Lithium problems with

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

Coin and Button Cell Commercial Systems. Initial commercialization of rechargeable lithium technology has been through the introduction of coin or button cells. The eadiest of these systems was the Li—C system commercialized by Matsushita Electric Industries (MEI) in 1985 (26,27). The negative electrode consists of a lithium alloy and the positive electrode consists of activated carbon [7440-44-0J, carbon black, and binder. The discharge curve is not flat, but rather slopes from about 3 V to 1.5 V in a manner similar to a capacitor. Use of lithium alloy circumvents problems with cycle life, dendrite formation, and safety. However, the system suffers from generally low energy density. 

Ms. Brawn comes to the mental health clinic for a followup visit. She is taking lithium to control a bipolar disorder. Ms. Brown tells you that she is concerned because her hands are always shaking and sometimes I walk like I have been drinking alcohol. Explain how you would explore this problem with Ms. Brown. 

In addition to the problem with the lithium anode, a new factor contributing to the capacity fade surfaced as the oxidative decomposition of ether-based compounds on the cathode surf ace. Electro-... 

ALkoxyalkyl-substituted arenechromium complexes have been lithiated enantioselec-tively in the benzylic position without control over planar chirahty and the tendency for lithium amides to lithiate at a benzyhc position rather than on the ring itself poses a problem with some substrates. In the lithiation of 433, an element of planar stereochemistry is introduced during a benzyhc lithiation (Scheme 176) . Exploiting... 

Finally, Stroberetal. (183) conducted an 18-month, prospective, naturalistic follow-up study of 37 bipolar-l adolescents (i.e., 13 to 17 years old) stabilized on lithium and found a relapse rate almost three times higher in those who discontinued prophylactic lithium (92%), as compared with those who complied (38%). Further, they noted that earlier relapse in these patients predicted a greater risk of subsequent relapse and that an early onset may be associated with a more virulent course, resistance to lithium, and the need to consider alternative mood stabilizers. Methodological problems with this study included a small sample size lack of assessment for personality disturbances and intrafamilial environment only a 4-week initial drug stabilization period and lack of precision in monitoring compliance to treatment. 

Reviews of the literature comparing CBZ or oxcarbamazepine with placebo, lithium, or various antipsychotics for acute mania find a response rate approaching 70% (203, 204). One of the problems with this literature, however, is that most studies qualify for only a class III design (see also the section Evaluation of Drug Study Designs in Chapter 2). 

Carbanions at C(2) of the aziridine ring may be generated by deprotonation or by exchange, e.g. tin-lithium. A major problem with the deprotonation approach is the necessity of a strong base which may also react by a nucleophilic ring-opening process. /V-(f-Butoxycarbonyl)aziridines may be deproto-nated with BusLi/TMEDA, as shown in Scheme 20 (94JOC276). 

As discussed below, there are problems with morphological changes and passivation reactions at lithium metal negative electrodes in secondary cells, which reduce cycle life and the practical energy density of the system, and may in some circumstances introduce safety hazards. A more recent development involves the replacement of the lithium metal anode by another insertion compound, say C Dm. In this cell, the electrochemical process at the negative side, rather than lithium plating and... 

The properties of lithium metal were described in Chapter 4, where particular note was made of its high specific capacity and electrode potential. However, because of its highly electropositive nature, it is thermodynamically unstable in contact with a wide variety of reducible materials. In particular, lithium reacts with components of most electrolytes to form a passivating layer. Film formation of this type ensures long shelf life for primary lithium cells, but causes severe problems when the electrode is cycled in a secondary cell. 

A 54-year old man, who had taken lithium for 15 years without problems, suddenly developed food and water aversion, hypercalcemia (2.75 mmol/1), and lithium toxicity, with a serum lithium concentration of 4.3 mmol/1 (677). He was confused, delirious, and irritable. Hemodialysis produced a marked improvement in laboratory tests, which became normal after 9 days. 

A major problem with lithium use is the danger of accumulation within the body.27 Lithium is not metabolized, and drug elimination takes place almost exclusively through excretion in the urine. Consequently, lithium has a tendency to accumulate in the body, and toxic levels can frequently be reached during administration. 

In the structure of lithium oxide, Li20, as shown in Figure 6.11, there is a ccp (3P) framework of oxide ions with Li+ ions filling both T layers (T+ and T ) between P layers. The very close T+ and T layers (above and below each P layer) are clearly shown. There is no problem with all T sites occupied for a ccp arrangement because the T sites are staggered (A, B, and C). Each oxide ion is at the center of a cube formed by eight Li+ ions. This structure is the reference structure for many related tetrahedral structure involving partial occupancy of T and/or P layers. 

There are a few surprising medical uses among the alkali and alkaline earth metals. Lithium combined with chlorine has been used for decades to treat a form of depression called bipolar disorder. Scientists are not exactly sure how lithium affects depression, but they think it may somehow change chemical messages in the brain. Doctors use barium, one of the heaviest alkaline earth metals, to get a better look at the stomach and intestines. They give their patients a drink called barium sulfate that travels to the gut. Bariums 56 electrons absorb X-rays and light up the stomach and intestines to reveal ulcers and other problems. 

---