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Identifying predictors for good lithium response – A retrospective analysis of 100 patients with bipolar disorder using a life-charting method

Published online by Cambridge University Press:  16 April 2020

Lena Backlund ,
Anna Ehnvall ,
Jerker Hetta ,
Göran Isacsson  and
Hans Ågren
Lena Backlund*
Affiliation:
Karolinska Institute, Department of Clinical Neuroscience, Section of Psychiatry, Karolinska University Hospital, Huddinge M57, SE-141 86Stockholm, Sweden
Anna Ehnvall
Affiliation:
Institute for Clinical Neuroscience, Gothenburg and Psychiatric Out-patient Clinic, Varberg, Swedan
Jerker Hetta
Affiliation:
Karolinska Institute, Department of Clinical Neuroscience, Section of Psychiatry, Karolinska University Hospital, Huddinge M57, SE-141 86Stockholm, Sweden
Göran Isacsson
Affiliation:
Karolinska Institute, Department of Clinical Neuroscience, Section of Psychiatry, Karolinska University Hospital, Huddinge M57, SE-141 86Stockholm, Sweden
Hans Ågren
Affiliation:
Sahlgrenska Academy at the University of Gothenburg, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Gothenburg, Sweden
*
*Corresponding author. Tel./fax: +46 8 585 857 08. E-mail address: lena.m.backlund@sll.se (L. Backlund).
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Abstract

Purpose

Our aim was to investigate bipolar patients in order to test the validity of various outcome measures and to identify prognostic predictors for pharmacological treatment.

Material and method

One hundred patients were interviewed using a computerized life-charting program in a descriptive, retrospective analysis. The concept “Burden of illness” was defined as a combination of severity and duration of episodes. Response to treatment was defined as the difference in burden before and after treatment, a low burden during treatment, and freedom of episodes for at least 3 years after insertion of treatment.

Results

The absence of mixed episodes and a high initial burden predicted a good response measured as the difference in burden. If remission for 3 years or a low burden during lithium treatment was used, the absence of rapid cycling and of mixed episodes were the most important predictors. The severity of illness before treatment had no impact.

Discussion and conclusion

We suggest the use of absolute measures of severity during treatment as the most appropriate measure of the outcome. Furthermore, our data provide corroboration that treatment with lithium ameliorates the prognosis of the illness, but that mixed episodes and rapid cycling predict a poorer response to lithium.

Keywords

Bipolar disorderTreatment outcomeLithium
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 3 , April 2009 , pp. 171 - 177
Copyright
Copyright © Elsevier Masson SAS 2009

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