Data are presented from psychiatric clinics in Glostrup, Prague and Zurich for 244 patients who suffered from recurrent affective disorders and were treated prophylactically with lithium. The disease course was followed by recording the numbers of psychotic episodes and hospital admissions and the durations of cycles and episodes.

Lithium effects were evaluated by two methods: (A) intra-individual comparisons of the disease course during lithium treatment and during control periods of similar length before lithium, and (B) multiple regression analyses of cycle and episode durations with lithium treatment as one of the variables.

Lithium treatment led to a pronounced and statistically significant reduction in the number of both episodes and hospital admissions. This was demonstrated at all three clinics and for each of the affective disorders, manic-depressive psychosis, recurrent depressive psychosis, and schizo-affective psychosis. The response to lithium treatment was independent of age at the start of lithium treatment, age at first episode, sex, and number of previous episodes.

The regression analyses confirmed previous observations on the course of recurrent affective psychoses. Duration of cycles decreased with increasing age at first episode and increasing number of previous episodes. There was a slight decrease of episode duration with increasing number of episodes.

Lithium treatment led to a statistically significant prolongation of the cycles, considerable in manic-depressive and recurrent depressive psychosis, and moderate in schizo-affective psychosis. In manic-depressive patients, there was a statistically significant shortening of episodes during lithium treatment.

The results afford strong evidence that lithium is an active prophylactic agent in recurrent affective disorders.

Lithium Prophylaxis in Recurrent Affective Disorders

This article approaches the question of bipolarity in childhood and adolescence from an "adult" perspective. It argues that clinically ascertained juvenile depressions--with onsets typically in late childhood or early adolescence--have affinity to bipolar spectrum disorders based on (1) early age at onset; (2) even gender ratio; (3) prominence of irritability, labile moods, and explosive anger indicative of mixed episodes; (4) high rates of "comorbid" substance abuse; (5) questionable response to antidepressants and/or brief hypomanic switches; (6) high rates of recurrence; (7) familial affective loading; and (8) frequent superposition on affective temperamental dysregulation. Building on the last point, the author submits that dysthymic, cyclothymic, and hyperthymic temperaments represent putative developmental pathways to bipolarity (as contrasted to "inhibited" anxious-phobic types, which appear related to nonbipolar outcomes.

Developmental pathways to bipolarity: are juvenile-onset depressions pre-bipolar?

Bipolar disorder (BPD), probably the most prevalent psychotic disorder in adults, has been relatively neglected or controversial in children and adolescents over the past century. We reviewed the literature on early-onset BPD.* Estimates of prevalence, particularly before puberty, are limited by historical biases against pediatric mood disorders and by formidable diagnostic complexity and comorbidity. Although clinical features of pediatric and adult BPD have similarities, pediatric cases probably cannot be defined solely by features characteristic of adult cases. Onset was before age 20 years in at least 25% of reported BPD cases, with some increase in this incidence over the past century. Pediatric BPD is familial more often than is adult-onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment. Pediatric BPD episodes frequently include irritability, dysphoria, or psychotic symptoms; they are commonly chronic and carry high...

Pediatric-onset bipolar disorder: a neglected clinical and public health problem.

Emotionally unstable character disorder (EUCD) is the diagnosis applied to those patients with chronic maladaptive behavior patterns, such as poor acceptance of reasonable authority, truancy, poor work history, manipulativeness, but with a core psychopathological disturbance of depressive and hypomanic mood swings that last hours to days. Their lability is not usually reactive to environmental or interpersonal events. We examined 21 such patients in a six-week, double-blind random assignment cross-over study comparing lithium carbonate to placebo. Using a global measure of mood swings, lithium carbonate was statistically significantly superior to placebo. This was also true for a week's rating of the mean of the daily range of mood swings. We interpret these findings to mean that EUCD is closely related to affective illness and that lithium carbonate joins chlorpromazine as a valuable, and perhaps a superior, therapy for EUCD.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=psych&articleId=490764&pdfFileName=archpsyc_27_4_014.pdf

Lithium Carbonate in Emotionally Unstable Character Disorder

The Psychopharmacology of Aggression

Lithium in the treatment of children and adolescents

In 1942 Klinefelter, Reifenstein & Albright described a syndrome in men marked by gynecomastia, hypoplastic testes containing atrophic tubules, absence of sperm, and an abnormally high content of gonadotropic hormones in the urine. Most men with this syndrome have a positive sex-chromatin pattern. The incidence of sex-chromatin-positivity among males in general is 1 per 500, judging by screening large populations of newborn boys (Maclean et al., 1964) and military recruits (Hambert, 1966). About 65 per cent of chromatin-positive Klinefelter males have an XXY sex chromosome complement. The next largest group is characterized by XY/XXY mosaicism. Others have shown the X X W , XXXY and XXXXY pattern and other forms of mosaicism than XY/XXY. The XXXY and XXXXY subjects are usually mentally retarded and have several other congenital defects. Subjects with the XXY pattern in all their cells rarely show anything in their physical appearance to make one suspect the syndrome until they reach puberty. After puberty, it can be seen that they have small testes, and closer analysis discloses that most of the seminiferous tubules are sclerosed and hyalinized and that no germ cells are present. This is the only consistent characteristic but a eunuchoid build, poorly developed secondary sex characteristics and an abnormally high level of gonadotropic hormones in the urine are common. About every second subject has gynecomastia. A number are slightly mentally retarded. Severe mental retardation, as well as mental disorders and epilepsy, are also over-represented among Klinefelter subjects. Their personality is characterized by asthenia, psychoinfantilism, a tendency to outbursts of aggression, uncertainty about their sexual identity and difficulty in adjusting themselves to society (Hambert, 1966).

Anna-Lisa Annell

Papers

Lithium in the treatment of children and adolescents

Chromosomal mosaicism in two emotionally disturbed adolescents with Klinefelter's syndrome (46,XY-47,XXY and 46,XY-47,XYY-48,XXYY).