Of a group of 133 patients given long-term prophylactic lithium treatment, approximately 25 percent discontinued the treatment prematurely within the first six months. Young male patients dominated in the nonadherent group. Clinically the nonadherent patients were characterized by having had an early onset of the illness, a large number of previous hospital admissions and a recent allocation to the diagnostic category of affective disorder. Furthermore, the presence of personality disorders and substance abuses characterized the nonadherent patients. Diagnostic grouping according to polarity did not allow for any distinction between the adherent and nonadherent patients. One half of the nonadherent patients mentioned the development of somatic side effects as their main reason for discontinuing the treatment. Psychological discomfort, such as development of concentration difficulties or impaired memory, was not stated as a reasons for discontinuation. One fourth of the nonadherent patients had their diagnoses, and consequently their treatment, changed by the physician in charge and one fourth neglected instructions and disregarded appointments.

The purpose of this prospective study of 133 affective disorder patients, consecutively referred to start long-term lithium therapy, was to identify predictors of importance for nonadherence. The nonadherent group was defined as the 31 (23.3%) patients who stopped treatment within the first six months. In the multivariate logistic analysis the most informative clinical, social, and psychosocial predictors were, in rank order: many admissions to mental hospitals, death or divorce of parent in childhood, heavy smoking, short duration of the mental disorder diagnosed as affective, not married, never economically active, and early onset of the affective disorder. The logical consequence of the results is to offer the subgroup of patients with an individually calculated high probability of nonadherence intensive control and support during the first month of lithium treatment.

We determined serum T4 and serum TSH serially in a cohort of patients given lithium treatment for up to 6 years; the total lithium exposure time was 409 years and the average serum lithium concentration 0.69 mmol/l. T4 showed a small and not significant fall at 6 months and returned to the pre-lithium level at 12 months. Hereafter, T4 rose gradually and after 6 years of lithium treatment T4 was 53% higher than the pre-lithium value. TSH was significantly increased at 6 and 12 months and then returned to the pre-lithium level. Eight patients required thyroxine treatment for lithium-induced hypothyroidism, i.e. 2 per 100 years of lithium exposure time. Single deviant values of T4 and TSH could be seen, followed by normal values. We suggest that TSH is determined at intervals during lithium treatment. It may be prudent to subject lithium-treated patients with abnormal thyroid values to re-examination and to abstain from starting thyroxine treatment on the basis of a single deviant value.

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for non-respons af recidivforebyggende lithiumbehandling. Nord Pyskiatr Tidsskr 1987; 41:50>506. Oslo. ISSN 0029-1455.The purpose of this prospective study of 78 affective disorder patients adherent to lithium treatment during two years was to identify predictors of importance for non-response. This was defined as patients with more than one readmission during the two years and amounted 29 (37.2%). Young age and female sex showed a strong association to non-response. Social background variables such as educational level, social class etc. were not of importance, but patients who were unfit for work or not married experienced more often non-response. Indices for social stability and support, and recent life events did not show any association to non-response. The diagnostic subgroups, the character of index episodes and free intervals only showed a non-significant trend, but indices for chronic course as many earlier admissions to psychiatric hospitals and long duration of the index episode were informative predictors. A multivariate logistic analysis was applied on both the non-response as the non-responsehon-adherence group versus response group. In conclusion it is suggested that patients with substance abuse should not be offered long-term lithium unless intensive control and support is practicable, and patients with a more chronic course andlor many earlier admissions need a more effective prophylactic treatment than lithium can offer.Nord J Psychiatry Downloaded from informahealthcare.com by University of Auckland on 11/03/14For personal use only.