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Fatigue as side effects of lithium
262S
BIOL. PSYCHIATRY
\90-1481
MR-spectroscopy In depressed patients undergoing Eel
D.F. Sraus, G. Ende, A. Schmitt, J. KOhnen, FA Henn. NMR Research in Psychiatry, Central Institute of Mental Health, Mannheim, Germany Purpose: We performed a serial 1 H MRSI Investigation of the hippocampal region In 5 depressed patients; tree patients undergoing a course of ECT and two receiving conventional medication. With this pilot study we aimed to answer the question: Are 1 H MRSI detectable signals changed during the course of ECT as signs for biochemical alterations? Materials and Methods: The' H MRSI studies were performed on a 1.5 T Siemens Vision MRIIMRS system eqUipped with a standard head coil. For MRSI localization 20 FLASH images In coronal, sagittal and oblique transverse orientation were acquired. The transverse images were angulated parallel to the long axis of the hippocampus. PRESS volume preselection was performed parallel to the transverse images and including both hippocampi. Serial MRSI data sets were obtained from each patient. The first data set was obtained before ECT started and then successively after the 4th, 8th, and 12th ECT treatment. The MRSI measurements were performed at least 30 hours after the last ECT to avoid possible effects of the anesthesia on the metabolite concentrations. Results: The NAAlCh ratio in the patients undergoing ECT shows a significant decrease after 6-8 ECT sessions. NAA and Ch signals 1rom the patients corrected for coil loading by multiplication with the transmitter reference voltage showed that during repetitive ECT, only MRS I detectable choline increases, whereas NAA remains unchanged.
190-1491
Electroconvulsive therapy in Parkinson's disease
Raymond Faber. University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, USA Methods: Electroconvulsive therapy (ECT) can have substantial beneficial effects on the motor impairments of Parkinson's disease. The under-appre• ciated literature on this subject will be reviewed. In addition, detailed de• scriptions of two patients who benefited markedly with a course of ECT and have had these benefits sustained with maintenance ECT will be presented. Results: The beneficial effects of ECT on Parkinson's disease are not due simply to antidepressant effects since 1) there can be a dissociation between antiparkinson and antidepressant effects and 2) many Parkinsonian patients without coexisting depression have responded 10 ECT. Most patients treated to date have had fairly advanced disease. There are no notable differences from unilateral or bilateral electrode placements In terms of antiparkinson effects. The duration of Improvement Is highly variable, ranging from days to months and even years in some cases. The two cases presented both had been dependent on tube feeding and one was not ambulatory. After ECT the feeding tubes were removed from both patients and the nonambulatory patient can now ambulate quite independently.
190-150
Poster session IV
1997:42:1S-297S
I Intoxications Lithium self-poisoning and therapeutic
S. SaTd, F. Montagnon, F. Lapostolle, F. Buneaux, J.P. Lepine. Department of Psychiatry, Femand Widal Hospital, Paris To our knowledge, apart from case reports there are only two pUblished stud• ies in the literature about lithium intoxications (Hansen and Amdisen, 1978, Dyson et ai, 1987). However the samples are small Including respectively 23 and 68 patients. The aim of our retrospective study was to describe ail patients suspected of lithium overdosage hospitalized in a toxicology Intensive care unit between july 1987 and december 1995. Among 114 patients suspected, only 81 had a definite lithium Intoxication. Most of them (63) were the result of intentional acute poisoning rather than the result of therapeutic overdosage or Interaction (18). In 20 cases Intoxication substance was lithium alone. Serum lithium concentrations were between 0.1 and 6.4 mEqIl (mean 2.2). Toxic effects on brain, heart and kidney were observed In respectively 72, 25 and 24 patients. Three patients died and 3 developed persisting sequelae. We analysed and compared for the two groups (self-poisoning patients and therapeutic intoxication patients) lithium therapy (duration, dosage, serum lithium concentration's supervision and efficiency), sociodemographic characteristics and main psychiatric diagnosis.
