title: Early improvement of psychotic symptoms with lithium monotherapy as a predictor of later response in mania.
abstract: Although lithium has been the first line agent in the treatment of bipolar disorder (BD), few studies have evaluated lithium's efficacy in mania with psychosis and its association with later response. Furthermore, given the widespread concern about antipsychotic side effects, answering a question about whether lithium alone can manage to treat both psychotic and non-psychotic mania seems a very relevant one. The present study addresses the antipsychotic efficacy of lithium monotherapy in acute mania and early improvement of psychotic symptoms as a predictor of later response of manic symptoms. Forty-six patients presenting a manic episode (32 with psychotic features and 14 subjects without psychotic features) were treated for 4 weeks with lithium monotherapy and evaluated weekly using the Young Mania Rating Scale (YMRS). Subjects with rapid cycling, substance abuse/dependence, or mixed episodes were excluded. The overall antimanic efficacy of lithium in psychosis vs. non-psychosis groups was evaluated. In addition, early improvement of psychotic symptoms and its prediction of subsequent response (>50% decrease in total YMRS scores) or remission were evaluated. Lithium showed a similar efficacy in both psychosis and non-psychosis mania. Early improvement of psychotic symptoms was associated with clinical response and remission at endpoint.
authors.affiliation: Laboratory of Neuroscience LIM-27, Department and Institute of Psychiatry, School of Medicine, University of Sao Paulo (HC-FMUSP), Rua Dr. Ovidio Pires de Campos 785, 3rd floor N., CEP: 05403-010, São Paulo, Brazil.
authors.forename: Rafael T
authors.initials: RT
authors.lastname: de Sousa
authors.forename: Joao V
authors.initials: JV
authors.lastname: Busnello
authors.forename: Orestes V
authors.initials: OV
authors.lastname: Forlenza
authors.forename: Marcus V
authors.initials: MV
authors.lastname: Zanetti
authors.forename: Marcio G
authors.initials: MG
authors.lastname: Soeiro-de-Souza
authors.forename: Martinus T
authors.initials: MT
authors.lastname: van de Bilt
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Moreno
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Zarate
authors.forename: Wagner F
authors.initials: WF
authors.lastname: Gattaz
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Machado-Vieira
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000008:administration & dosage*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008094:Lithium / Q000008:administration & dosage*; D008297:Male; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018692:Antimanic Agents; D008094:Lithium