Factors predicting inefficacy of lithium in patients with Bipolar I Disorder
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Introduction: The aim of this study was to investigate whether factors, that are related to a more severe course of bipolar disorder, will predict the efficacy of lithium in BPI patients. For this purpose it was examined whether earlier onset, comorbid anxiety, comorbid alcohol dependence, comorbid substance dependence and early extreme adversity predict lithium response in a large sample of BPI patients. Method: Based on a questionnaire about lithium response, 446 lithium users were selected and groups were created: A group that used lithium at the time of inclusion and was (very) satisfied with the performance, versus a group that once used lithium but discontinued the treatment because of inefficacy. Furthermore an additional group was created which contained all patients who discontinued lithium treatment due to reasons other than inefficacy, including motivation and negative side effects. Results: As expected, the current study found an association between lifetime alcohol dependence and bad lithium response, alcohol dependence was associated with the discontinuation of lithium treatment due to motivational reasons and due to inefficiency. However, none of the other factors of the severity profile i.e. earlier onset, comorbid anxiety, comorbid substance dependence and early extreme adversity were related to bad lithium response. Discussion: Apart from alcohol dependence, the severity profile appeared unusable for drafting a predictive model for discontinuation of lithium treatment. This makes further research based on other profiles necessary. However, the results may reflect an influence of motivation on lithium treatment in BPI patients with comorbid alcohol dependence. Therefore, strictly monitoring motivation for treatment and enhancing compliance within this group should be an essential component in treatment with lithium.