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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
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.ORCID iD: 0000-0003-2393-9750
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2019 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 5, no 6, article id e101Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Cambridge University Press, 2019. Vol. 5, no 6, article id e101
Keywords [en]
Bipolar disorder, lithium, mood stabiliser, admission, hospitalisation
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-168871DOI: 10.1192/bjo.2019.83ISI: 000514372200015PubMedID: 31753046OAI: oai:DiVA.org:umu-168871DiVA, id: diva2:1415729
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Norrbotten County CouncilAvailable from: 2020-03-19 Created: 2020-03-19 Last updated: 2020-03-19Bibliographically approved

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Öhlund, LouiseOtt, MichaelSandlund, MikaelWerneke, Ursula

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