Literature Review

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The paper conducts an assessment of five articles that deal with the use of lithium in treating patients with diverse behavioral and neurobehavioral symptoms. Thus the focus of the articles is the assessment of how effective the adoption of lithium is in treating the diverse symptoms relating to the behavioral and neurobehavioral conditions. The research into these articles was implemented via the use of the online articles relating to the use of lithium in the treatment of the different neurobehavioral conditions. Although the articles vary on the type of conditions they address, the implement an effective assessment of the research relating to the effectiveness of lithium. The paper further implements a reliable comparison of the articles in the assessment of the strengths as well as limitations of each in its effort address the topic of the study.


Neurobehavioral disorders encompass a large group of behavioral conditions that are seen in association with brain disease temporary as well as permanent brain impairments. Lithium has been in use in the classic treatment for the diverse bipolar disorder from the 1950s, presenting a prophylactic along with delicate efficacy against maniac moreover depressive episodes. On most occasions, more basic, however vital, attributes of human behavioral evaluation along with treatment do not get addressed or only ostensibly addressed via the evaluating clinicians. Physicians frequently excessively rely on pharmacological intercessions as initial and solitary treatment methods instead of taking a pragmatic biopsychosocial intervention whose focuses is on the holistic disease state management. The paper offers an overview assessment of the use of lithium in the treatment of the diverse behavioral conditions that have an impact on the patients’ quality of life. Through the assessment of the diverse studies that have been implemented in the assessment of the impact that lithium has on the diverse conditions, it will be possible to assess its applicability in treating bipolar conditions. The additional assessment of the strengths, as well as weaknesses of these studies, further present us with the opportunity of assessing how possible it is for the findings to be applied to the general population.

The Effectiveness of Lithium in Treating Different Behavioral and Neurobehavioral Symptoms

In Gonzalez-Pinto, et al. (2006), Regardless of considerable recent progress, some attributes of treatment relating to bipolar disorder (BPD) are still clinically challenging furthermore surprisingly little has been studied on the subject. Following half a century of clinical employment along with the far-reaching investigation, lithium salts still provide substantial furthermore consistent therapeutic impacts across the range of phases along with symptoms of BPD. The additional steadily established evidence of enduring prophylactic efficiency than is obtainable for substitute treatments nonetheless, the use of lithium differs greatly among countries along with clinical settings.

The objective of this study by Gonzalez-Pinto, Mosquera, Alonso, Lo´ pez, Ramı´rez, Vieta, & Baldessarini, (2006) was to assess the broad spectrum of effectiveness that the use of lithium continues to offers, which encompass the reduction of the suicidal risk. The study method encompassed the assessment of the association of suicidal tendencies with the observance of long-term lithium preservation treatment along with additional possible risk factors in 72 BP I patients. The study encompassed following of the patients prospectively for ten years at the Mood Disorders Research Center located in Spain. In the case of data collection, every subject underwent follow-up assessment at the intervals of less than eight weeks meant to review their morbidity, in the context of the type, severity as well as duration. The additionally encompassed the assessment of the alcohol abuse, suicide attempts, hospitalizations as well as the use of all psychotropic agents.

The study observed that the rates of suicide were 0.143, moreover attempts, 2.01%/annually, indicating a 5.2-fold (95%CI: 1.5–18.6) bigger risk among patients constantly rated defectively against high observation of lithium prophylaxis (11.4/2.2 acts/100 person-years) (Gonzalez-Pinto, et al. 2006). The treatment of non-adherence was additionally linked with substance abuse, being male, being unmarried, furthermore having more hypomanic–manic illness along with hospitalizations. The suicidal risk was elevated with previous attempts, additional depression plus hospitalization, family mood disorders, moreover being single and younger, and treatment non-adherence, although with neither sex nor substance abuse. In the multivariate scrutiny, the suicidal risk was connected to previous suicidality, poor adherence to treatment, more depressive episodes and younger age.

The second article by Wilkinson, et al. (2002), tries to compare the rate of relapse of the elderly depressed patients who are taking low dosage lithium as a supplementary therapy amid antidepressant medication to those who receive antidepressant medications alone. The study method employed by the researchers encompassed randomizing fifty elderly subjects who were recovering from major depressive illness and taking persistence antidepressants, in a double-blind study, obtaining supplementary lithium carbonate or placebo furthermore followed up more than a two-year period for verification of relapse.

