Clinical course and need for hospital admission after lithium discontinuation in patients with bipolar disorder type I or II: mirror-image study based on the LiSIE retrospective cohort
Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of ass...
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Published in | BJPsych open Vol. 5; no. 6; p. e101 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Cambridge University Press
22.11.2019
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Abstract | Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups.
To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder.
Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers.
For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions.
The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission. |
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AbstractList | Background: Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups.
Aims: To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder.
Method: Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers.
Results: For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions.
Conclusions: The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission. BACKGROUNDCurrently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups. AIMSTo compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder. METHODMirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers. RESULTSFor the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions. CONCLUSIONSThe higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission. Background Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups. Aims To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder. Method Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers. Results For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 ( P <0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 ( P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions. Conclusions The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission. Copyright © The Author(s) 20192019The Author(s)http://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.BackgroundCurrently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups.AimsTo compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder.MethodMirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers.ResultsFor the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions.ConclusionsThe higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission. Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups. To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder. Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers. For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions. The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission. |
ArticleNumber | e101 |
Author | Renberg, Ellinor Salander Werneke, Ursula Sandlund, Mikael Bergqvist, Malin Ott, Michael Lundqvist, Robert Oja, Sofia Öhlund, Louise |
AuthorAffiliation | Associate Professor of Psychiatry, Sunderby Research Unit – Psychiatry, Department of Clinical Sciences, Umeå University , Sweden Research Registrar, Sunderby Research Unit – Psychiatry, Department of Clinical Sciences, Umeå University , Sweden Consultant Psychiatrist, Piteå Älvdals Hospital , Department of Psychiatry, Sweden Consultant Psychiatrist, Department of Psychiatry, Sunderby Hospital , Sweden Consultant Physician, Department of Public Health and Clinical Medicine – Medicine, Umeå University , Sweden Statistician, Research Unit, County Council of Norrbotten , Sweden Professor of Psychiatry, Department of Clinical Sciences – Psychiatry, Umeå University , Sweden |
AuthorAffiliation_xml | – name: Consultant Psychiatrist, Piteå Älvdals Hospital , Department of Psychiatry, Sweden – name: Professor of Psychiatry, Department of Clinical Sciences – Psychiatry, Umeå University , Sweden – name: Research Registrar, Sunderby Research Unit – Psychiatry, Department of Clinical Sciences, Umeå University , Sweden – name: Associate Professor of Psychiatry, Sunderby Research Unit – Psychiatry, Department of Clinical Sciences, Umeå University , Sweden – name: Consultant Psychiatrist, Department of Psychiatry, Sunderby Hospital , Sweden – name: Consultant Physician, Department of Public Health and Clinical Medicine – Medicine, Umeå University , Sweden – name: Statistician, Research Unit, County Council of Norrbotten , Sweden |
Author_xml | – sequence: 1 givenname: Louise surname: Öhlund fullname: Öhlund, Louise organization: Research Registrar, Sunderby Research Unit - Psychiatry, Department of Clinical Sciences, Umeå University, Sweden – sequence: 2 givenname: Michael surname: Ott fullname: Ott, Michael organization: Consultant Physician, Department of Public Health and Clinical Medicine - Medicine, Umeå University, Sweden – sequence: 3 givenname: Malin surname: Bergqvist fullname: Bergqvist, Malin organization: Consultant Psychiatrist, Piteå Älvdals Hospital, Department of Psychiatry, Sweden – sequence: 4 givenname: Sofia surname: Oja fullname: Oja, Sofia organization: Consultant Psychiatrist, Department of Psychiatry, Sunderby Hospital, Sweden – sequence: 5 givenname: Robert surname: Lundqvist fullname: Lundqvist, Robert organization: Statistician, Research Unit, County Council of Norrbotten, Sweden – sequence: 6 givenname: Mikael surname: Sandlund fullname: Sandlund, Mikael organization: Professor of Psychiatry, Department of Clinical Sciences - Psychiatry, Umeå University, Sweden – sequence: 7 givenname: Ellinor Salander surname: Renberg fullname: Renberg, Ellinor Salander organization: Professor of Psychiatry, Department of Clinical Sciences - Psychiatry, Umeå University, Sweden – sequence: 8 givenname: Ursula orcidid: 0000-0002-5023-3254 surname: Werneke fullname: Werneke, Ursula organization: Associate Professor of Psychiatry, Sunderby Research Unit - Psychiatry, Department of Clinical Sciences, Umeå University, Sweden |
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Keywords | lithium Bipolar disorder mood stabiliser admission hospitalisation |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Declaration of interest: M.O. has been a scientific advisory board member of Astra Zeneca Sweden, 2018. U.W. has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme 2014–2018 and EAPM 2016, Luleå, Sweden) from: Astra Zeneca, Eli Lilly, Janssen, Novartis, Otsuka/Lundbeck, Servier, Shire and Sunovion. |
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Snippet | Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate... Background Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate... Copyright © The Author(s) 20192019The Author(s)http://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the... BACKGROUNDCurrently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate... Background: Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly... BackgroundCurrently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate... |
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SubjectTerms | admission Alcohol Bias Bipolar disorder Cohort analysis Consent Drug use hospitalisation Hospitals Lithium Medical records mood stabiliser Self destructive behavior Suicides & suicide attempts |
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Title | Clinical course and need for hospital admission after lithium discontinuation in patients with bipolar disorder type I or II: mirror-image study based on the LiSIE retrospective cohort |
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