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
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...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2019-11-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472419000838/type/journal_article |
| _version_ | 1811157014088253440 |
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| author | Louise Öhlund Michael Ott Malin Bergqvist Sofia Oja Robert Lundqvist Mikael Sandlund Ellinor Salander Renberg Ursula Werneke |
| author_facet | Louise Öhlund Michael Ott Malin Bergqvist Sofia Oja Robert Lundqvist Mikael Sandlund Ellinor Salander Renberg Ursula Werneke |
| author_sort | Louise Öhlund |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-10T05:00:25Z |
| format | Article |
| id | doaj.art-87e08ce4dab64a2098405cf7659b33e6 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T05:00:25Z |
| publishDate | 2019-11-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-87e08ce4dab64a2098405cf7659b33e62023-03-09T12:28:54ZengCambridge University PressBJPsych Open2056-47242019-11-01510.1192/bjo.2019.83Clinical 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 cohortLouise Öhlund0Michael Ott1Malin Bergqvist2Sofia Oja3Robert Lundqvist4Mikael Sandlund5Ellinor Salander Renberg6Ursula Werneke7https://orcid.org/0000-0002-5023-3254Research Registrar, Sunderby Research Unit – Psychiatry, Department of Clinical Sciences, Umeå University, SwedenConsultant Physician, Department of Public Health and Clinical Medicine – Medicine, Umeå University, SwedenConsultant Psychiatrist, Piteå Älvdals Hospital, Department of Psychiatry, SwedenConsultant Psychiatrist, Department of Psychiatry, Sunderby Hospital, SwedenStatistician, Research Unit, County Council of Norrbotten, SwedenProfessor of Psychiatry, Department of Clinical Sciences – Psychiatry, Umeå University, SwedenProfessor of Psychiatry, Department of Clinical Sciences – Psychiatry, Umeå University, SwedenAssociate Professor of Psychiatry, Sunderby Research Unit – Psychiatry, Department of Clinical Sciences, Umeå University, SwedenBackgroundCurrently, 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.https://www.cambridge.org/core/product/identifier/S2056472419000838/type/journal_articleBipolar disorderlithiummood stabiliseradmissionhospitalisation |
| spellingShingle | Louise Öhlund Michael Ott Malin Bergqvist Sofia Oja Robert Lundqvist Mikael Sandlund Ellinor Salander Renberg Ursula Werneke 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 BJPsych Open Bipolar disorder lithium mood stabiliser admission hospitalisation |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Bipolar disorder lithium mood stabiliser admission hospitalisation |
| url | https://www.cambridge.org/core/product/identifier/S2056472419000838/type/journal_article |
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