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Biomedical subjects

P Vestergaard

Publications and source records attributed to P Vestergaard.

At least 37 records · Page 2Linked to original sources
PubMed1988

Adherence to lithium prophylaxis: I. Clinical predictors and patient's reasons for nonadherence.

Of a group of 133 patients given long-term prophylactic lithium treatment, approximately 25 percent discontinued the treatment prematurely within the first six months. Young male patients dominated in the nonadherent group. Clinically the nonadherent patients were characterized by having had an early onset of the illness, a large number of previous hospital admissions and a recent allocation to the diagnostic category of affective disorder. Furthermore, the presence of personality disorders and substance abuses characterized the nonadherent patients. Diagnostic grouping according to polarity did not allow for any distinction between the adherent and nonadherent patients. One half of the nonadherent patients mentioned the development of somatic side effects as their main reason for discontinuing the treatment. Psychological discomfort, such as development of concentration difficulties or impaired memory, was not stated as a reasons for discontinuation. One fourth of the nonadherent patients had their diagnoses, and consequently their treatment, changed by the physician in charge and one fourth neglected instructions and disregarded appointments.

Adult↗
PubMed1988

Adherence to lithium prophylaxis: II. Multivariate analysis of clinical, social, and psychosocial predictors of nonadherence.

The purpose of this prospective study of 133 affective disorder patients, consecutively referred to start long-term lithium therapy, was to identify predictors of importance for nonadherence. The nonadherent group was defined as the 31 (23.3%) patients who stopped treatment within the first six months. In the multivariate logistic analysis the most informative clinical, social, and psychosocial predictors were, in rank order: many admissions to mental hospitals, death or divorce of parent in childhood, heavy smoking, short duration of the mental disorder diagnosed as affective, not married, never economically active, and early onset of the affective disorder. The logical consequence of the results is to offer the subgroup of patients with an individually calculated high probability of nonadherence intensive control and support during the first month of lithium treatment.

Adult↗
PubMed1988

Prospective studies on a lithium cohort. 1. General features.

Since 1979, patients started on long-term lithium treatment at the Psychiatric Hospital in Risskov have been followed systematically with recording of clinical and laboratory variables before the start of treatment, after 6 and 12 months of treatment, and thereafter at yearly intervals. By June 1987, 480 examinations had been carried out before the start of lithium treatment, 236 after treatment for 6 months, and decreasing numbers up to 7 years of lithium treatment. The total lithium exposure time was 548 years. The mean lithium dose was 23.2 mmol/d and the mean serum lithium concentration 0.68 mmol/l. These values are about 30% lower than the corresponding values in patients given lithium treatment prior to 1979. About one half of the patients who had gone through the pre-lithium examinations did not reach the 6-month examination. This was because they did not start lithium, or because they stopped it again before 6 months of treatment or before they had reached that point. Thereafter there was a drop-out rate of about 25% per year during the first 2 years of lithium treatment and about 10% per year after 4-5 years of treatment. More men than women left the cohort.

Adult↗
PubMed1988

Prospective studies on a lithium cohort. 2. Renal function. Water and electrolyte metabolism.

A cohort of manic-depressive patients given prophylactic lithium treatment were examined before treatment started and at intervals during treatment for up to 7 years. The mean lithium dosage was 23.2 mmol/d and the mean serum lithium concentration 0.68 mmol/l. The treatment did not affect glomerulus function. Urine volume rose by 10-20% and renal concentrating ability fell by 7-10% during the treatment. These changes were markedly smaller than those found in patients treated previously with higher lithium doses and serum lithium concentrations. High urine volumes and low renal concentrating abilities were not more frequent during than before lithium treatment. Complaints of increased thirst, frequent urination, and nycturia were presented more often during than before lithium treatment. Serum concentrations, urinary excretions and renal clearances of sodium and potassium were not altered by the treatment.

Adult↗
PubMed1988

Prospective studies on a lithium cohort. 3. Tremor, weight gain, diarrhea, psychological complaints.