Accoirding to Ardern et al., (1993), evidence that is available suggests that the continuation of antidepressant therapy plays a role in the prevention of the recurrence of chief depression in the aged, at least over a two-year period. The attribute of adding lithium to the antidepressant therapy with the intention of preventing relapse in the elderly patients is less clear. In the young adults, use of placebo-controlled studies of adding lithium to antidepressant continuance therapy posit to the efficacy (Katona et al., 1995; Baumann et al,1996; Bauer et al., 2000). Nonetheless, in the case of the elderly, the extensive use of low dose lithium therapy, which exhibits a lower result profile although possibly less efficacious additionally is taken into consideration.

Among the outcomes of the study is that the long-term inclusion of low dose lithium to antidepressant therapy could assist in the prevention of relapse of depressive illness for the elderly patients. The cases of relapse in the event it occurred, was approximately entirely reserved for the patients who are not taking lithium. The case of relapse timing was extremely variable furthermore suggests that the elderly patient group profit from the prophylactic impacts of lithium for up to 2 years following the recovery from depression.

The study by Senturk V, Goker C, Bilgic A, Olmez S, Tugcu H, Oncu B, & Atbasoglu BC, (2007), focuses on the assessment of whether the use of lithium and valproate 2, which are the commonly used mood stabilizers in bipolar patients contribute to the increase in the cognitive impairment among patients taking the drug. In this study, there was a comparison of 17 euthymic outpatients who had bipolar disorder on lithium monotherapy to 11 other euthymic outpatients with BD on valproate monotherapy. There are numerous factors that are believed to impact the cognitive functions in bipolar disorders as some hospitalizations, mood symptoms, age at illness onset, the number of affective episodes, and duration of illness. Additionally, issues as the length of remission, suicide attempts, presence or absence of psychotic features, along with the current medication are considered as contributing factors to the cognitive functions of an individual. The number of episodes, the number of hospital admissions and the duration of illness, in particular, were found to be negatively related to cognitive functions.

The fact that there has been the reporting of cognitive impairments in euthymic patients along with the unaffected first-degree associations of bipolar patients some authors have been led to suggest that cognitive dysfunctions might be a trait marker of BD. In that case, the mood symptoms along with simultaneous medication utilization are taken to be the chief confounders on this topic. From this assessment, it was evident that lithium along with valproate could be linked with instant verbal and memory impairment, protecting other cognitive functions. The presence of a comparable verbal memory discrepancy in the lithium moreover valproate groups implies that the deficit could be inherent to BD or that the two medications manipulate immediate verbal and memory correspondingly.

The study by Rombold, et al., (2014), was an attempt to assess whether lithium’s anti-suicidal properties in the patients with affective disorders have an impact on the reduction in the suicidal behavior among the patients with both significant depressions and personality disorders. Kessler et al. 1999; Krysinska et al.2006; Oumaya et al. 2008  contend that both the patients who have a depressive spectrum disorder as well as those who have personality disorder exhibit a huge risk of suicidal behavior. It is evident that the patients who exhibit major depressive disorder along with comorbid personality disorder are more likely to exhibit a positive history for, along with the Supreme number of, suicide attempts. Schulze et al. 2010; Tondo and Baldessarini 2009 argue that the Long-term treatment with lithium for the patients who have bipolar disorder demonstrates a strong reduction in the suicidal behavior along with in suicides committed.

Diverse studies indicate that lithium has the potential of being a valuable treatment regarding suicidal behavior or suicide that is committed. Lithium has additionally demonstrated several positive impacts on the patients who have personality disorders. In the study by Mercer et al. (2009), lithium demonstrated effectiveness in the reduction of irritation, anger as well as self-harming behavior in those patients with borderline personality disorder.  Nevertheless, there does not exist studies that assess the anti-suicidal impacts of lithium in patients with the personality disorder or those with patients with affective disorders and comorbid personality disorder.

