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Relationship Between Serum Lithium Level and Clinical Response in Acute Mania Treated with Lithium

Published online by Cambridge University Press:  29 January 2018

Robert F. Prien
Affiliation:
VA-NIMH Collaborative Study on Lithium Carbonate Therapy in Affective Disorders, Central NP Research Laboratory, Veterans Administration Hospital, Perry Point, Maryland, U.S.A. U902
Eugene M. Caffey Jr
Affiliation:
Psychiatry Division, Psychiatry, Neurology and Psychology Service, Veterans Administration Central Office, Washington, D.C., U.S.A.
C.James Klett
Affiliation:
Central NP Research Laboratory, Veterans Administration Hospital, Perry Point, Maryland, U.S.A.

Extract

In 1968, the Veterans Administration and the National Institute of Mental Health organized a multi-hospital collaborative study on the effectiveness of lithium carbonate in acute mania. Two hundred and fifty five newly-admitted patients with this disorder were randomly assigned to lithium or chlorpromazine treatment for a three-week period. Patients were classified as highly active or mildly active on the basis of hyperactivity shown at admission. Results have been reported in a previous paper (7). Briefly, it was found that chlorpromazine was significantly superior to lithium in treating the highly active patient: chlorpromazine acted more quickly than lithium, produced significantly fewer treatment failures, and had a lower incidence of severe side effects. The difference between treatments was less clear-cut with mildly active patients, although lithium appeared to be the better treatment. Both drugs effectively reduced manic symptomatology, but lithium produced fewer severe side effects and left the patient less sluggish and fatigued. The poor results with lithium among highly active patients were attributed to the drug's relatively slow onset of action. As a group, highly active patients on lithium showed relatively little change in manic behaviour during the first week; it was ten days before some patients showed any improvement. Almost 40 per cent of the highly active patients had to be taken off lithium before the end of three weeks because of unmanageable behaviour or toxicity. In contrast, chlorpromazine, with its quick onset of action, generally controlled manic symptoms

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1972 

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References

1. Gershon, S. (1968). ‘Use of lithium salts in psychiatric disorders.’ Diseases of the Nervous System, 29, 51–5.Google ScholarPubMed
2. Klein, D. F., and Davis, J. M. (1969). Diagnosis and Drug Treatment of Psychiatric Disorders, Baltimore: Williams and Wilkins.Google Scholar
3. Lorr, M., and Klett, C. J. (1966). Inpatient Multidimensional Psychiatric Scale (Manual). Palo Alto: Consulting Psychologists Press.Google Scholar
4. Lynn, E. J., Satloff, A., and Tinling, D. C. (1971). ‘Mania and the use of lithium: a three year study.’ American Journal of Psychiatry, 127, 1176–80.Google Scholar
5. Mayer-Gross, W., Slater, E., and Roth, M. (1967). Clinical Psychiatry. London: Baillière, Tindall and Cassell.Google Scholar
6. Prescribing information for Eskalith (Smith, Kline and French Laboratories), Lithonate (Rowell Laboratories, Inc.) and Lithane (Roerig Division, Pfizer Laboratories), March, 1970.Google Scholar
7. Prien, R. F., Caffey, E. M. Jr., and Klett, C. J. (1971). ‘A comparison of lithium carbonate and chlorpromazine in the treatment of mania.’ Archives of General Psychiatry. In press.Google Scholar
8. Schou, M., Amdisen, A., and Baastrup, P. C. (1971). ‘The practical management of lithium treatment.’ British Journal of Hospital Medicine. In press.Google Scholar
9. Spring, G., Schweid, D., Gray, G., Steinberg, J., and Horwitz, M. (1970). ‘A double-blind comparison of lithium and chlorpromazine in the treatment of manic states.’ American Journal of Psychiatry, 126, 1306–9.CrossRefGoogle ScholarPubMed
10. Tupin, J. (1970). ‘The use of lithium for manic-depressive psychosis.’ Hospital and Community Psychiatry, 21, 7380.Google Scholar
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