Mortality in 497 Patients with Affective Disorders Attending a Lithium Clinic or after Having Left it

 

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The impact of lithium prophylaxis on mortality has been studied in 497 patients, 405 bipolars and 92 unipolars, who attended the same out-patient lithium clinic for up to 30 years. In order to avoid preselection, no minimum period of lithium treatment was required in our study. Of a total of 6014 patient-years, 4330 were spent in regular contact with the study clinic. General mortality due to natural causes was not significantly increased; among cardiovascular diseases, only pulmonary embolism showed an excess mortality. No patients died of lithium intoxication or chronic renal insufficiency. Patients were divided into three groups: Group A, 277 patients, attended the study clinic until death or the end of the study, Group B, 86 patients, left the clinic but continued to take lithium, and Group C, 134 patients, both left the clinic and stopped taking lithium. Among bipolars, the suicide rate compared to the general population was in excess in all three groups. Among unipolars, suicides occurred only after the patients had left the study clinic and stopped taking lithium. A special analytical method was used for intergroup comparisons of suicide rates. Bipolars in Group A attending the study clinic regularly had a suicide rate of 3.5 per 1000 patient-years. The rate increased to 6.3 or by 80 % if patients had left the clinic and did not take lithium any longer as in Group C. The suicide rate in Group C increased by 45 % compared to Group B, patients who left the clinic but continued to take lithium. Our results support the hypothesis that lithium has a significant antisuicidal effect in bipolars as well as in unipolars. The suicide mortality can be further reduced by regular attendance in a specialised mood disorder clinic.

References

• 1 Ahrens B, Müller-Oerlinghausen B, Schou M, Wolf T, Alda M, Grof E, Grof P, Lenz G, Simhandl C, Thau K, Vestergaard P, Wolf R, Möller H J. Excess cardiovascular and suicide mortality of affective disorders may be reduced by lithium prophylaxis.  J Affect Disord. 1995;  33 67-75
  CrossrefPubMedGoogle Scholar
• 2 Alström C H. Mortality in mental hospitals with especial regard to tuberculosis.  Acta Psychiatr Scand (Kbh). 1942;  24 40-44
  PubMedGoogle Scholar
• 3 American Psychiatric Association .Diagnostic and statistical manual of mental disorders. Third edition, revised. (DSM-III-R). Washington D.C.; American Psychiatric Association 1987
  Google Scholar
• 4 Causeman B, Müller-Oerlinghausen B. Does lithium prevent suicides and suicide attempts?. In: Birch NY (ed) Lithium: Inorganic pharmacology and psychiatric use. Oxford; IRL Press 1988: 23-24
  Google Scholar
• 5 Coppen A. Depression as a lethal disease: prevention strategies.  J Clin Psychiatry. 1994;  55 37-54
  PubMedGoogle Scholar
• 6 Kallner G, Petterson U. Renal, thyroid and parathyroid function during lithium treatment: laboratory tests in 207 people treated for 1 - 30 years.  Acta Psychiatr Scand. 1995;  91 45-51
  PubMedGoogle Scholar
• 7 Kreitman N. Suicide, age and marital status.  Psychol Med. 1988;  18 121-128
  PubMedGoogle Scholar
• 8 Lindberg S, Ågren G. Mortality among male and female hospitalized alcoholics in Stockholm 1962 - 1983.  Br J Addict. 1988;  83 -1200
  PubMedGoogle Scholar
• 9 Lindelius R. A study in schizofrenia.  Acta Psychiatr Scand. 1970;  216 56
  PubMedGoogle Scholar
• 10 Lundqvist G. Prognosis and cause of manic-depressive psychoses.  Acta Psychiatr et Neurol Scand. 1945;  35 1-96
  PubMedGoogle Scholar
• 11 Müller-Oerlinghausen B, Ahrens B, Grof E, Grof P, Lenz G, Schou M, Simhandl C, Thau K, Volk J, Wolf R, Wolf T. The effect of long-term lithium treatment on the mortality of patients with manic-depressive and schizoaffective illness.  Acta Psychiatr Scand. 1992a;  86 218-222
  PubMedGoogle Scholar
• 12 Müller-Oerlinghausen B, Müser-Causemann B, Volk J. Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication.  J Affect Disord. 1992b;  25 261-270
  CrossrefPubMedGoogle Scholar
• 13 Müller-Oerlinghausen B, Wolf T, Ahrens B, Schou M, Grof E, Lenz G, Simhandl C, Thau K, Wolf R. Mortality during initial and during later lithium treatment. A collaborative study by the International Group for the Study of Lithium-Treated Patients (IGSLI).  Acta Psychiatr Scand. 1994;  90 295-297
  PubMedGoogle Scholar
• 14 Müller-Oerlinghausen B, Wolf T, Ahrens B, Glaenz T, Schou M, Grof E, Grof P, Lenz G, Simhandl C, Thau K, Vestergaard P, Wolf R. Mortality of patients who dropped out from regular lithium prophylaxis: a collaborative study by the International Group for the Study of Lithium-Treated Patients (IGSLI).  Acta Psychiatr Scand. 1996;  94 -347
  PubMedGoogle Scholar
• 15 Nilsson A, Axelsson R. Lithium discontinuers. I. Clinical characteristics and outcome.  Acta Psychiatr Scand. 1990;  82 433-438
  PubMedGoogle Scholar
• 16 Nilsson A. Mortality in recurrent mood disorders during periods on and off lithium.  Pharmacopsychiat. 1995;  28 8-13
  PubMedGoogle Scholar
• 17 Norton B, Walley L J. Mortality of a lithium-treated population.  Br J Psychiatry. 1984;  145 277-282
  PubMedGoogle Scholar
• 18 Petterson U. Manic-depressive illness. A clinical, social and genetic study.  Acta Psychiatr Scand. 1977;  269 1-93
  PubMedGoogle Scholar
• 19 Pratt L A, Ford D E, Crum R M, Armenian H K, Gallo J J, Eaton W W. Depression, psychotropic medication and risk of myocardial infarction.  Circulation. 1996;  94 3123-3129
  PubMedGoogle Scholar
• 20 Schou M. Forty years of lithium treatment.  Arch Gen Psychiatry. 1997;  54 9-13
  PubMedGoogle Scholar
• 21 Schou M. Has the time come to abandon prophylactic lithium treatment? A review for clinicians.  Pharmacopsychiat. 1998;  31 -215
  PubMedGoogle Scholar
• 22 Sharma R, Markar H R. Mortality in affective disorder.  J Affect Disord. 1994;  31 91-96
  PubMedGoogle Scholar
• 23 Vestergaard P, Aagaard J. Five year mortality in lithium-treated manic-depressive patients.  J Affect Disord. 1991;  21 33-38
  CrossrefPubMedGoogle Scholar
• 24 Winokur G, Coryell W, Endicott J, Akiskal H. Further distinction between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression).  Am J Psychiatry. 1993;  150 1176-1181
  PubMedGoogle Scholar

Ph.D. M.D., Ulla Petterson,

Karolinska Institutet Institution of Clinical Neuroscience Department of Psychiatry St. Göran's Hospital

S-112 81 Stockholm

Sweden