2019, volume 35, issue 3-4

Original article

The effect of long-term lithium administration on thyroid function and structure as compared with monotherapy by other mood stabilising drugs – a preliminary study

Agnieszka Kraszewska, Ewa Ferensztajn-Rochowiak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (3–4), 169–176

Aims: Long-term treatment with lithium in patients with bipolar disorder (BD) exerts a significant effect on thyroid structure and function. Previously, it was found that adding to lithium other mood stabilising or antidepressant drugs can also be important. The aim of this preliminary study was to compare thyroid structure and function in patients with BD receiving long-term lithium monotherapy with monotherapy using other mood stabilising drugs, such as carbamazepine, valproates or quetiapine.

Method: Forty-one BD patients were studied (13 male, 28 female) aged 28–80 years. In 15, monotherapy with lithium was given; in 10 – with carbamazepine; and in 8 – with valproate and quetiapine. In all patients, the thyroid-stimulating hormone (TSH), free thyroxine (fT3) free triiodothyronine (fT4), and the antibodies against thyroid peroxidase (TPOAb), thyroglobulin (TGAb) and TSH receptors (TSHRAb) were estimated. Goiter was diagnosed when the thyroid volume exceeded 18 cm3 in women and 25 cm3 in men.

Results: The groups were of similar age; however, the duration of quetiapine therapy was shorter than lithium or carbamazepine. Comparing to patients on lithium monotherapy, the median of TSH concentration was lower in patients on quetiapine, and the median of TPOAB lower in patients on valproates. The highest frequency of goiter (47%) was observed in patients receiving lithium.

Conclusions: The results obtained may suggest that among the studied mood stabilisers, lithium exerts the biggest goiter-inducing effect. The differences between groups as to thyroid hormones and antibodies were not significant. The limitation of the study was a small number of studied patients.

Review article

Obesity and the pharmacotherapy of bipolar disorder

Anna M. Wasik, Aleksandra Gorostowicz, Dominika Dudek, Jarosław Woroń, Marcin Siwek
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (3–4), 177–192

Obesity, as an important risk factor for the development of diabetes, cancer or cardiovascular diseases, is one of the most important problems of modern medicine. Studies show that obesity often coexists with psychiatric disorders, including the bipolar disorder (BD) – the prevalence of obesity can be 1.5 times higher in BD patients when compared with the general population. Additionally, the risk of mood disorders in obese patients is also increased. The probable aetiology of the bidirectional relation between BD and overweight and obesity is likely complex – genetic factors, abnormalities in the immune system or an increased frequency of eating disorders are all present. Obesity in BD patients may be associated with an impairment of the mental and physical well-being, poorer co-operation in the treatment and lower quality of life. Drugs used in BD therapy have different predilections for inducing significant weight gain. The highest metabolic risk is associated with olanzapine and clozapine (among antipsychotics), amitriptyline, mirtazapine and paroxetine in the antidepressant group, and among the mood stabilizers (excluding antipsychotics) lithium and valproate. Amongst the possible therapeutic measures in patients with overweight or obesity, nonpharmacological as well as pharmacological procedures are mentioned. The newly registered antipsychotics with a possibly favourable metabolic profile (lurasidon, Cariprazine, and brexpiprazole) as well as the combination of bupropion/naltrexone or bariatric surgery carry interesting prospects for the future.

Review article

Polytherapy in schizophrenia in light of the literature data

Jan Jaracz
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (3–4), 193–199

The use of several drugs is quite common in the treatment of diseases, such as hypertension and epilepsy. Since the 1990s, there has been a tendency to use simultaneously two or more antipsychotic drugs to treat schizophrenia patients. It is estimated that 30–40% of patients are treated with two or more antipsychotic drugs. This was also confirmed by research carried out in Poland. This is despite the fact that the standards of pharmacological treatment of schizophrenia consistently recommend the use of monotherapy. There are also doubts about the safety of polytherapy. So far, it has not been clearly shown whether this is more effective than monotherapy. A recently published meta-analysis showed that only the combined use of clozapine and aripiprazole is more effective than other monotherapy and polytherapy. It has not yet been confirmed that the combined use of two antipsychotic drugs was associated with a higher risk of metabolic syndrome symptoms and QTc segment prolongation. The paper presents data on the scale of the phenomenon of polytherapy as well as publications on the effectiveness and safety of such proceedings as compared to monotherapy. Due to the ambiguity of the results, it is difficult to make clear recommendations regarding the management of monotherapy ineffectiveness. The work ends with a few questions that concern doubts about how to treat patients with schizophrenia to make the treatment rational.

Case report

Eighteen-year patient observation with very early onset of bipolar disorder

Agnieszka Słopień
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (3–4), 201–209

A clinical picture of bipolar affective disorders in children and adolescents is variable and dependent on the specificity of developmental age. From diagnostic and therapeutic point, especially difficult are cases with the pre-pubertal onset. In the article, a case report of 18-year observation of male patient with the onset of bipolar affective disorder at 11 years of age is presented. This very early pre-pubertal onset of the illness was manifested with rapid cycling, depressive episode with psychotic symptoms and the classic symptoms of mania. The use of lithium carbonate appeared effective and safe. Lithium was used for two years in combination with valproates, and in following years as monotherapy. In recent two years, due to depressive episodes of moderate intensity, the patients also received fluoxetine on periodic basis. No adverse effects of the treatment were observed.