Abstract
Background
Lithium is a commonly prescribed pharmacological treatment for mood disorders. It is associated with a number of side effects and potentially serious toxicity. To date, there is little data from Irish samples on the subject of Lithium toxicity.
Aim
To examine the incidence and clinical correlates of lithium toxicity in Cork, Ireland.
Results
Our study identified 130 cases of biochemical lithium toxicity over 5 years, with an incidence rate of approximately 5.4 cases per 100,000 per year. Mean toxic lithium level was 2.16 mmol/L ±SD 0.87 mmol/L. Of these, 36% cases were reviewed medically in the general hospital at the time of toxicity. A number of issues in relation to lithium toxicity were identified. Neurological symptoms were common, including tremor, confusion, ataxia, drowsiness. However, only 4.2% patients were reviewed by a neurologist while in hospital. Medications that interact with lithium were found in 50% cases, with significant polypharmacy in 15%. The psychiatric services were involved in patient care in 76% cases, and 85% patients presenting with toxicity were reviewed by a psychiatrist. Rates of admission to hospital and haemodialysis were 70 and 11%, respectively.
Conclusion
Improvements in the standards of care in relation to lithium prescribing are required.
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References
Bauer M, Dopfmer S (1999) Lithium augmentation in treatment—resistant depression: a meta-analysis of placebo-controlled studies. J Clin Pharmacol 19:427–434
Baldessarini RJ, Tondo L, Davis P, Pompili M, Goodwin FK, Hennen J (2006) Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord 8:625–639
Cipriani A, Pretty H, Hawton K, Geddes J (2005) Lithium in the prevention of suicidal behaviour and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 162(10):1805–1819
Moore GJ, Bebchuk JM, Hasanat K et al (2000) Lithium increases N-acetyl-aspartate in the human brain: in vivo evidence of support of bcl-2’s neurotrophic effects? Biol Psychiatry 48:1–8
Nunes P, Forlenza O, Gattaz W (2007) Lithium and risk for Alzheimer’s in elderly patients with bipolar disorder. Br J Psychiatry 190:359–360
Goodwin G (1994) Recurrence of mania after lithium withdrawal: implications for the use of lithium in the treatment of bipolar affective disorder. Br J Psychiatry 164:149–152
Johnson G (1998) Lithium-early development, toxicity, and renal function. Neuropsychopharmacology 19(3):200–205
Müller-Oerlinghausen B, Felber W, Berghofer A, Lauterbach E, Ahrens B (2005) The impact of lithium long-term medication on suicidal behavior and mortality of bipolar patients. Arch Suicide Res 9(3):307–319
Gonzalez-Pinto A, Mosquera F, Alonso M et al. (2006) Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment. Bipolar Disord 8(5p2):618–624
Young A, Newham J (2006) Lithium in maintenance therapy for bipolar disorder. J Psychopharmacol 20:17–22
Post R, Denicoff K, Leverich G et al (2003) Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiat 64(6):680
Harris E, Barraclough B (1997) Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 170(3):205
Birch NJ, Groft P, Hullin R, Kehoe R (1993) Lithium prophylaxis: proposed guidelines for good clinical practice. Lithium 4(4):225–230
Schou M (2001) Lithium treatment at 52. J Affect Disord 67(1–3):21–32
Amdisen A (1977) Serum level monitoring and clinical pharmacokinetics of lithium. Clin Pharmacokinet 2(2):73–92
Sproule B (2002) Lithium in bipolar disorder: Can drug concentrations predict therapeutic effect? Clin Pharmacokinet 41(9):639–660
Coppen A, Abou-Saleh M, Milln P, Bailey J, Wood K (1983) Decreasing lithium dosage reduces morbidity and side-effects during prophylaxis. J Affect Disord 5(4):353–362
Alexander M, Farag Y, Mittal B, Rennke H, Singh A (2008) Lithium toxicity: a double-edged sword. Kidney Int 73(2):233–237
Eagles J, McCann I, Neil T, MacLeod N, Paterson N (2000) Lithium monitoring before and after the distribution of clinical practice guidelines. Acta Psychiatr Scand 101(5):349–353
Hansen HE, Amdisen A (1978) Lithium intoxication. (Report of 23 cases and review of 100 cases from the literature). Q J Med 47(186):123–144
Petersen V, Hvidt S, Thomsen K, Schou M (1974) Effect of prolonged thiazide treatment on renal lithium clearance. Br Med J 3:143–145
Finley P, O’Brien J, Coleman R (1996) Lithium and angiotensin-converting enzyme inhibitors: evaluation of a potential interaction. J Clin Psychopharm 16(1):68–71
Ragheb M (1990) The clinical significance of lithium-nonsteroidal: anti-inflammatory drug interactions. J Clin Psychopharm 10(5):350–354
Apte SN, Langston JW (1983) Permanent neurological deficits due to lithium toxicity. Ann Neurol 13(4):453–455
Nagaraja D, Taly A, Sahu R, Channabasavanna S, Narayanan H (1987) Permanent neurological sequelae due to lithium toxicity. Clin Neurol Neurosur 89(1):31–34
Gadallah MF, Feinstein EI, Massry SG (1988) Lithium intoxication: clinical course and therapeutic considerations. Miner Electrolyte Metab 14(2–3):146
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Dennison, U., Clarkson, M., O’Mullane, J. et al. The incidence and clinical correlates of lithium toxicity: a retrospective review. Ir J Med Sci 180, 661–665 (2011). https://doi.org/10.1007/s11845-011-0712-6
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DOI: https://doi.org/10.1007/s11845-011-0712-6