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. Issue 6 (November 2019)

• Record Type: Journal Article
• Authors: Öhlund, Louise; Ott, Michael; Bergqvist, Malin; Oja, Sofia; Lundqvist, Robert; Sandlund, Mikael; Renberg, Ellinor Salander; Werneke, Ursula
• Is Part Of: BJPsych open. Volume 5:Issue 6(2019)
• Publication Date: 2019-11
• Subjects: Bipolar disorder, -- lithium, -- mood stabiliser, -- admission, -- hospitalisation; Psychiatry -- Periodicals; Mental health -- Periodicals; 616.89005
• DOI: 10.1192/bjo.2019.83
• Languages: English
• ISSNs: 2056-4724

Abstract

Abstract : 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.