title: Clinical factors associated with lithium response in bipolar disorders.
abstract: BACKGROUND
  Bipolar disorder is a common chronic illness characterized by high levels of morbidity and all-cause mortality. Lithium is one of the gold standard mood stabilizer treatments, but the identification of good, partial and non-responders in clinical settings is inconsistent.
  
  
  METHODS
  We used an established rating scale (the Alda scale) to classify the degree of lithium response (good response, partial response, non-response) in a large, multicentre clinically representative sample of well-characterized cases of bipolar disorders I and II. Next, we examined previously reported clinical predictors of response to determine which factors significantly differentiated between the three response groups.
  
  
  RESULTS
  Of 754 cases, 300 received lithium, for at least 6 months, as a treatment for bipolar disorder (40%). Of these cases, 17% were classified as good response, 52% as partial response and 31% as non-response. Lifetime history of mixed episodes ( p = 0.017) and alcohol use disorders ( p = 0.015) both occurred in >20% of partial response and non-response groups but <10% of good response cases. Family history of bipolar disorder I was of borderline statistical significance, being more frequent in the good response group (38%) compared with the non-response group (18%). There was a trend ( p = 0.06) for bipolar disorder II to be associated with non-response.
  
  
  CONCLUSIONS
  Only three factors previously identified as predictors of lithium response significantly differentiated the response groups identified in our sample. Interestingly, these factors have all been found to co-occur more often than expected by chance, and it can be hypothesized that they may represent a shared underlying factor or dimension. Further prospective studies of predictors and the performance of the Alda scale are recommended.
authors.affiliation: 1 Inserm, U1144, Paris, France.|2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.|3 Fondation FondaMental, Créteil, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sportiche
authors.affiliation: 1 Inserm, U1144, Paris, France.|2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.|3 Fondation FondaMental, Créteil, France.|4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.|5 Université Paris Descartes, UMR-S 1144, Paris, France.
authors.forename: Pierre Alexis
authors.initials: PA
authors.lastname: Geoffroy
authors.affiliation: 1 Inserm, U1144, Paris, France.|2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.|3 Fondation FondaMental, Créteil, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Brichant-Petitjean
authors.affiliation: 3 Fondation FondaMental, Créteil, France.|6 Hôpital Charles Perrens, Centre Expert Bipolaire, Pôle de Psychiatrie Générale Universitaire, Bordeaux, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gard
authors.affiliation: 3 Fondation FondaMental, Créteil, France.|7 Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Centre Psychothérapique de Nancy-Laxou, Nancy, France.|8 Université de Lorraine, Nancy, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Khan
authors.affiliation: 3 Fondation FondaMental, Créteil, France.|9 Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, Marseille, France.|10 EA 3279-Self-perceived Health Assessment Research Unit, School of Medicine, Timone University, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.affiliation: 3 Fondation FondaMental, Créteil, France.|11 Inserm, U955, Equipe de psychiatrie génétique et Université Paris Est, Faculté de médecine et AP-HP, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France.|12 Institut Pasteur, Unité Perception et Mémoire, Paris, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Henry
authors.affiliation: 3 Fondation FondaMental, Créteil, France.|11 Inserm, U955, Equipe de psychiatrie génétique et Université Paris Est, Faculté de médecine et AP-HP, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Leboyer
authors.affiliation: 1 Inserm, U1144, Paris, France.|2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.|3 Fondation FondaMental, Créteil, France.|4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Etain
authors.affiliation: 13 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.|14 Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
authors.affiliation: 1 Inserm, U1144, Paris, France.|2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.|3 Fondation FondaMental, Créteil, France.|4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000494:pharmacology*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds
keywords: Bipolar disorder; alcohol misuse; clinical predictors; lithium response; mixed state