering a lithium clinic in the study period.

RESULTS

Lithium was given as the only mood stabilizer in 132 (89.2%) of the cases. Thirty-two (21.6%) patients were readmitted with a new affective disorder episode. Twenty-nine (19.6%) patients discontinued treatment prematurely. Variables predicting the recurrence of new affective disorder episodes as well as premature discontinuation of treatment were identified.

CONCLUSION

The majority of bipolar patients received lithium for prophylaxis against recurrent affective disorder episodes. The outcome was moderate but comparable to the 30-40% improvement usually reported in follow-up studies of bipolar patients given long-term prophylactic treatment with lithium. Better long-term treatment results for bipolar patients depend on both the development of more effective mood stabilizing drugs or drug combinations and the improvement of patients' adherence to treatment.

Sixteen-year mortality in patients with affective disorder commenced on lithium

BACKGROUND

Lithium treatment is claimed to reduce mortality in patients with affective disorder, but the evidence is conflicting.

AIM

To estimate mortality rates from a cohort of patients with affective disorder commenced on lithium with an observation period of two years and a follow-up after 16 years.

METHOD

The mortality rates of patients were compared with those of the general Danish population, standardised for age, gender and calendar time with respect to death from all causes, suicide and death from cardiovascular disease.

RESULTS

Forty of the study's 133 patients died during the 16-year observation period (11 from suicide). Mortality among patients commenced on lithium was twice that of the general population. The statistically significantly elevated mortality was due largely to an excess of suicides; mortality from all other causes was similar to the background populations. Thirty-two patients died after the first two years of observation and were included in the analysis of the association between death and treatment compliance. Suicide occurred more frequently among those patients not complying with treatment.

CONCLUSION

Mortality, especially suicide, was significantly increased in unselected patients with affective disorder commenced on lithium relative to the general population.

Outcome of lithium prophylaxis: a prospective follow-up of affective disorder patients assigned to high and low serum lithium levels

The purpose of the study was to examine the outcome of long-term lithium treatment in consecutively admitted affective disorder patients assigned to high and low serum lithium levels. A total of 91 patients were diagnosed according to DSM-III criteria and randomly allocated to two open treatment groups in which prophylactic lithium was administered in high (serum lithium 0.8-1.0 mmol L-1) and low (serum lithium 0.5-0.8 mmol L-1) doses, respectively. The patients were followed for 2 years or until discontinuation of lithium treatment or readmission to hospital for recurrence of affective illness. The main outcome of the treatment groups was compared with Kaplan-Meier survival curves and by Cox regression analysis. A total of 31 patients (34%) completed 24 months of prophylactic lithium treatment without recurrence and readmission to hospital. In total, 18 patients (20%) suffered a recurrence on lithium, and 42 patients (46%) discontinued lithium or were lost to follow-up. No effect of treatment group was seen, either for the total patient group or for the large subgroup of bipolar patients when analysed separately. A number of patients did not maintain their original assignment to the high serum lithium levels group. The results were analysed both according to assignment and according to actual serum lithium levels. Abuse of alcohol or medication was associated with a poor outcome. Only one third of the patients completed 2 years of lithium prophylaxis successfully. No difference in the protection against recurrences was observed between patients maintained on high and low serum lithium levels.

Foot deformity and the length of the triceps surae in Danish children between 3 and 17 years old

We report the results of examination in 1991 of 759 children and adolescents between 3 and 17 years old, comprising 98% of pupils in different age groups from seven schools and ten kindergartens in Funen (Denmark). The triceps surae was considered to be short if the foot held with the talus in neutral position relative to the calcaneus could only be dorsiflexed to a right angle. The proportion of children with shortening of one or both triceps surae rose from 24% to 62% between the ages of 3 and 17 years with no difference between the sexes. In 13% of adolescents, one or both feet failed to reach a right angle by > or = 5 degrees. Footprints made in 1,520 feet showed that the proportion of feet with a high arch increased from 2% to 7%; there was a smaller number of such feet with a short triceps surae than in feet with a normal arch. The proportion of feet with a flat arch declined from 42% to 6% in spite of a strong relationship with a short triceps surae. In the oldest age group, all the flat feet had a short triceps surae, which is probably one of the reasons for the persistence of the deformity.

[Incidence of complaints about heel-, knee- and back-related discomfort among Danish children, possible relation to short muscles]

Four hundred and fifty-nine children and adolescents from third, sixth and ninth classes in seven schools on Funen were questioned in 1991. Seven percent had complaints from back and knee, and 3% from the heel. When the hamstrings were so short that one knee had an extension deficit gently measured to more than 40 degrees, when the hip was flexed 90 degrees, the incidence of back pain rose significantly to 15%. Furthermore 18% had complaints from the knee and 35% from the heel when the passive range of motion of the foot was less than 0 degrees of dorsiflexion measured with the knee extended. As 75% of the boys and 35% of the girls over age ten have short hamstrings and 13% of both sexes have short Achilles tendons, it is recommended that school children be involved in a daily stretching programme in order to diminish the complaints from the extremities often seen in this group.

[Foot deformities and relation to the length of leg muscles in Danish children aged 3-17 years]

Seven hundred and sixty-nine children and adolescents from three to seventeen years of age, being 98% of the pupils in different classes in seven schools and ten kindergartens on Funen, Denmark, were examined in 1991. The Triceps Surae muscle was found to be too short, if the corrected foot can only be pressed slowly to the right angle. The 1520 footprints showed an increase in the number of highly-arched feet through the age groups from 2.3% to 7.3% and a decrease in flat-footedness from 41.8% to 5.7%. In the two oldest age groups, 39% of those with a high arch, 56% of those with a normal arch and 77% of those with flat feet had short calf muscles. We therefore conclude, that it is necessary that a few minutes be spent daily in Danish kindergartens and schools on stretching the triceps surae.

[Incidence of short hamstrings and leg muscles at ages 3-17 years]

In 1991, 769 children and adolescents, 98% of the pupils in the various age groups in seven schools and ten kindergartens on Funen, were examined. Seventy-five percent of the boys and 35% of the girls over the age of ten proved to have such short hamstrings that one knee had a extension deficit without violence of > or = 40 degrees when the hip was flexed 90 degrees. More than 10% of the boys over the age of ten had an extension deficit of > or = 60 degrees. Forty-five children had a difference > or = 15 degrees between the two legs. The triceps surae muscles are too short if the corrected foot can only be pressed slowly to the right angle. This was found to be the case for 25-64% of the children from the age of three to 17. Therefore, we must conclude that it is necessary to allow time in kindergarten and school for the children to stretch their muscles a few minutes daily.

Innate bacteriostatic and bactericidal activity of normally sterile human body fluids

Forty-four cerebrospinal fluids and 14 pleural fluids were tested for innate bacteriostatic and bactericidal activity against six pathogens. Innate activity was demonstrated in only two cerebrospinal and two pleural fluids. Serum static and cidal activity was demonstrated in four specimens from patients with negative fluid activity. The conclusion is that innate static and cidal activity in serum is not usually present in cerebrospinal and pleural fluid.