190-151
I
Fatigue as side effects of lithium
M. Nikolic, O. Marinkovic, M. Zdravkovic, I. Timotljevlc. Institute for Mental Health, Palmoti6eva 37, 11 000 Belgrade, FR, Yugoslavia Uthium can be chosen as a medicine in the maintenance treatment of bipolar affective disorders. Its appliance can be followed by side effects, even intoxication. Fatigue as unwanted effect attracted our attention be• cause during our research we often found subjective feeling of fatigue and exhaustion. The purpose of this research was to examine this phenomenon by out-patients who were on lithium maintenance treatment and the correla• tion of this phenomenon with Iithemy and affectivity. The research Included 60 patients treated with lithium (20 patients with bipolar affective disorder who were on maintenance treatment tor more than 2 years, 20 patients on maintenance treatment less than 2 years but more than a year and 20 patients with schizoaffective disorder on lithium maintenance treatment for more than a year) and control group of 20 patients treated with classical medicine therapy (antldepressives and neuroleptics). Depression was de• termined by the Hamilton Depression Rating Scale, lithium bloodserum level by the method of flame spectrophotometry and the state of fatigue by the neurophysiological methods.
190-1521
Lithium effects on circadian rhythms and agresslve behavior In circadian phase dependence
T.A. lamochshlna, A.S. Saratikov. State University, Siberian Medical University, Tomsk, Russia Uthium hydroxybutirate (LH) is effective for affective disorders treatment. The present study was designed to examine the lithium effects on rafs agressive behavior as regards mouse (anacs, stings, killing) and circadian rhythms of body temperature and behavior In "open field" in circadian phase dependence treatment. Methods: LH (10 mglkg, 7 days) to the rats with raphe midbrain lesion was done in the beglning light or dark phase. Rats were placed into individual cages under natura/light regimen. Experiments was doing from October to December. The spectral and "Cosinor" methods was carryed out for analyse. Results: Agressive behavior was Inhibited only after evening LH pretreat• ment. In this circadian phase LH lengthend circadian rhythms of rat's body temperature and behavior In "open field". This results come to agreement with our previous date, indicating that evening LH Ingection Increased brain serotonin content, and chronoblological hypothesis of lithium antydepressive effects.
190-1531
Failure of lithium to prevent behavioural sensitization of DA receptors Induced by imipramine
P.S. 0'Aquila 1, M. Collu 2, P. Devoto 2, G. Serra'. 1 Dipartlmento dl Scienze del Farmaco Universita di Sassari, Italy, 2 Dipartimento di Neuroscienze Universita dl Gagliari, Italy We have suggested that the enhanced dopamlnerglc transmission Induced by different antidepressant (AD) treatments might be relevant not only for their therapeutic effects but also for their ability to produce switches from depression to mania. Accordingly, a great deal of evidence suggests that an increased dopamlnergic transmission Is associated with mania. The aim of the present work was to Investigate on the ability of lithium to prevent the developemenl of the behavioural supersensitivity of DA receptors IndUCed by chronic Imipramine. Indeed, lithium exerts antlmanlc effects and not only does prevent both manic and depressive episodes In manic-depressive patients, but also the developement of supersensitivity of DA receptors induced by different experimental manipulations In animals. As expected chronic treatment with Imipramine (20 mglkg J.p. for 21 days) markedly potentiated the locomotor activity Induced by qulnplrole (0.15 mglkg s.c.), a selective 02-03 receptor agonist. The stimulatory effect of quinpirole in lithium-treated rats did not differ from that observed In control rats. In rats administered with lithium (serum lithium level 0.76 :I: 0.1 mEqIl) and imipramine the behavioural response to quinplrole did not differ from that observed after chronic Imipramine. These results suggest that lithium fails to prevent the behavioural supersensitlvlty of DA receptors Induced by chronic ADs. Th~ possible. cl~nical relevance of this finding, particularly with respect to the efficacy of lithium In preventing AD-Induced manic episodes, will be discussed.
