title: Clinical characteristics associated with lithium use among adolescents with bipolar disorder.
abstract: OBJECTIVE
  Little is known regarding demographic and/or clinical characteristics associated with the use of lithium among adolescents with bipolar disorder (BP) in naturalistic clinical settings. We therefore examined factors associated with lithium among adolescents with BP presenting to a tertiary outpatient clinic.
  
  
  METHODS
  Participants were 100 adolescents 13-19 years of age, with BP-I, BP-II, or BP not otherwise specified (BP-NOS). Diagnoses and lifetime medication exposure were determined using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (KSADS-PL). Analyses examined for demographic and clinical correlates of lifetime lithium exposure.
  
  
  RESULTS
  Twenty percent of participants reported lifetime lithium use. Participants with, versus those without, lifetime lithium use were significantly older and significantly more likely to have BP-I, lifetime history of psychiatric hospitalization, and psychosis. Lithium-treated participants were significantly more likely to report use of second-generation antipsychotics (SGAs) and antimanic anticonvulsants. In contrast, participants with lithium exposure were significantly less likely to have BP-II, self-injurious behavior, and a family history of depression. Adolescents with lithium exposure had significantly less parent-reported family conflict and mood lability, and significantly less self-reported impulsivity, emotional dysregulation, identity confusion, and interpersonal problems. In multivariable analyses, lithium use was associated with greater lifetime SGA use, lower parent-reported family conflict, and lower adolescent-reported interpersonal problems.
  
  
  CONCLUSIONS
  Lithium was infrequently used among adolescents with BP in this sample. Although constrained by retrospective methodology and a single site, our findings suggest that clinicians may be deferring lithium use until late in treatment. The fact that there are lower rates of lithium use among adolescents with suicidal ideation, impulsivity, mood lability, and family history of depression suggests potential missed opportunities for use of lithium among high-risk adolescents with BP.
authors.affiliation: Centre for Youth Bipolar Disorder , Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .
authors.forename: Athena
authors.initials: A
authors.lastname: Ko
authors.forename: Brenda
authors.initials: B
authors.lastname: Swampillai
authors.forename: Vanessa
authors.initials: V
authors.lastname: Timmins
authors.forename: Antonette
authors.initials: A
authors.lastname: Scavone
authors.forename: Katelyn
authors.initials: K
authors.lastname: Collinger
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D009864:Ontario / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D018020:Lithium Compounds; D011619:Psychotropic Drugs