This paper addresses considerations in recommencing lithium in elderly patients with Bipolar I Disorder and medical comorbidity. We focus on nephrotoxicity and cognitive impairment.
Methods:
Case reports and review of relevant literature.
Results:
Three elderly psychogeriatric inpatients admitted with severe manic relapse following lithium cessation are described. In all cases, lithium was recommenced safely with good response.
Conclusions:
Even with medical comorbidity it may be possible to recommence modified lithium therapy.
AlmeidaOPFennerS.Bipolar disorder: similarities and differences between patients with illness onset before and after 65 years of age. Int Psychogeriatr2002; 14: 311–322.
2.
AngstJGammaASellaroRet al. Recurrence of bipolar disorders and major depression. A life-long perspective. Eur Arch Psychiatry Clin Neurosci2003; 253: 236–240.
3.
KessingLVAndersenPKMortensenPBet al. Recurrence in affective disorder. I. Case register study. Br J Psychiatry1998; 172: 23–28.
4.
SubramaniamHDennisMSByrneEJ.The role of vascular risk factors in late onset bipolar disorder. Int J Geriatr Psychiatry2007; 22: 733–737.
5.
Da Costa LaneLStellaFForlenzaOV. Mood disorders in the elderly: prevalence, functional impact and management challenges. Neuropsychiatr Dis Treat2016; 12: 2105–2114.
6.
TamashiroJHZungSZanettiMVet al. Increased rates of white matter hyperintensities in late-onset bipolar disorder. Bipolar Disord2008; 10: 765–775.
7.
MalhiGSBassettDBoycePet al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry2015; 49: 1087–1206.
ShulmanKI.Lithium for older adults with bipolar disorder: should it still be considered a first-line agent?Drugs Aging2010; 27: 607–615.
10.
RejSElieDMucsiIet al. Chronic kidney disease in lithium-treated older adults: a review of epidemiology, mechanisms, and implications for the treatment of late-life mood disorders. Drugs Aging2015; 32: 31–34.
11.
YaziciOKoraKPolatAet al. Controlled lithium discontinuation in bipolar patients with good response to long-term lithium prophylaxis. J Affect Disord2004; 80: 269–271.
12.
WijeratneCDraperB.Reformulation of current recommendations for target serum lithium concentration according to clinical indication, age and physical comorbidity. Aust N Z J Psychiatry2011; 45: 1026–1032.
13.
NasreddineZSPhillipsNABedirianVet al. The Montreal Cognitive Assessment, MOCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc2005; 53: 695–696.
14.
FolsteinMFolsteinSEMcHughPR. “Mini-Mental State” a Practical Method for Grading the Cognitive State of Patients for the Clinician. J Psychiatr Res1975; 12: 189–198.
15.
MioshiEDawsonKMitchellJ. The Addenbrooke’s Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry2006; 21: 1078–1085.
16.
SprouleBAHardyBGShulmanKI.Differential pharmacokinetics of lithium in elderly patients. Drugs Aging2000; 16: 165–177.
17.
BedfordJJWeggerySEllisGet al. Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride. Clin J Am Soc Nephrol2008; 3: 1324–1331.
18.
KnebelRJRosenlichtNCollinsL.Lithium carbonate maintenance therapy in a haemodialysis patient with end-stage renal disease. Am J Psychiatry2010; 167: 1409–1410.
19.
ShahVCKayathiPSinghGet al. Enhance your understanding of lithium neurotoxicity. Prim Care Companion CNS Disord2015; 17: 1–4.
20.
KessingLVSondergardLFormanJLet al. Lithium treatment and risk of dementia. Arch Gen Psychiatry2008; 65: 1331–1335.
21.
Dell’OssoLDel GrandeCGesiCet al. A new look at an old drug: neuroprotective effects and therapeutic potentials of lithium salts. Neuropsychiatr Dis Treat2016; 12: 1687–1703.
22.
BeardenCEThompsonPMDalwaniMet al. Greater cortical gray matter density in lithium-treated patients with bipolar disorder. Biol Psychiatry2007; 62: 7–16.
23.
LanCCLiuCCLinCHet al. A reduced risk of stroke with lithium exposure in bipolar disorder: a population-based retrospective cohort study. Bipolar Disord2015; 17: 705–714.
24.
SaniGPerugiGTondoL.Treatment of bipolar disorder in a lifetime perspective: is lithium still the best choice?Clin Drug Investig2017; 713–727.
25.
GareriPSegura-GarciaCManfrediVGLet al. Use of atypical antipsychotics in the elderly: a clinical review. Clin Interv Aging2014; 9: 1363–1373.