BIOL. PSYCHIATRY
\90-1481
MR-spectroscopy In depressed patients undergoing Eel
D.F. Sraus, G. Ende, A. Schmitt, J. KOhnen, FA Henn. NMR Research in Psychiatry, Central Institute of Mental Health, Mannheim, Germany Purpose: We performed a serial 1 H MRSI Investigation of the hippocampal region In 5 depressed patients; tree patients undergoing a course of ECT and two receiving conventional medication. With this pilot study we aimed to answer the question: Are 1 H MRSI detectable signals changed during the course of ECT as signs for biochemical alterations? Materials and Methods: The' H MRSI studies were performed on a 1.5 T Siemens Vision MRIIMRS system eqUipped with a standard head coil. For MRSI localization 20 FLASH images In coronal, sagittal and oblique transverse orientation were acquired. The transverse images were angulated parallel to the long axis of the hippocampus. PRESS volume preselection was performed parallel to the transverse images and including both hippocampi. Serial MRSI data sets were obtained from each patient. The first data set was obtained before ECT started and then successively after the 4th, 8th, and 12th ECT treatment. The MRSI measurements were performed at least 30 hours after the last ECT to avoid possible effects of the anesthesia on the metabolite concentrations. Results: The NAAlCh ratio in the patients undergoing ECT shows a significant decrease after 6-8 ECT sessions. NAA and Ch signals 1rom the patients corrected for coil loading by multiplication with the transmitter reference voltage showed that during repetitive ECT, only MRS I detectable choline increases, whereas NAA remains unchanged.
190-1491
Electroconvulsive therapy in Parkinson's disease
Raymond Faber. University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, USA Methods: Electroconvulsive therapy (ECT) can have substantial beneficial effects on the motor impairments of Parkinson's disease. The under-appre• ciated literature on this subject will be reviewed. In addition, detailed de• scriptions of two patients who benefited markedly with a course of ECT and have had these benefits sustained with maintenance ECT will be presented. Results: The beneficial effects of ECT on Parkinson's disease are not due simply to antidepressant effects since 1) there can be a dissociation between antiparkinson and antidepressant effects and 2) many Parkinsonian patients without coexisting depression have responded 10 ECT. Most patients treated to date have had fairly advanced disease. There are no notable differences from unilateral or bilateral electrode placements In terms of antiparkinson effects. The duration of Improvement Is highly variable, ranging from days to months and even years in some cases. The two cases presented both had been dependent on tube feeding and one was not ambulatory. After ECT the feeding tubes were removed from both patients and the nonambulatory patient can now ambulate quite independently.
190-150
Poster session IV
1997:42:1S-297S
I Intoxications Lithium self-poisoning and therapeutic
S. SaTd, F. Montagnon, F. Lapostolle, F. Buneaux, J.P. Lepine. Department of Psychiatry, Femand Widal Hospital, Paris To our knowledge, apart from case reports there are only two pUblished stud• ies in the literature about lithium intoxications (Hansen and Amdisen, 1978, Dyson et ai, 1987). However the samples are small Including respectively 23 and 68 patients. The aim of our retrospective study was to describe ail patients suspected of lithium overdosage hospitalized in a toxicology Intensive care unit between july 1987 and december 1995. Among 114 patients suspected, only 81 had a definite lithium Intoxication. Most of them (63) were the result of intentional acute poisoning rather than the result of therapeutic overdosage or Interaction (18). In 20 cases Intoxication substance was lithium alone. Serum lithium concentrations were between 0.1 and 6.4 mEqIl (mean 2.2). Toxic effects on brain, heart and kidney were observed In respectively 72, 25 and 24 patients. Three patients died and 3 developed persisting sequelae. We analysed and compared for the two groups (self-poisoning patients and therapeutic intoxication patients) lithium therapy (duration, dosage, serum lithium concentration's supervision and efficiency), sociodemographic characteristics and main psychiatric diagnosis.
