Neuropsychologic Effects of Lithium Discontinuation

Kocsis, James H.; Shaw, Eric; Stokes, Peter E.; Wilner, Philip J.; Elliot, Alan S.; Sikes, Carolyn; Myers, Barnett; Manevitz, Alan; Parides, Michael K.

doi:10.1097/00004714-199308000-00007

Cited by 91 publications

(74 citation statements)

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“…This is particularly important in terms of functional imaging studies investigating patients suffering from bipolar disorder. Patients on treatment, in particular lithium, often suffer cognitive side effects (Squire et al, 1980;Stoll et al, 1996;Kocsis et al, 1993;Pachet et al, 2003) and various studies have demonstrated cognitive deficits in bipolar patients (Martinez-Aran et al, 2004;Harmer et al, 2002;Adler et al, 2004;Tam et al, 2004;Marvel and Paradiso, 2004;Clark and Goodwin, 2004) as well as functional alterations during task performance (Caliguiri et al, 2003;Adler et al, 2004;Caliguiri et al, 2004;Elliot et al, 2004;Gruber et al, 2004;Lawrence et al, 2004;Malhi et al, 2004a;Malhi et al, 2004b;Monks et al, 2004). However, because most patients are medicated at the time of study it is difficult to interpret to what extent treatment factors into these performance deficits.…”

Section: Discussionmentioning

confidence: 99%

Differential effects of chronic lithium and valproate on brain activation in healthy volunteers

Bell

Willson

Wilman

et al. 2005

Hum. Psychopharmacol. Clin. Exp.

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Section: Discussionmentioning

confidence: 99%

Differential effects of chronic lithium and valproate on brain activation in healthy volunteers

Bell

Willson

Wilman

et al. 2005

Hum. Psychopharmacol. Clin. Exp.

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“…Of five studies (67-71) evaluating effects of medication on cognition of euthymic BPD patients, three found that lithium adversely affected cognitive performance (67,68,70), one reported that lithium and carbamazepine had no adverse effects on cognition (69), and another found lithium and valproate to have equivocal effects on cognition (71). More studies are needed to elucidate the extent of adverse psychopharmacologic effects on cognition of euthymic BPD patients as a contribution to assessing risk ⁄ benefit relationships.…”

Section: Psychopharmacologic Effects On Neurocognitionmentioning

confidence: 99%

Neurocognitive impairment in bipolar disorder patients: functional implications

2009

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Growing evidence suggests that bipolar disorder (BPD) patients experience prominent neurocognitive impairment not only during acute mood episodes (1-3) but also during euthymia (1,(4)(5)(6)(7)(8)(9)(10)(11)(12). A recent meta-analytic review of 39 studies comparing neurocognitive functioning in 948 euthymic BPD patients and 1,128 normal controls, matched for age, sex, education, and estimated premorbid IQ, found medium-to-large effect sizes (ES, as group differences ⁄ variance) for impaired attention and processing speed (ES = 0.60-0.79), episodic memory (ES = 0.43-0.81), and executive functioning (ES = 0.47-0.71) in the BPD patients (11). Another meta-analytic review of 20 studies, also comparing neurocognitive performance in euthymic BPD patients to matched normal controls, found deficits of similar magnitude in measures of executive functions, verbal learning, immediate Background: Functional recovery among treated bipolar disorder (BPD) patients is far less likely than syndromal and even symptomatic recovery. We hypothesized that increasingly well-documented aspects of cognitive impairment may contribute to poor functional outcomes in BPD patients, and reviewed the available research on the topic.Methods: Computerized literature searching identified 12 studies with 13 comparisons that simultaneously evaluated cognitive and functional status in euthymic (n = 8) or non-euthymic (n = 5 comparisons) adult BPD patients versus otherwise similar healthy controls.Results: In 6 ⁄ 8 studies of euthymic BPD patients and 5 ⁄ 5 studies of non-euthymic BPD patients, neurocognitive impairment was significantly associated with impaired psychosocial functioning, even after adjusting for residual mood symptoms and relevant demographic and clinical variables. Cognitive status was consistently assessed with standardized, performance-based neuropsychological tests, but functional status usually was based on subjective self-appraisals. Approximately 55% of BPD patients were unemployed.Conclusions: Available studies are limited by subjective assessments of functional status rather than objective, performance-based measures. Nevertheless, they support the hypothesis that enduring aspects of cognitive impairment found even in euthymic BPD patients are associated with inferior functioning. These findings encourage further studies with better assessment methods and greater rehabilitative efforts in BPD patients.

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“…The authors analyzed influence of six possible intervening variables: age, sex, lithium concentration in plasma, thyroid function, duration of lithium maintenance, and depressive symptoms. Further analysis suggested that lithium has a greater neuropsychological effect in younger, less-depressed patients having higher plasma lithium concentrations in plasma [72].…”

Section: Factors Associated With Cognitive Deficitsmentioning

confidence: 98%

“…Differentiation between cognitive dysfunctions related to the illness and those related to its treatment is difficult. Four studies showed that lithium had a negative effect on memory and speed of information processing, often without subjective complaints or awareness of mental slowness [72,73], lithium did not cause memory impairment or a change in self-assessment of memory functions [74]. In Engelsmann et al observation survey mean memory test scores remained remarkably stable over the entire 6-year lithium therapy [75].…”

Section: Factors Associated With Cognitive Deficitsmentioning

confidence: 99%

“…Those results support opinion about lithium -influenced worsening in information processing. The effects of blind lithium discontinuation and resumption on measures of cognition, creativity, and fine motor performance in 46 lithium-maintained euthymic out-patients were investigated [72]. Scores on memory measures, tests of tapping speed, and associative productivity all improved significantly during the time off of lithium.…”

Section: Factors Associated With Cognitive Deficitsmentioning

confidence: 99%

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