Response to Lithium in Patients with Bipolar Disorder: What are Psychiatrists’ Experiences and Practices Compared to Literature Review?

Abstract

Background This study aims at characterizing French psychiatrists’ opinions regarding definition criteria and factors associated with lithium prophylactic response in patients with bipolar disorders.

Methods After a literature review, an online survey targeted French psychiatrists in 2016.

Results Literature review showed inconsistencies in reported definition criteria and clinical predictors of lithium prophylactic response. A total of 104 psychiatrists, mostly working in hospitals, completed the survey. The inconsistencies regarding definition criteria and predictors of lithium response were confirmed. Five factors were commonly reported by psychiatrists as positively associated with successful response (family history of lithium response and of bipolar I disorder, and lithium efficacy in acute mood phases treatment) or with an unsuccessful response (rapid cycling and alcohol misuse).

Discussion The divergence in psychiatrists’ opinions surely plays a major role in the variability of lithium prescriptions among psychiatrists. Currently, the large variations in response definitions, and in study designs used to quantify each factor’s effect, preclude synthesizing the findings. A standardization of response measures is needed to explore factors that influence the prophylactic lithium efficacy.

Key words

bipolar disorder - lithium - prophylactic response - survey - opinion

• References

• 1 Müller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. Lancet 2002; 359: 241-247
• 2 Goodwin GM, Haddad PM, Ferrier IN. et al. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2016; 30: 495-553
• 3 Grof P, Alda M, Grof E. et al. The challenge of predicting response to stabilising lithium treatment. The importance of patient selection. Br J Psychiatry Suppl. 1993; 16-19
• 4 Grof P, Duffy A, Cavazzoni P. et al. Is response to prophylactic lithium a familial trait?. J Clin Psychiatry 2002; 63: 942-947
• 5 Manchia M, Adli M, Akula N. et al. Assessment of response to lithium maintenance treatment in bipolar disorder: A Consortium on Lithium Genetics (ConLiGen) Report. PloS One 2013; 8: e65636
• 6 Kleindienst N, Engel RR, Greil W. Psychosocial and demographic factors associated with response to prophylactic lithium: A systematic review for bipolar disorders. Psychol Med. 2005; 35: 1685-1694
• 7 Kleindienst N, Engel R, Greil W. Which clinical factors predict response to prophylactic lithium? A systematic review for bipolar disorders. Bipolar Disord. 2005; 7: 404-417
• 8 Tighe SK, Mahon PB, Potash JB. Predictors of lithium response in bipolar disorder. Ther Adv Chronic Dis 2011; 2: 209-226
• 9 Samalin L, Guillaume S, Auclair C. et al. Adherence to guidelines by French psychiatrists in their real world of clinical practice. J Nerv Ment Dis. 2011; 199: 239-243
• 10 Bellivier F, Etain B, Malafosse A. et al. Age at onset in bipolar I affective disorder in the USA and Europe. World J Biol Psychiatry. 2014; 15: 369-376
• 11 Vieta E, Langosch JM, Figueira ML. et al. Clinical management and burden of bipolar disorder: Results from a multinational longitudinal study (WAVE-bd). Int J Neuropsychopharmacol. 2013; 16: 1719-1732
• 12 Harris PA, Taylor R, Thielke R. et al. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42: 377-381
• 13 Young AH, Hammond JM. Lithium in mood disorders: Increasing evidence base, declining use?. Br J Psychiatry J Ment Sci 2007; 191: 474-476
• 14 Malhi GS, Goodwin GM. The rise and fall of mood stabilizers. Aust N Z J Psychiatry 2007; 41: 779-783
• 15 Kessing LV, Hansen HV, Bech P. Attitudes and beliefs among patients treated with mood stabilizers. Clin Pract Epidemiol Ment Health 2006; 2: 8
• 16 Leadholm AKK, Rothschild AJ, Nolen WA. et al. The treatment of psychotic depression: is there consensus among guidelines and psychiatrists?. J Affect Disord 2013; 145: 214-220
• 17 Renes JW, Regeer EJ, van der Voort TYG. et al. Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice. BMC Psychiatry 2014; 14: 58
• 18 Kessing LV, Hellmund G, Andersen PK. Predictors of excellent response to lithium: Results from a nationwide register-based study. Int Clin Psychopharmacol. 2011; 26: 323-328
• 19 Sportiche S, Geoffroy PA, Brichant-Petitjean C. et al. Clinical factors associated with lithium response in bipolar disorders. Aust N Z J Psychiatry 2017; 51: 524-530
