Tuesday, 16 August 2011

Lithium

How many older adults present, after retirement, for the first time with schizophrenia? Almost none. How many older adults present, in later life, with mood swings which are so significant that they need long term management with interventions which include a mood stabiliser? I don't know. But there aren't that many folk presenting in later life with major mood swings for the first time.

Why's this in my thoughts? It's because a number of folk, who have had significant mood swings (by which I mean, they've literally tried to kill folk, being consumed with rage or jealousy and felt righteous in their actions) have been referred to my door. And, to a one, all of them have asked for lithium.

Why?

Has there been a campaign about it? Is there new good press about it, somewhere? Has some celebrity trash mag carped on 'bout how it cured someone of mood changes? Enquiring minds need to know!

My patients had mood problems arising mostly from stroke damage within their limbic system and/or frontal lobes so they'd lost the bits to experience, regulate and control mood as effectively as they used to. In one patient lithium's had major benefit, resulting in a move from a very restrictive care setting back in to mainstream care services. In two others it's improved interactions and quality of life appreciably (that is, other than through speech, there's no expressed hostility) with both patients and their families feeling it's been transformational.

I'm not really sure why lithium should be so miraculous, especially when the problem's mostly structural brain change rather than purely chemical pathology (to which chemical solutions, like lithium, can be brilliant).

Still, they're better. That's good. It just puzzles me why they sought out lithium, why they were right to do so and why it's been so curiously helpful!

7 comments:

The Shrink said...

Lars Vedel Kessing, Gunnar Hellmund, John R. Geddes, Guy M. Goodwin, Per Kragh Andersen. Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study. BJPsych 18th May 2011; 199 : 57-63
DOI : 10.1192/bjp.bp.110.084822

"In daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate."

Single Female Doc said...

Yes, I also saw that paper and then someone on the web proselytising about the benefits of lithium. I even mentioned it to a punter who then mentioned it to her psychiatrist (who wrote to me to tell me) who must now also be wondering why all these patients are asking about it!

Graham said...

From the current UK SmPC -
Therapeutic indications:
"The treatment and prophylaxis of mania, manic depressive illness and recurrent depression, and the treatment of aggressive or self mutilating behaviour"

Maybe it's helping with aggression or impulse control?

The Shrink said...

Single Female Doc, I'm impressed! It's so hard as a GP to keep up to date over all the medical, surgical, public health and management areas you have to, to be up to date with niche areas of current psychiatry is ace!

Graham, I'm sure you're absolutely right, it's seeming to be much more about better impulse control than it is to do with directly improving anything about mood!

Carruthers said...
This comment has been removed by the author.
Carruthers said...

Why Lithium?

Perhaps it's the celebrity effect. Stephen Fry's TV program about living with bipolar included a significant section on the lithium option.

He decided against it, but gave the option serious consideration going over pros and cons.

(Sorry about previous post being deleted - a brain glitch and I pressed the "Submit" button.)

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