A Lithium Register for Adults with Intellectual Disabilities – Can It Work?

Bhaumik, Sabyasachi; Watson, Janet; Smith, James Falconer; Nadkarni, Sanyogita; Biswas, Amitava; Gangadharan, Satheesh

doi:10.1179/096979507799103496

Cited by 3 publications

(3 citation statements)

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“…In many individuals with 48,XXYY with specific psychiatric symptoms, including ADHD and mood disorders, psychiatric medications can be highly effective ( 15 ). Apart from the significant role of lithium in treating bipolar disorder, there was evidence of the effect of lithium in reducing aggressive behaviors in patient with intellectual disability and it was usually well-tolerated ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Bipolar disorder in 48,XXYY syndrome

et al. 2023

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48,XXYY syndrome is a rare condition. The presentations of impulsive and aggressive behavior have been reported in several case reports among patients with 48,XXYY syndrome. The management of the psychological impact and neuropsychiatric sequela of this condition is a significant issue faced by families, carers, and healthcare professionals. We report a patient, 21-year-old Malay male, with underlying 48,XXYY syndrome with attention deficit hyperactivity disorder (ADHD) and intellectual disability, diagnosed later in adulthood with a bipolar mood disorder and benefited after being started on lithium. We describe the key clinical features and diagnostic workouts that allowed the arrival of the correct psychiatric diagnosis. Challenges in psychopharmacotherapy, including the risks of metabolic syndrome and deep vein thrombosis associated with 48,XXYY syndrome, are also considered. We suggest that for patients with 48,XXYY syndrome, routine psychological screening for mood symptoms such as mania and depression should be done by healthcare professionals with early involvement of psychiatrist in the multidisciplinary team due to the challenges in the management of these patients.

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Section: Discussionmentioning

confidence: 99%

Case report: Bipolar disorder in 48,XXYY syndrome

et al. 2023

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“…In people with ID, lithium toxicity may occur at serum levels considered therapeutic in the general population (Andrade et al, 1988;Maruta, 2003;Otsuka et al, 2012;Soni, 2019). Additionally, there are many examples highlighting the disproportionately high burden of polypharmacy in this group (El-Bakush et al, 2014;Hadley et al, 1989 � ;Takahashi et al, 2000;Valdovinos et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…Behavior change being the sole or primary change noted in a patient experiencing lithium-related adverse effects is evidenced clearly (Hadley & Cason, 1989;Maruta, 2003;Nishikawa et al, 1992;Takahashi et al, 2000;Valdovinos et al, 2005). The difficulty that clinicians may encounter in assessing and monitoring patients is described in the literature, with evidence presented of methods to increase engagement between healthcare providers and service users to help empower patients and reduce diagnostic overshadowing (Bhaumik et al, 2007;Buckley & Sharrard, 2003;Clarke & Pickles, 1994;� ;Pary & Hurley, 2006;Paton et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Community Monitoring of Health Parameters in People with Intellectual Disabilities Prescribed Lithium

Howkins

Wilcock

Shankar

2021

Journal of Mental Health Research in Intellectual Disabilities

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Background: Lithium is well described in managing certain mental illnesses including in people with intellectual disabilities (ID). It requires regular monitoring particularly of serum levels and relevant biochemistry. However, existing monitoring protocols do not provide ID-specific guidance leading to increased risk of poorquality care. This study aims to construct a protocol to aid monitoring in primary care in this cohort. Need for a protocol is further explored by retrospectively auditing monitoring standards in people with ID in Cornwall, UK, and confirming gaps in current practice which may be minimized with clearer guidance. Methods: Protocol was developed drawing on existing guidance for the general population and considering challenges and best practice associated with monitoring in people with ID. The protocol was applied as an audit to all people with ID currently on lithium on the GP ID register across all GP practices in the county of Cornwall, UK, to explore current standards of monitoring to help elucidate whether increased guidance may be of use. Results: A novel protocol was developed and supplemented with additional information which is hoped to provide a useful reference guide in primary care. During audit, nine of the ten people with ID receiving prescriptions for lithium across the county were identified and data collected. Audit showed monitoring was to a reasonably high standard, though blood tests and annual health checks were not always performed within preferred maximum timeframes. Conclusions: This protocol represents the first ID-specific approach for monitoring lithium and associated health parameters in primary care. Auditing against the protocol showed gaps in current standards of care which may indicate a need for clearer published guidance. Some groupings of results highlighted particular areas of need. We hope that clear protocols, such as ours, may aid safe and timely monitoring of lithium treatment in future.

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