Citation

Öhlund L, Ott M, Bergqvist M, Oja S, Lundqvist R, Sandlund M, Renberg ES, Werneke U. BJPsych Open 2019; 5(6).

Copyright

(Copyright © 2019, Royal College of Psychiatrists)

DOI

10.1192/bjo.2019.83

PMID

unavailable

Abstract

Background Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups. AimsTo compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder.

METHOD Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers.

RESULTS For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions.

CONCLUSIONS The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission. Copyright © The Author(s) 2019.

Language: en

Keywords

adult; human; suicide; female; male; aged; alcoholism; Bipolar disorder; depression; lithium; Lithium; major clinical study; controlled study; antidepressant agent; retrospective study; hospital admission; automutilation; priority journal; quetiapine; disease course; drug dependence; follow up; carbamazepine; olanzapine; risperidone; drug withdrawal; valproic acid; bipolar I disorder; bipolar II disorder; cohort analysis; lamotrigine; topiramate; hypomania; maintenance therapy; schizoaffective psychosis; Hospitalisation; aripiprazole; Article; observational study; drug substitution; Admission; comparative effectiveness; DSM-5; study design; adverse event; mirror image study; Mood stabiliser