• 20 Rybakowski JK, Dembinska D, Kliwicki S. et al. TEMPS-A and long-term lithium response: Positive correlation with hyperthymic temperament. J Affect Disord. 2013; 145: 187-189
• 21 Nierenberg AA, Sylvia LG, Leon AC. et al. Clinical and health outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE): A pragmatic trial of complex treatment for a complex disorder. Clin Trials Lond Engl 2014; 11: 114-127
• 22 Findling RL, Chang K, Robb A. et al. Adjunctive maintenance lamotrigine for pediatric bipolar I disorder: A placebo-controlled, randomized withdrawal study. J Am Acad Child Adolesc Psychiatry. 2015; 54: 1020-1031
• 23 Muti M, Del Grande C, Musetti L. et al. Serum uric acid levels and different phases of illness in bipolar I patients treated with lithium. Psychiatry Res. 2015; 225: 604-608
• 24 Passmore MJ, Garnham J, Duffy A. et al. Phenotypic spectra of bipolar disorder in responders to lithium versus lamotrigine. Bipolar Disord. 2003; 5: 110-114
• 25 Duffy A, Alda M, Milin R. et al. A consecutive series of treated affected offspring of parents with bipolar disorder: Is response associated with the clinical profile?. Can J Psychiatry 2007; 52: 369-376
• 26 Garnham J, Munro A, Slaney C. et al. Prophylactic treatment response in bipolar disorder: Results of a naturalistic observation study. J Affect Disord. 2007; 104: 185-190
• 27 Maj M. Clinical prediction of response to lithium prophylaxis in bipolar patients: the importance of the previous pattern of course of the illness. Clin Neuropharmacol. 1990; 13 (Suppl. 01) S66-S70
• 28 State RC, Frye MA, Altshuler LL. et al Chart review of the impact of attention-deficit/hyperactivity disorder comorbidity on response to lithium or divalproex sodium in adolescent mania. J Clin Psychiatry. 2004; 65: 1057-1063
• 29 O’Connell RA, Mayo JA, Flatow L. et al. Outcome of bipolar disorder on long-term treatment with lithium. Br J Psychiatry. 1991; 159: 123-129
• 30 Kessing LV, Vradi E, Andersen PK. Starting lithium prophylaxis early v. late in bipolar disorder. Br J Psychiatry. 2014; 205: 214-220
• 31 Iskedjian M, Einarson TR, MacKeigan LD. et al. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta-analysis. Clin Ther. 2002; 24: 302-316
• 32 Gasperini M, Scherillo P, Manfredonia MG. et al. A study of relapses in subjects with mood disorder on lithium treatment. Eur Neuropsychopharmacol. 1993; 3: 103-110
• 33 Tondo L, Baldessarini RJ, Floris G. Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders. Br J Psychiatry. 2001; 178: S184-S190
• 34 Viguera AC, Baldessarini RJ, Tondo L. Response to lithium maintenance treatment in bipolar disorders: Comparison of women and men. Bipolar Disord. 2001; 3: 245-252
• 35 Yazici O, Kora K, Uçok A. et al. Predictors of lithium prophylaxis in bipolar patients. J Affect Disord. 1999; 55: 133-142
• 36 de Almeida Lima e Silva LF, Loureiro JC. Assessing treatment response to prophylactic lithium use in patients with bipolar disorder. J Bras Psiquiatr 2016; 65: 9-16
• 37 Rybakowski JK, Suwalska A. Excellent lithium responders have normal cognitive functions and plasma BDNF levels. Int J Neuropsychopharmacol. 2010; 13: 617-622
• 38 Choi-Kwon S, Kwon SU, Kim JS. Compliance with risk factor modification: early-onset versus late-onset stroke patients. Eur Neurol. 2005; 54: 204-211
• 39 Jin J, Sklar GE, Min Sen Oh V. et al. Factors affecting therapeutic compliance: a review from the patient’s perspective. Ther Clin Risk Manag 2008; 4: 269-286
• 40 Fodor GJ, Kotrec M, Bacskai K. et al. Is interview a reliable method to verify the compliance with antihypertensive therapy? An international central-European study. J Hypertens. 2005; 23: 1261-1266
• 41 Garay-Sevilla ME, Nava LE, Malacara JM. et al. Adherence to treatment and social support in patients with non-insulin dependent diabetes mellitus. J Diabetes Complications 1995; 9: 81-86
• 42 García S, Martínez-Cengotitabengoa M, López-Zurbano S. et al. Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: A systematic review. J Clin Psychopharmacol. 2016; 36: 355-371
• 43 Coryell W, Akiskal H, Leon AC. et al. Family history and symptom levels during treatment for bipolar I affective disorder. Biol Psychiatry. 2000; 47: 1034-1042
• 44 Okuma T. Effects of carbamazepine and lithium on affective disorders. Neuropsychobiology 1993; 27: 138-145