Lithium: Its Role in Psychiatric Research and Treatment

Psychopharmacology has certainly had the greatest impact on psy- chiatric theory and practice since the psychoanalytic discoveries by Freud. Beginning more than 20 years ago, psychopharmacology has become a vigorous interdisciplinary science, and over the last 10 to 15 years has witnessed a tremendous growth both from a scientific and practical point of view. Lithium occupies a unique and central position in modern psycho- pharmacology for several reasons. The introduction of the lithium ion in 1949 as a psychoactive drug preceded the advent of reserpine or chlorprom- azine and placed it as the first agent in the modern era of pharmacopsy- chiatry. In fact, this first report on the use of lithium by an Australian clinician set a pattern to be followed for all other major groups of psychoac- tive chemical agents. Unlike the now established antipsychotic and antidepressant drugs, however, no reliable predictions based on preclinical pharmacological studies were available about the profile of lithium's clinical activity. This problem of clinical predictability based on current preclinical pharmacological studies is now surfacing with the advent of many newer investigational psychoactive agents. As in the introduction of other therapeutic modalities in medicine, including psychiatry, serendipity was the midwife for lithium. The use of this ion in psychiatry, from its fortuitous introduction by Cade in 1949 to its present-day acceptance as a universal treatment modality in the affective emotional disorders, presents, however, a clear example of a hapless lag between discovery and application.

Table of Contents:
1 A Narrative Account of Lithium Usage in Psychiatry.- I. Discovery.- II. Uses of Lithium.- III. Commercial Production of Lithium.- IV. Conclusion.- V. References.- 2 The Chemistry and Biochemistry of Lithium.- I. Introduction.- II. General Properties of Cations.- III. Chemistry of Lithium.- IV. The Biochemistry of Lithium.- V. Concluding Remarks.- VI. References.- 3 Pharmacology—Lithium Absorption, Distribution, Renal Handling, and Effect on Body Electrolytes.- I. Absorption.- II. Distribution.- III. Renal Handling.- IV. Effect on Body Electrolytes.- V. Summary.- VI. References.- 4 Pharmacology—The Effects of Lithium on Biogenic Amines.- I. Introduction.- II. Catecholamines.- III. Indoleamines.- IV. Conclusion.- V. Acknowledgments.- VI. References.- 5 Pharmacology—Lithium’s Effects on Cyclic AMP, Membrane Transport, and Cholinergic Mechanisms.- I. Cyclic AMP.- II. Membrane Transport.- III. Cholinergic Mechanisms.- IV. Acknowledgment.- V. References.- 6 Pharmacology—Neurophysiology of Lithium.- I. Introduction.- II. Microelectrode Studies.- III. Animal Studies.- IV. Human Studies.- V. Summary and Conclusions.- VI. References.- 7 Pharmacology—Toxicology of the Lithium Ion.- I. Introduction.- II. Mild-Moderate Toxic Side Effects: Minor Lithium Intolerance.- III. Lithium Poisoning.- IV. General Considerations.- V. Complications of Lithium Treatment.- VI. Other Effects of Lithium Treatment.- VII. References.- 8 Pharmacology—Lithium Teratology.- I. Introduction.- II. General Principles.- III. Studies in Premammalian Species.- IV. Studies in Mammals Other than Man.- V. Chromosome Studies.- VI. Human Studies.- VII. The Use of Lithium in Pregnancy.- VIII. Acknowledgment.- IX. References.- 9 Pharmacology—The Biology of Lithium.- I. Introduction.- II. LithiumTreatment and Electrolyte Balance.- III. Lithium Metabolism.- IV. Central Effect of Lithium.- V. Acknowledgment.- VI. References.- 10 Preparations, Dosage, and Control.- I. Preparations.- II. Initial Treatment of Mania: Dosage and Control.- III. Maintenance Treatment.- IV. References.- 11 The Affective Disorders: Clinical and Epidemiological Aspects.- I. Introduction.- II. The Classification Problem.- III. Epidemiology.- IV. Clinical Depressions.- V. Mania and Elations.- VI. Conclusions.- VII. Acknowledgment.- VIII. References.- 12 Lithium in Mania: Clinical Trials and Controlled Studies.- I. Introduction.- II. Uncontrolled and Single-Blind Studies.- III. Controlled Studies.- IV. Experimental Drugs in the Treatment of Mania.- V. Summary and Conclusions.- VI. References.- 13 Lithium and Depression.- I. Introduction.- II. Uncontrolled Studies.- III. Controlled Studies.- IV. Discussion.- V. Summary.- VI. Acknowledgment.- VII. References.- 14 Prophylactic Lithium Maintenance Treatment in Recurrent Endogenous Affective Disorders.- I. Introduction.- II. Terminology.- III. Lithium Maintenance Treatment.- IV. Remarks.- V. Acknowledgments.- VI. References.- 15 Lithium in Other Psychiatric Disorders.- I. Introduction.- II. The Use of Lithium in Schizophrenia.- III. The Use of Lithium in Neuroses and Personality Disorders without an Affective Component.- IV. The Use of Lithium in Neuroses and Personality Disorders with an Aggressive or Affective Component.- V. The Use of Lithium in Epilepsy.- VI. The Use of Lithium in Childhood Disorders.- VII. The Use of Lithium for Premenstrual Tension.- VIII. The Use of Lithium in Normals.- IX. Summary and Discussion.- X. References.- 16 Overview of Therapeutic and Prophylactic Trials with Lithium in Psychiatric Patients.- I. Introductory Analysis.- II. Confusion in Classification of the Affective Disorders: A Proposed Model for Biogenetic Investigations.- III. Therapeutic Effects in Mania.- IV. Effects in Depression.- V. Effects in Other Psychiatric Disorders.- VI. Effects on Normals, Productive Cyclothymics, and the Creative Personality.- VII. Prophylaxis.- VIII. Lithium versus Electroshock Therapy.- IX. Summary.- X. References.