Is There a Loss of Efficacy of Lithium in Patients Treated for Over 20 Years?

Berghöfer, Anne; Müller‐Oerlinghausen, B.

doi:10.1159/000054853

Cited by 14 publications

(5 citation statements)

References 19 publications

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“…In the current version of MI, degrees from 0 to 3 are defined (Berghofer and Muller-Oerlinghausen, 2000). Degree 0 indicates no symptoms, degree 1 indicates depressive or manic symptoms without necessity of additional medication or hospitalization, degree 2 indicates depressive or manic symptoms with necessity of additional medication and degree 3 indicates necessity of hospitalization.…”

Section: MImentioning

confidence: 99%

Impulsivity predicts illness severity in long-term course of bipolar disorder: A prospective approach

Rote

Dingelstadt

Aigner

et al. 2018

Aust N Z J Psychiatry

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Section: MImentioning

confidence: 99%

Impulsivity predicts illness severity in long-term course of bipolar disorder: A prospective approach

Rote

Dingelstadt

Aigner

et al. 2018

Aust N Z J Psychiatry

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“…Using the morbidity index, Berghöfer and colleagues reported on long-term response in a subgroup of bipolar patients over maximum time periods of 15 years 46 and 20 years. 50 In both studies, which included subjects from the present investigation, the severity and duration of recurrences remained stable, and even decreased, over the observation periods, albeit in small samples sizes. Two recent reviews also support our finding that the effectiveness of lithium prophylaxis does not diminish over time.…”

Section: Discussionmentioning

confidence: 61%

Long-Term Effectiveness of Lithium in Bipolar Disorder

Berghöfer¹,

Alda²,

Adli³

et al. 2008

J. Clin. Psychiatry

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Poor response to long-term lithium treatment has been reported to be associated with atypical features of bipolar disorder. The purpose of this study was to investigate the influence of atypical symptoms on the effectiveness and stability of long-term lithium treatment in a prospective, multicenter cohort of bipolar patients in a naturalistic setting. Method: Patients were initially selected according to International Classification of Diseases, 8th Revision, criteria for bipolar disorder and required long-term treatment. Their diagnoses were reconfirmed according to DSM-IV upon its publication. They were prospectively followed for an approximately 20-year period ending in 2004 in 5 centers participating in the International Group for the Study of Lithium-Treated Patients. Examinations included a comprehensive psychiatric evaluation, an assessment of typical and atypical features on an 8-item scale, and an evaluation of clinical course using the morbidity index. Unbalanced repeatedmeasures regression models with structured covariance matrices were used to assess the extent to which the morbidity index was influenced by atypical symptoms, duration of treatment, and pretreatment features. Results: A total of 242 patients were followed for a mean period of 10 years. In 142 patients, the number of typical features was greater than the number of atypical features, whereas in 100 patients the number of atypical features was greater than or equal to the number of typical features. The mean morbidity index remained stable over a period of 20 years in both groups of patients and was not significantly associated with the presence of atypical features, the duration of lithium treatment, the number or frequency of episodes, or latency from the onset of bipolar disorder to the start of lithium treatment. Conclusion: Our study suggests that long-term response to lithium maintenance treatment is stable both in patients with typical and in patients with atypical features. The predominance of either typical or atypical features did not result in different responses to longterm lithium treatment in this sample of bipolar patients.

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“…The results of the present analysis are in agreement with those of several studies from the same group of researchers and, in part, derived from the same patient data. Berghöfer et al used the MI to report on long-term response in a subgroup of bipolar patients over a maximum of 15 years (Berghöfer et al 1996 ), as noted above, and in another study over a maximum of 20 years (Berghöfer and Müller-Oerlinghausen 2000 ). In both studies, which included a subset of subjects from the present investigation, the severity and duration of recurrences remained stable, and even decreased, over the observation period, albeit in small sample sizes.…”

Section: Discussionmentioning

confidence: 99%

Stability of lithium treatment in bipolar disorder - long-term follow-up of 346 patients

Berghöfer

Alda

Adli

et al. 2013

Int J Bipolar Disord

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BackgroundThe purpose of this study was to investigate the effectiveness and stability of long-term lithium treatment in a prospective, international, multicenter cohort of bipolar patients in a naturalistic setting.MethodsPatients were selected according to DSM IV criteria for bipolar disorder and required long-term treatment. They were prospectively followed and documented in five centers belonging to the International Group for the Study of Lithium-Treated Patients. This was a prospective cohort study without a comparison group. Lithium treatment was administered in a naturalistic and specialized outpatient setting. All patients underwent a comprehensive psychiatric examination, which included the use of standard rating scales, as well as an evaluation of clinical course based on the morbidity index (MI).Wald tests were used to assess the significance of fixed effects and covariates when analyzing the relationship between depressive, manic, and total morbidity index and several characteristics of illness course.Results and discussionA total of 346 patients with bipolar disorder I or II were followed for a mean period of 10.0 years (standard deviation (SD) 6.2, range 1 to 20). The morbidity index remained stable over time: the mean MI was 0.125 (SD 0.299) in year 1 and 0.110 (SD 0.267) in year 20. The MI was not associated with the duration of lithium treatment, the number or frequency of episodes prior to treatment, or latency from the onset of bipolar disorder to the start of lithium treatment. The drop-out rate was high over the study period. Our findings suggest that long-term response to lithium maintenance treatment remains stable over time.

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Is There a Loss of Efficacy of Lithium in Patients Treated for Over 20 Years?

Cited by 14 publications

References 19 publications

Impulsivity predicts illness severity in long-term course of bipolar disorder: A prospective approach

Impulsivity predicts illness severity in long-term course of bipolar disorder: A prospective approach

Long-Term Effectiveness of Lithium in Bipolar Disorder

Stability of lithium treatment in bipolar disorder - long-term follow-up of 346 patients

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