190-151
I
Fatigue as side effects of lithium
M. Nikolic, O. Marinkovic, M. Zdravkovic, I. Timotljevlc. Institute for Mental Health, Palmoti6eva 37, 11 000 Belgrade, FR, Yugoslavia Uthium can be chosen as a medicine in the maintenance treatment of bipolar affective disorders. Its appliance can be followed by side effects, even intoxication. Fatigue as unwanted effect attracted our attention be• cause during our research we often found subjective feeling of fatigue and exhaustion. The purpose of this research was to examine this phenomenon by out-patients who were on lithium maintenance treatment and the correla• tion of this phenomenon with Iithemy and affectivity. The research Included 60 patients treated with lithium (20 patients with bipolar affective disorder who were on maintenance treatment tor more than 2 years, 20 patients on maintenance treatment less than 2 years but more than a year and 20 patients with schizoaffective disorder on lithium maintenance treatment for more than a year) and control group of 20 patients treated with classical medicine therapy (antldepressives and neuroleptics). Depression was de• termined by the Hamilton Depression Rating Scale, lithium bloodserum level by the method of flame spectrophotometry and the state of fatigue by the neurophysiological methods.
190-1521
Lithium effects on circadian rhythms and agresslve behavior In circadian phase dependence
T.A. lamochshlna, A.S. Saratikov. State University, Siberian Medical University, Tomsk, Russia Uthium hydroxybutirate (LH) is effective for affective disorders treatment. The present study was designed to examine the lithium effects on rafs agressive behavior as regards mouse (anacs, stings, killing) and circadian rhythms of body temperature and behavior In "open field" in circadian phase dependence treatment. Methods: LH (10 mglkg, 7 days) to the rats with raphe midbrain lesion was done in the beglning light or dark phase. Rats were placed into individual cages under natura/light regimen. Experiments was doing from October to December. The spectral and "Cosinor" methods was carryed out for analyse. Results: Agressive behavior was Inhibited only after evening LH pretreat• ment. In this circadian phase LH lengthend circadian rhythms of rat's body temperature and behavior In "open field". This results come to agreement with our previous date, indicating that evening LH Ingection Increased brain serotonin content, and chronoblological hypothesis of lithium antydepressive effects.
190-1531
Failure of lithium to prevent behavioural sensitization of DA receptors Induced by imipramine
P.S. 0'Aquila 1, M. Collu 2, P. Devoto 2, G. Serra'. 1 Dipartlmento dl Scienze del Farmaco Universita di Sassari, Italy, 2 Dipartimento di Neuroscienze Universita dl Gagliari, Italy We have suggested that the enhanced dopamlnerglc transmission Induced by different antidepressant (AD) treatments might be relevant not only for their therapeutic effects but also for their ability to produce switches from depression to mania. Accordingly, a great deal of evidence suggests that an increased dopamlnergic transmission Is associated with mania. The aim of the present work was to Investigate on the ability of lithium to prevent the developemenl of the behavioural supersensitivity of DA receptors IndUCed by chronic Imipramine. Indeed, lithium exerts antlmanlc effects and not only does prevent both manic and depressive episodes In manic-depressive patients, but also the developement of supersensitivity of DA receptors induced by different experimental manipulations In animals. As expected chronic treatment with Imipramine (20 mglkg J.p. for 21 days) markedly potentiated the locomotor activity Induced by qulnplrole (0.15 mglkg s.c.), a selective 02-03 receptor agonist. The stimulatory effect of quinpirole in lithium-treated rats did not differ from that observed In control rats. In rats administered with lithium (serum lithium level 0.76 :I: 0.1 mEqIl) and imipramine the behavioural response to quinplrole did not differ from that observed after chronic Imipramine. These results suggest that lithium fails to prevent the behavioural supersensitlvlty of DA receptors Induced by chronic ADs. Th~ possible. cl~nical relevance of this finding, particularly with respect to the efficacy of lithium In preventing AD-Induced manic episodes, will be discussed.