A Controlled Study of Lithium vs. Chlorpromazine in Acute Schizophrenics

Abstract

A previous double-blind controlled evaluation of lithium and chlorpromazine in both manic and schizo-affective individuals carried out in this unit (Johnsonet al., 1968) indicated that 85 per cent of the schizo-affectives showed a worsening of thought disorder when treated with lithium carbonate, the majority developing symptoms of an acute brain syndrome. The possibility of experimental design accounting for such treatment outcome must be considered.

Lithium Neurotoxicity in Schizophrenie and Schizoaffective Patients

“…In contrast to the high rates of lithium-induced toxic-confusional states reported by Johnson et al [1968] and Shopsin et al [1971] (i.e., 71 and 54%, respectively), other investigators (see table I) have reported rates of lithium-induced toxic-confusional states in schizophrenic patients of 30% or below [West and Meitzer, 1979;Prien et al, 1972;Small et al, 1975]; six studies have reported rates of 0% [Zall et al, 1968;Angst et al, 1969;Alexander et al, 1977;Biederman et al, 1979;Growe et al, 1979;Carmen et al, 1981]. Also contrary to Johnson et al [1968] and Shopsin et al [1971] who reported that lithium produced a worsening of psychomotor excite ment, delusions and hallucinations, a number of investigators have re ported clinical improvements in lithium-treated schizophrenic patients [Zall et al, 1968;Prien et al, 1972;Growe et al, 1979;Angst et al, 1969Angst et al, , 1970Small et al, 1975;Alexander, 1979;Biederman et al 1979;Carmen et al, 1981].…”

“…Shopsin et al [1971] soon afterwards reported a similarly high rate (54% of cases) of severe lithium neurotoxicity in another sample of schizophrenic patients representing a variety of subtypes of schizophrenia. These reports led to the hypothesis that schizo phrenics have a lower threshold for the neurotoxic effects of lithium.…”

“…The significance of severe lithium neurotoxicity (i.e., toxic-confusional states) in schizophrenic and schizoaffective patients has been in doubt due to the great variability in frequency of this toxicity as observed by different research groups. It is intended here to review the Johnson et al [1968] from admission1 schizoaffective 71 (5/7) 7 acute o V> Shopsin et al [1971] mixed subtypes newly admitted 54 (6/11) 11 acute West and Meitzer [ 1979] 30 (4/13) mixed subtypes 1st episode of psychotic illness preferred2_____…”

Effect of Treatment and Withdrawal from Chronic Lithium in Rats on Stimulant-Induced Responses

“…High dose amphetamine may cause hyperactivity via release of dopamine and a mechanism not inhibitable by lithium at therapeutic doses [Taylor and Snyder, 1971;Thornburg and Moore, 1973;Reches et al, 1978]. A clinical parallel may be the ability of Li to calm manic excitement with little benefit for the excitement of schizophrenia [Shopsin et al, 1971], Fig. 4.…”

The Lithium Ion: A Foundation for Psychopharmacological Specificity

“…Shopsin et al (1971) conducted a controlled study with 21 acute schizophrenic patients, treated with either lithium or chlorpromazine. They found that lithium had no effect in schizophrenic symptoms, and some of the schizophrenic patients got worse, developing symptoms of a "toxic-confusional state."…”