scholarly journals Accidental chronic lithium toxicity

2018 ◽  
Vol 7 (12) ◽  
pp. 2456
Author(s):  
Vangelis George Kanellis ◽  
Ramila Varendran
Keyword(s):  
Serum Levels ◽  
Endocrine Function ◽  
Lithium Toxicity ◽  
First Line ◽  
Salt Restriction ◽  
Refractory Depression ◽  
Prevention Studies ◽  
Disorder Treatment ◽  
Treatment Refractory ◽  
Nomadic Life

Lithium is an effective first-line mood stabiliser for bipolar disorder, treatment-refractory depression and suicide prevention. Studies have demonstrated its ability to produce neuroprotective benefits. Despite this, Lithium can cause neurotoxicity, cardiotoxicity and endocrine derangement resulting in severe (and potentially permanent) side effects. Lithium toxicity can be precipitated by illness, salt restriction diets, dehydration, nephrogenic diabetes insipidus, impaired creatinine clearance, concomitant drugs. This is particularly true in older patients with altered pharmacodynamics and pharmacokinetics. We present a 52-year-old female who presented with prolonged signs of lithium toxicity post-diarrhoea. Lack of monitoring due to her nomadic life-style resulted in the combination of long-lasting neurotoxicity and thyroid dysfunction. Our patient displayed neurotoxicity that was not present on imaging. This highlights the importance of regular monitoring of renal function, lithium serum levels and neuro-endocrine function to reduce complications associated with lithium toxicity.

scholarly journals Long term outcome of thermal anterior capsulotomy for chronic, treatment refractory depression

2010 ◽  
Vol 82 (6) ◽  
pp. 594-600 ◽  
Author(s):  
D. Christmas ◽  
M. S. Eljamel ◽  
S. Butler ◽  
H. Hazari ◽  
R. MacVicar ◽  
...  
Keyword(s):  
Chronic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Refractory Depression ◽  
Treatment Refractory ◽  
Anterior Capsulotomy

scholarly journals Intoxicação por Lítio após Cirurgia Bariátrica: Um Caso Clínico

2019 ◽  
Vol 33 (13) ◽  
Author(s):  
André Ribeirinho Marques ◽  
António Alho ◽  
João Malhadas Martins ◽  
Margarida Bairrão
Keyword(s):  
Bariatric Surgery ◽  
High Risk ◽  
Psychotropic Drugs ◽  
Scientific Literature ◽  
Therapeutic Option ◽  
Serum Levels ◽  
Laboratory Monitoring ◽  
Lithium Toxicity ◽  
Lithium Intoxication ◽  
Post Surgery

Bariatric surgery is a therapeutic option to treat obesity in (carefully selected) patients with psychiatric disorders. About half of the patients referred for bariatric surgery have a diagnosis of (at least one) mental disorder and most of them are treated with psychotropic drugs. This procedure may modify the bioavailability of drugs and lithium is no exception. However, although absorption seems to decrease in most drugs, in the case of lithium, there is a high risk of toxicity. In this article, we describe the case of a 44-year-old female patient with lithium intoxication after bariatric surgery. We conducted a review of the published clinical cases in the scientific literature about lithium toxicity after bariatric surgery, and we propose potential preventive clinical solutions. It is essential to increase awareness of changes to the absorption of psychotropic drugs in the post-surgery period, particularly in the case of lithium. Regular postoperative clinical and laboratory monitoring of lithium serum levels is strongly recommended.

Deep Brain Stimulation for Treatment-Refractory Depression—Part I

2014 ◽  
Vol 36 (14) ◽  
pp. 1-5
Author(s):  
Purushottam B. Thapa ◽  
Faiza A. Khan ◽  
Erika Petersen ◽  
Sushma Thapa
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Refractory Depression ◽  
Treatment Refractory ◽  
Deep Brain

Author response for "Rare variants and biological pathways identified in treatment‐refractory depression"

2020 ◽  
Author(s):  
Lora Lee McClain ◽  
Patricia Shaw ◽  
Roisin Sabol ◽  
Anna Maria Chedia ◽  
Anna Maria Segretti ◽  
...  
Keyword(s):  
Rare Variants ◽  
Biological Pathways ◽  
Author Response ◽  
Refractory Depression ◽  
Treatment Refractory

Rare variants and biological pathways identified in treatment‐refractory depression

2020 ◽  
Vol 98 (7) ◽  
pp. 1322-1334
Author(s):  
Lora Lee McClain ◽  
Patricia Shaw ◽  
Roisin Sabol ◽  
Anna Maria Chedia ◽  
Anna Maria Segretti ◽  
...  
Keyword(s):  
Rare Variants ◽  
Biological Pathways ◽  
Refractory Depression ◽  
Treatment Refractory

scholarly journals Evaluation of pituitary and thyroid hormones in patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm

