The usage of lithium for forty years without problem: a case report

Abstract

Lithium’s first rise in psychiatry was in 1949 when John Cade tried lithium in manic patients successfully. Clinical research which conducted later on, showed the lithium’s effectivity in maintenance treatment of bipolar disorder (BD) and mania. On the other hand, U.S. Food and Drug Administration (FDA) approved lithium for mania treatment in 1970, and for maintenance treatment against mania in 1974. Lithium still keeps its importance as the first line treatment option in acute mania, maintenance treatment, and depressive episode of BD. However, despite this wide usage area, lithium has a narrow therapeutic index and as a result of this, a lot of serious acute and chronic side effects may occur. Neurologic, endocrine, renal, dermatologic, and gastrointestinal, and cardiovascular systems may be affected in different severities. Lithium intoxication may result in neurological sequela, even in death. In this article, a BD patient who has been treated with lithium for forty years without side effects, and who has been found to be normal in lab and monitoring examination will be reported.

Keywords

• bipolar disorder, treatment, lithium

Lityumun kırk yıldır sorunsuz kullanımı: Olgu sunumu

Öz

Lityumun psikiyatride adından söz ettirmeye başlaması ilk defa 1949 yılında John Cade’nin lityumu manik hastalarda denemesinin başarılı olması sonucudur. Daha sonra yapılan klinik çalışmalarda iki uçlu bozukluğun (İUB) koruyucu tedavisi ve manide lityumun etkinliği gösterilmiştir. Amerikan Gıda ve İlaç Dairesi (FDA) lityuma mani tedavisi için 1970’de, maniyi önlemede idame tedavi olarak 1974’de onay vermiştir. Lityum son tedavi kılavuzlarında akut manide, İUB idame ve İUB depresif dönem tedavilerinde halen birinci sıra tedavi seçeneği olarak yerini korumaktadır. Geniş kulanım alanına rağmen lityum dar bir tedavi aralığına sahiptir ve bununla ilişkili olarak birçok ciddi akut ve süreğen yan etki oluşabilmektedir. Nörolojik, endokrin, renal, dermatolojik, gastrointestinal ve kardiyovasküler sistemler değişik şiddette etkilenebilmektedir. Lityum zehirlenmesi durumu ise nörolojik sekelle, hatta ölümle sonuçlanabilmektedir. Bu yazıda ilaç yan etkisi olmadan sorunsuz bir şekilde kırk yıldır lityum ile tedavi edilen, yapılan laboratuvar ve görüntüleme incelemelerinde de herhangi bir anormallik saptanmayan bir İUB hastası sunulacaktır.

Anahtar Kelimeler

• iki uçlu bozukluk, tedavi, lityum

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