Lithium children

The issue of later behavioral teratogenesis was studied in 60 lithium children (whose mothers took lithium when pregnant) as compared with 57 normal siblings. Reassuringly, the incidence of anomalous developmental disorders was essentially equal ( 340). 

Kowatch, R.A., Suppes, T., Carmody, T.J., Bucci, J.P., Hume, J.H., Kromelis, M., Emslie, G.J., Weinberg, W.A., and Rush, A.J. (2000) Effect size of lithium, divalproex sodium, and carbama-zepine in children and adolescents with bipolar disorder. / Am Acad Child Adolesc Psychiatry 39 713-720. 

In this chapter we review the mechanisms of action, pharmacokinetics, side effects, and uses of lithium and the anticonvulsants as they apply to child psychiatric clinical practice. 

Campbell, M., Adams, P.B., Small, A.M., Kafantaris, V., Silva, R.R., Shell, J., Perry, R., and Overall, J.E. (1995) Lithium in hospitalized aggressive children with conduct disorder a double-blind and placebo-controlled study. / Am Acad Child Adolesc Psychiatry 34 445-453. [published erratum appears in / Am Acad Child Adolesc Psychiatry 1995 34(5) 694]. ... 

Geller, B., Cooper, T.B., Sun, K., Zimerman, B., Frazier, J., Williams, M., and Heath, J. (1998a) Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. / Am Acad Child Adoles Psychiatry 37 171-178. 

Hagino, O.R., Weller, E.B., Weller, R.A., Washing, D., Fristad, M.A., and Kontras, S.B. Untoward effects of lithium treatment in children aged four through six years. / Am Acad Child Adolesc Psychiatry 34 1584-1590. 

Ryan, N., Meyer, V, Dachille, S., Mazzie, D., and Puig-Antich, J. (1988a) Lithium antidepressant augmentation in TCA-refractory depression in adolescents. J Am Acad Child Adolesc Psychiatry 27 371-376. 

Strober, M., Freeman, R., Rigali, J., Schmidt, S., and Diamond, R. (1992) The pharmacotherapy of depressive illness in adolescence II. Effects of lithium augmentation in nontesponders to imipra-mine. J Am Acad Child Adolesc Psychiatry 31 16—20. 

Catlson, G.A., Rapport, M.D., Pataki, C., and Kelly, K.K. (1992a) Lithium in hospitalized children at 4 and 8 weeks affective, behavioral and cognitive effects. / Child Psychol Psychiatry 33 411— 425. 

Delong, G.R., and Aldershof, A.L. (1987) Long-term experience with lithium treatment in childhood correlation with clinical diagnosis. Am Acad Child Adolesc Psychiatry 26 389-394. 

Similarly, Kaplan and Busner (1997) assessed the prevalence of psychotropic use during 1991 among inpatient pediatric (< 18 years) populations who were treated by child psychiatrists in a New York suburban area. One state, one county-university, and one private hospital were surveyed. Findings showed that overall, 79% (state), 68% (county-university), and 76% (private) of the child and adolescent patients in the population received a psychotropic treatment during the course of the study. The prevalence of antidepressant treatment in the private hospital was very high (80%) but relatively low in the other hospitals (26% each). Antipsychotics were prescribed to 74% of the county hospital patients, and to 57% and 35% of the patients at the other locations. Stimulants were prescribed only rarely (2%, 3%, and 4% of patients). Lithium was prescribed to 35% and 34% of state and county hospital patients, respectively, and to 16% of private hospital patients. Other mood stabilizers (anticonvulsants) were prescribed frequently to private and county hospital patients (31% and 23%, respectively). 

Kafka M, Wirz-Justice A, Naber D, et al Effect of lithium on circadian neurotransmitter receptor rhythms. Neuropsychobiology 8 41-50, 1982 Kagan J, Reznick JS, Snidman N The physiology and psychology of behavioral inhibition. Child Dev 58 1459-1473, 1987... 

Case Example A 28-year-old woman had been stable on lithium treatment for several years. When she became pregnant, her lithium was discontinued, and within a few weeks she was hospitalized for a severe exacerbation of mania unresponsive to CPZ in doses up to 1,200 mg/day. After a course of ECT she became euthymic and was adequately maintained on lower doses of CPZ (i.e., 50 to 100 mg/day) for the remainder of her pregnancy. The delivery and the immediate postpartum period went well, but lithium was not resumed because she opted to nurse her infant. Several weeks later, she was rehospitalized for an episode of depression, which also responded to a course of ECT. She then agreed to discontinue nursing her child and resume lithium. The patient was doing well at follow-up 1 year later. 

Campbell M, Adams PB, Small AM. Lithium in hospitalized aggressive children with conduct disorder a double blind placebo controlled study. J Am Acad Child Adolesc Psychiatry 1995 34 445-453. 

As we move down the family of alkali metals on the periodic table, metal chemical reactivity increases. This increase in reactivity corresponds to an increase in atomic size. As atomic size increases, the outermost electrons are farther from the atomic nucleus. The positively charged protons in the atomic nucleus are trying to attract the negatively charged outermost electrons, but attractive force decreases as distance increases. This is analogous to a mother trying to keep her children home while the children, as they become more energetic, wander farther away and often eventually leave home. A child can leave home more easily when already distanced from home. Therefore, cesium (Cs), in which the outermost electron is far from the positive nucleus and can easily leave home, is much more chemically reactive than lithium (Li), in which the outermost electron is close to home, the nucleus. 

Pravin et al. (2004) described four patients, age 6-15, who developed mania on citalopram. One child first developed mania when exposed to fluoxetine and then again when given citalopram. Three of the children required additional treatment with lithium or antipsychotic drugs, and the fourth ended up being given ECT. 

The program is straightforward in its call to start drugging children in the absence of any scientific basis In the absence of treatment data, treatment of childhood bipolar illness is modeled on that of adults. Even if the child shows no signs of psychosis, the most toxic adult drugs are recommended For non-psychotic children, in descending order, treatment should be tried with lithium, divalproex, atypical antipsychotic, combining any of these approaches, and other anticonvulsants plus atypical antipsychotics or conventional antipsychotic. ... 

Cases of lithium toxicity, its cardiac effects, and issues of cardiac dysfunction in children have been reviewed in the light of a cardiac dysrhythmia in a child. 

Anencephaly in the child of a woman taking lithium appears to have been coincidental (491). 

Findling RL, McNamara NK, Youngstrom EA, Stansbrey R, Gracious BL, Reed MD, Calabrese JR. Double-bhnd 18-month trial of lithium versus divalproex maintenance treatment in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005 44 409-17. 

Moltedo JM, Porter GA, State MW, Snyder CS. Sinus node dysfunction associated with lithium therapy in a child. Tex Heart Inst J 2002 29(3) 200-2. 

Gracious BL, Liana M, Barton DD. Lithium and geographic tongue. J Am Acad Child Adolesc Psychiatry 1999 38(9) 1069-70. 

Owley T, Leventhal B, Cook EH Jr. Risperidone-induced prolonged erections following the addition of lithium. J Child Adolesc Psychopharmacol 2001 ll(4) 441-2. 

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