Lithium guidelines

Lithium and other mood-stabilizing drugs require baseline and routine laboratory monitoring to help determine medical appropriateness for initiation of therapy and monitoring of potential adverse effects. Guidelines for such monitoring are outlined in Table 36-6. 

Treatment of depressive episodes in bipolar disorder patients presents a particular challenge because of the risk of a pharmacologic mood switch to mania, although there is not complete agreement about such risk. Treatment guidelines suggest lithium or lamotrigine as first-line therapy.17,41 Olanzapine has also demonstrated efficacy in treatment of bipolar depression, and quetiapine is under review for approval of treatment of bipolar depression.42 When these fail, efficacy data support use of antidepressants. 

Chemicals from brine, 5 784-803 calcium chloride, 5 793-795 iodine, 5 795—796 lithium, 5 796-797 magnesium compounds, 5 797-798 minerals from brine, 5 790-793 potassium compounds, 5 798-799 recovery process, 5 786-790 sodium carbonate, 5 799-800 sodium chloride, 5 800-801 sodium sulfate, 5 801-802 Chemicals Guideline, integrated,... 

Although the above findings came from studies on mixtures of the cyclic carbonate PC with ethers, they remain qualitatively true for mixtures of cyclic and linear carbonates, that is, compositions of the state-of-the-art lithium electrolytes. Most likely, it was the work by Matsuda et al. that delineated the basic guidelines for electrolyte formulation, which eventually led to the formulations by Tarascon and Guyo-mard using cyclic (high e) and linear (low rj) carbonate mixtures. ... 

Out of the belief that the alkyl esters are reactive in a lithium ion cell during the long-term operation. Smart et al. proposed a carbonate-only guideline and formulated a series of quaternary compositions consisting of EC/DEC/DMC/EMC, in which the EC concentration remained under 25%. The solution of 1.0 M LiPFe in EC/DEC/DMC/EMC (1 1 1 3) was reported to be the best composition, whose ion conductivity at —40 °C was 1.32 mS cm and its cycling in LiNiCo02/MCMB lithium ion cells was comparable to that of the baseline electrolyte 1.0 M LiPFe in EC/DMC (3 7) or (1 1) at room temperatures. At —20 °C, the superiority of these quaternary electrolytes became pronounced, as compared with the ternary and binary baselines shown in Figure 60. 

A Guideline for the Safety Evaluation of Secondary Lithium Cells. Japan Battery Association, 1997. 

Kleiner, J., Altshuler, L., Hendrick, V, and Hershman, J.M. (1999) Lithium-induced subclinical hypothyroidism review of the literature and guidelines for treatment. / Clin Psychiatry 60 249-255. 

Although there are continuation and maintenance guidelines for the use of antidepressants for unipolar depression, it is not clear how long a patient with bipolar depression should be treated with these medications. Rates of recurrence of bipolar depression of approximately 60% have been observed in patients taking adequate doses of lithium, alone or in combination with imipramine (APA, 1994b). As the TCAs have not been shown to be efficacious for youth with... 

In a review of lithium-induced subclinical hypothyroidism (TSH over 5 mU/1, free thyroxine normal), a prevalence of up to 23% in lithium patients was contrasted with up to 10% in the general population. It was stressed that subclinical hypothyroidism from any cause can be associated with subtle neuropsychiatric symptoms, such as depression, impaired memory and concentration, and mental slowing and lethargy, as well as with other somatic symptoms. Management guidelines were discussed (628). 

The distribution of clinical practice guidelines in Northeast Scotland had no impact on whether appropriate action was taken for high serum lithium concentrations (80% before the guidelines, 82% after). There was no significant difference in proper attention to high concentrations between those in primary care alone (77%) and those in shared care (85%) (365). 

Eagles JM, McCann I, MacLeod TN, Paterson N. Lithium monitoring before and after the distribution of clinical practice guidelines. Acta Psychiatr Scand 2000 101(5) 349-53. 

Kasahara H, Shinozaki T, Nukariya K, Nishimura H, Nakano H, Nakagawa T, Ushijima S. Hemodialysis for lithium intoxication preliminary guidelines for emergency. Jpn J Psychiatry Neurol 1994 48(1) 1-12. 

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