Van der Loos et al. 2010 conducts an assessment of whether the addition of lamotrigine to lithium had an impact on the patients with bipolar depressions. The study further assesses the effect that adding paroxetine to the ongoing treatment for the nonresponders had an impact on their bipolar depression. From the year 1993, there have been numerous cases regarding the effectiveness of lamotrigine in the acute treatment of bipolar depressions. Paroxetine entails a selective serotonin reuptake inhibitor that is broadly utilized in the treatment of main depressive disorders, and that has additionally been tested in some RCTs in bipolar depression as monotherapy as well as adjunctive therapy. Though the studies were not affirmative and that SSRIs are presently not addressed as a first-line healing option in the treating bipolar depression, they could exert a role in those patients resistant to the first-line therapies.

The study offers a reliable description of the results of two dissimilar treatment algorithms. These encompass treatment with lamotrigine that is added to lithium in the first eight weeks, the first phase with the subsequently addition of paroxetine in the non-responders during weeks 9–16, the second phase. The treatment contrasted with eight weeks of treatment via the use of lithium and placebo in the first phase that is additionally supplementary addition of paroxetine to the non-responder entailing the second phase, during weeks 9–16. Through the randomization of the controlled trial, it was possible to compare the efficacy, safety as well as tolerability of the tow treatment algorithms in those patients that are suffering from bipolar depression.


The article by Gonzalez-Pinto et al. (2006),  made an attempt towards the assessment of whether long-term lithium use has positive impacts in the context of reducing the risk of suicide among the bipolar I patients. Among the most evident assertions is the fact that the suggested ant- suicidal effects of lithium do not accord full protection from the suicide attempts. The considerably large sample that was employed in the study implies is an indication that the results can be generalized to the rest of the population, in the context of the information needed. The additional standard approaches that have been employed in the study make it possible for the study to be replicated in a different area and in a different time with their being a production of comparable findings. The fact that the study takes a period of ten years is an indication that it is expensive and time-consuming. Additionally, many factors can come into play that affects the respondents and consequently study results.

The second article by Wilkinson et al. has a considerably small number of subjects which makes the study quick in the enrolling of patients, reviewing their records as well as assessing conditions. The study further offers information that is more detailed in explaining complex issues. However, the small nature of the study implies that the findings are fewer representatives of the situation under study and that additional study needs to be undertaken with an emphasis on confirming the findings as well as on the improvement of the compliance care.

The study by Senturk et al. uses the small sample that makes the generation of the result an easy task. The small sample further makes the follow-up and the consequent costs of the study manageable considering the condition under assessment. The study, however, has shortcomings in that the information on the history of antipsychotic was collected from the accounts and review charts of the patients which make them not entirely reliable as it limited the access to information as lifetime use of antipsychotics. Additionally, the sample sizes are small due to the strict inclusion as well as exclusion criteria that were applied, preventing the determination of the small group variances and raising the likelihood of a type II error. The implications of the study were additionally imitated by the cross-sectional model of the design.

The article by Rumbold et al. develops results that can easily be applied in the comprehension of the issue under assessment. The additional application of a small sample size is vital in keeping the costs of the study low and additionally ensuring that there is the effective assessment of the subjects. However, the issue of the small sample size is a limitation as it makes it impossible to analyses the odds ratio relating to the risk for the dissimilar personality disorder, making the results to be rated as inconclusive. The additional depressive spectrum of the inclusion criterion is quite heterogeneous making it impossible to impact the inclusion and exclusion criteria.

The large sample in the Van der Loos et al. study makes the findings possible to generalize to the larger population. Additionally, Structural attributes that decide how inequalities are produced are analyzed. The limitations of the study include the fact that the sample size regarding non-responders to lithium plus or placebo was comparatively small. The period of this study was small about the lifelong model of mood episodes in the bipolar disorders.


The article encompassed an assessment of the diverse studies that have been conducted in the examination of the impact the use of lithium has in the treatment of behavioral disorders. Among the issues addressed include those of suicide and irritability, with the studies producing diverse as well as interesting findings. However, the most evident attribute in these studies is the fact that most of them have limitations that make their generalization an issue, thus making it imperative that additional studies are conducted. Among the topics that need further studies encompass the impact that lithium use has on the reduction of suicide rates among the patients with depression and comorbid PD and that of Prophylactic therapy using lithium in the case of elderly patients having Unipolar Major Depression.


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