2003 ◽  
Vol 61 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Paola Mangieri ◽  
Kunio Suzuki ◽  
Moema Ferreira ◽  
Lucília Domingues ◽  
Luiz Augusto Casulari
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Thyroid Hormones ◽  
Serum Levels ◽  
Clinical Severity ◽  
Endocrine Function ◽  
Pituitary Hormone ◽  
Hormonal Changes ◽  
Euthyroid Sick Syndrome ◽  
Ruptured Intracranial Aneurysm ◽  
Normal Mean

It is well known that the central nervous system (CNS) influences the pituitary hormone secretions and that diseases of CNS are frequently associated with an altered endocrine function. The aim of this study has been the evaluation of the serum concentrations of the pituitary and thyroid hormones in a series of patients with subarachnoid hemorrhage due to a ruptured cerebral aneurysm. Thirty-five patients (23 females and 12 males), aged 51.9±13.3 years on the mean were admitted. They were evaluated to assess the clinical severity of the subarachnoid hemorrhage by Hunt & Hess scale: nine patients were in the grade I, 14 in the grade II, and 12 in the grade III. Blood samples were obtained between 8:00 and 9:00 a.m. and serum hormones were measured by commercial kits (IRMA or MEIA methods). Cortisol serum levels (normal range (NR) = 5 to 18 µg/dL) were increased in all the patients (mean ± standard deviation = 31.4±12.4 µg/dL). Mean prolactin levels (NR < 20 ng/mL) were 18.6±17.1 ng/mL and five patients (14.2%) had levels higher than normal. FSH and LH levels were normal according to age and sex: men: FSH = 4±2.9 mUI/mL (NR = 1 to 10.5 mUI/mL); LH = 6.1±6.3 mUI/mL (NR = 2 to 12 mUI/mL); premenopausa women: FSH = 2.5±1.5 mUI/mL (NR = 2.4 to 9.3 mUI/mL); LH 3.9±5.1 mUI/mL (NR =2 to 15 mUI/mL); post- menopausal women: FSH = 48.3±18.5 mUI/mL (NR =31 to 134 mUI/mL); LH = 29±13.8 mUI/mL (NR =16 to 64 mUI/mL). Mean TSH levels were 3.9±5.2 µUI/mL (NR =0.5 to 4.7 µUI/mL) and five patients (14.2%) had levels higher than normal. Mean triiodothyronine levels (T3) were 66.4±18.7 ng/dL (NR = 45 to 137 ng/dL) and five patients (14.2%) had levels lower than normal (33.8±9 ng/dL). Mean thyroxine levels (T4) (NR= 4.5 to 12.5 µg/dL) were 7.4±1.7 µg/dL and two patients (5.6%) had levels lower than normal. Thyroglobulin and microsomal antibodies were not detectable. Conclusions: In the first 24 hours following ictus, the hormonal changes may be due to the stress produced by the intracranial bleeding; thyroid hormone alterations suggest that patients with subarachnoid hemorrhage might have an euthyroid sick syndrome.

Evaluating the relationship of high-dose venlafaxine prescribing to treatment-resistant depression

2003 ◽  
Vol 27 (3) ◽  
pp. 93-95 ◽  
Author(s):  
Arwel Thomas ◽  
David Taylor
Keyword(s):  
Antidepressant Treatment ◽  
Demographic Data ◽  
Patient Characteristics ◽  
Primary Diagnosis ◽  
Prior History ◽  
High Dose ◽  
Treatment Resistant ◽  
Refractory Depression ◽  
Treatment Refractory ◽  
Higher Doses

Aims and MethodPrescribing of venlafaxine in The South London and Maudsley NHS Trust was found to account for over 50% of the antidepressant costs, but only 15% of the prescriptions. There is evidence to suggest that higher doses of venlafaxine may be effective in treating treatment-refractory depression. We aimed to discover if higher doses of venlafaxine used in the trust were related to prior failure to respond to antidepressant treatment. Hospital in-patients being treated with venlafaxine during a 1-week period in October 2001 were identified and case notes were reviewed to determine patient demographic data and prior history of antidepressant therapy.ResultsThere were 38 patients identified as being prescribed venlafaxine (18 of whom had a primary diagnosis of depression). Twenty-five were classed as non-treatment-resistant and 13 were classed as treatment-resistant. Doses of venlafaxine were statistically significantly higher in patients considered treatment-resistant (245 mg v. 180 mg daily, P=0.03). All other recorded patient characteristics were similar.Clinical ImplicationsHigher doses of venlafaxine were prescribed to patients who were retrospectively defined as treatment-refractory. Further studies should address the reasons for this prescribing practice.

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