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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Congenital heart defects, particularly Ebstein’s anomaly, were increased among the infants of mothers who took lithium carbonate during the first trimester (Nora et al., 1974). However, the magnitude of these risks has been questioned (Cohen et al., 1994), and recent analyses seem to attenuate the risks associated with lithium use during pregnancy to levels lower than previously thought (Table 10.4).
Inhalational Durg Abuse
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Jacob Loke, Richard Rowley, Herbert D. Kleber, Peter Jatlow
The chronic effects of cocaine lead to psychological dependence and addiction. It is difficult to treat the drug’s dependence because cocaine is a powerful reinforcing agent. In a survey of crack users who called the “800-COCAINE” national hotline, psychiatric complaints include severe depression (85%), irritability (78%), paranoia (65%), loss of sexual desire (58%), memory lapses (40%), violent behavior (31%), and suicide attempts (18%) (Washton et al., 1986). The psychotherapeutic modalities for the addictive behaviors consist of behavioral, supportive, and psychodynamic treatments (Kleber and Gawin, 1984a,b). Pharmacotherapy is useful and may control the psychiatric symptoms when used in addition to psychotherapy without the need for hospitalization. Severe depression or psychotic symptoms that last beyond 1-3 days after the postcocaine crash warrant hospitalization for in-patient therapy. In severe abusers of cocaine, the pharmacologic agents used for cocaine abstinence are mainly tricyclic antidepressants such as desipramine (Kleber and Gawin, 1984a,b). Lithium carbonate can be used when a diagnosis of bipolar disorder is present and methylphenidate if a diagnosis of attention deficit disorder is made; otherwise, these two drugs are not useful in these patients. Bromocriptine has been used for the treatment of postcocaine craving (Dackis and Gold, 1985), but the number of cases are too small to allow one to draw conclusions yet.
Miscellaneous
Published in Michael McGhee, A Guide to Laboratory Investigations, 2019
Start with 200–500 mg lithium carbonate for the first week or two, measuring the serum lithium weekly and increasing the dose of lithium (Li+) to between 300 and 1250 mg nocte until the serum level reaches 0.4–0.8 mmol/l.
Lithium – past, present, future
Published in International Journal of Psychiatry in Clinical Practice, 2020
In women with bipolar disorder, there is an increased risk for a recurrence of illness during pregnancy. Therefore, women with the previous favourable effect of lithium should continue using lithium during pregnancy. A recent meta-analysis included data from pregnant women and their children from six international cohorts based on the community (Denmark, Sweden and Canada) and clinics (the Netherlands, UK and the USA), identifying 727 lithium-exposed out of 22,124 eligible pregnancies. Lithium exposure was not associated with any of the predefined pregnancy complications or delivery outcomes. Such an exposure during the first trimester was associated with a 1.7-fold increased risk of major malformations but for major cardiac malformations, the difference was not significant. A 1.6-fold increased risk for neonatal readmission within 28 days of birth was also seen in the lithium-exposed group (Munk-Olsen et al. 2018). It is recommended that in the first trimester, the daily dose of lithium carbonate should not exceed 500 mg. Starting with the second trimester, there is a necessity to increase the lithium dose. The dose of lithium should be reduced or lithium temporarily stopped for one or two days before expected delivery. Lithium is excreted in breast milk and then in infants, the plasma levels may reach 30–50% of the mother. Therefore, the mother should rather avoid breastfeeding or reduce lithium dose and monitor closely the infant for any signs of toxicity (Rybakowski et al. 2019).
Survival genes expression analysis following ionizing radiation to LiCl treated KG1a cells
Published in International Journal of Radiation Biology, 2020
Yogesh Kumar Verma, Ajay Kumar Singh, Gangenahalli Ugraiah Gurudutta
Lithium chloride (LiCl) is a white-colored ionic compound, which affects the central nervous system (Gould and Manji 2005) and has toxic effects in high concentration (Kaufmann et al. 2011). Its salts, like lithium carbonate and lithium citrate tetrahydrate, are used prophylactically in bipolar and unipolar manic depressive illness for attenuation of both manic and depressive episodes. After oral intake, the peak concentration of lithium reaches within about 4–5 h. Its plasma half-life ranges from 8 to 45 h. Experimental studies have shown that LiCl stimulates the post-irradiation recovery of human hematopoietic marrow cells and provides considerable protection against radiation-induced damage in mouse spermatogonia (LiCl dose reduction factor is 1.84) (Bhattacharjee et al. 1997). It exerts its effect by decreasing cell death via up-regulation of Bcl-2. This is mediated through PP2A methylation and caspase-2 inhibition (Manji et al 2000; Chen et al. 2006). In a similar study, it has been shown that long term, but not acute, treatment of cultured cerebellar granule cells with LiCl results in a concentration-dependent decrease in mRNA and protein levels of proapoptotic p53 and Bax. Pretreatment of these cells with LiCl for 7 d elevates Bcl-2 expression and prevents glutamate-induced increase in p53 and Bax expression (Chen and Chuang 1999). The downregulation of p53 is mediated through phosphorylation of p38 MAPK, leading to G2/M arrest of cells (Tsui et al. 2012).
Predicting individual responses to lithium with oxidative stress markers in drug-free bipolar disorder
Published in The World Journal of Biological Psychiatry, 2019
Qinyu Lv, Yanhong Guo, Minghuan Zhu, Ruijie Geng, Xiaoyan Cheng, Chenxi Bao, Yingyi Wang, Xinxin Huang, Chen Zhang, Yong Hao, Zezhi Li, Zhenghui Yi
Patients with BD were treated with lithium for 6 weeks. The initial dose of lithium carbonate was 250 mg/day, which could be increased by 250 mg/day every 3 days depending on the situation of the patient and the concentration of lithium. Blood lithium concentration was measured weekly. The lithium dose range was 250–1000 mg/day, and the effective concentration of lithium ranged from 0.8 to 1.2 mmol/l. During the lithium treatment, 13 patients combined with antidepressants, 6 patients combined with antipsychotics, 13 patients combined with antidepressants as well as antipsychotics and 29 patients received lithium monotherapy. Benzodiazepines could be taken briefly if the patient had insomnia or obvious anxiety.