A cohort of manic-depressive patients given prophylactic lithium treatment were examined before treatment started and at intervals during treatment for up to 7 years. The mean lithium dosage was 23.2 mmol/d and the mean serum lithium concentration 0.68 mmol/l. About 40% of the patients were entirely free of side effects, as compared with 10% among patients treated previously with higher lithium doses and serum lithium concentrations. Tremor complaints were presented by 5% of the patients before and by 15% during lithium treatment. The frequency fell with continued treatment, and after a few years it was not higher than before treatment started. Tremor complaints were positively correlated with age and with the use of neuroleptics and antidepressants. The tremorigenic effects of lithium and antidepressants seemed to potentiate each other. Tremor complaints were more frequent at serum lithium levels over than under 0.7 mmol/l. Body weight increased during the first 1-2 years of lithium treatment and then remained constant. The average gain was 4 kg. Weight gain was positively correlated with the patients' body weight before treatment and with the concurrent administration of antidepressant drugs. The frequency of diarrhea complaints (loose stools, defecation urge) rose from 1% to 6% during the first 6 months of lithium treatment and then leveled off. The frequency rose steeply at serum lithium values over 0.8 mmol/l. During lithium administration about one tenth of the patients had psychological complaints, which might or might not have been caused by the treatment: memory impairment and concentrating difficulty, tiredness and "greyness of life", in a few cases altered taste or lowered libido and potency.

Adult↗
PubMed1988

Distinction between proximal and distal regulations of sodium and potassium excretion in humans.

The clearances of creatinine (CCr), lithium (CLi), sodium (CNa), and potassium (CK) were determined during three consecutive 2-hour periods in a large number of physically healthy persons who were in lithium treatment for manic-depressive illness. CLi was used as a measure of the proximal tubular fluid output (Vprox). CLi showed considerable spontaneous variations from one 2-hour period to another, and neither bladder emptying errors nor changes of CCr could account for these. The variations of CLi, which reflected variations of Vprox, resulted in joint variations of CNa and CK. Also the ratios CNa/CLi and CK/CLi, which reflected the distal handling of sodium and potassium, showed considerable spontaneous variations. These were correlated neither with each other nor with variations of CLi. Our study indicates that through the use of CLi as a measure of Vprox it is possible to distinguish between a single joint proximal regulation and two separate distal regulations of sodium and potassium excretion. Further studies concerning the interplay between proximal and distal regulations under normal and pathological conditions may provide deeper insight into the way in which the kidney functions.

Bipolar Disorder↗
PubMed1987

Changes in serum thyroxine (T4) and serum thyroid stimulating hormone (TSH) during prolonged lithium treatment.

We determined serum T4 and serum TSH serially in a cohort of patients given lithium treatment for up to 6 years; the total lithium exposure time was 409 years and the average serum lithium concentration 0.69 mmol/l. T4 showed a small and not significant fall at 6 months and returned to the pre-lithium level at 12 months. Hereafter, T4 rose gradually and after 6 years of lithium treatment T4 was 53% higher than the pre-lithium value. TSH was significantly increased at 6 and 12 months and then returned to the pre-lithium level. Eight patients required thyroxine treatment for lithium-induced hypothyroidism, i.e. 2 per 100 years of lithium exposure time. Single deviant values of T4 and TSH could be seen, followed by normal values. We suggest that TSH is determined at intervals during lithium treatment. It may be prudent to subject lithium-treated patients with abnormal thyroid values to re-examination and to abstain from starting thyroxine treatment on the basis of a single deviant value.

Follow-Up Studies↗
PubMed1987

Does long-term lithium treatment induce diabetes mellitus?

Fasting blood sugar was determined in manic-depressive patients before the start of lithium treatment and at intervals during treatment for up to 6 years. The total exposure time to lithium was 495.5 years. Even though the patients gained significantly in age and body weight during the treatment, their mean blood sugar values remained the same as before treatment was started, and only 1 patient developed manifest diabetes. There is no reason to believe that long-term lithium treatment leads to increased risk of developing diabetes mellitus.

Adolescent↗
PubMed1986

Renal function of patients in long-term treatment with lithium citrate alone or in combination with neuroleptics and antidepressant drugs.

Renal function was studied in patients given lithium citrate alone or in combination with neuroleptics or tricyclic antidepressants or both. No other drugs were given. None of the groups given lithium citrate with other drugs had lithium ion clearances that differed significantly from the groups given lithium citrate alone, nor was there any difference in the clearances of sodium, potassium, or creatinine between these groups. The 24-hour urine volume of patients receiving antidepressant drugs was similar to that of the patients receiving lithium citrate monotherapy but was significantly higher in patients given neuroleptics. The increase in urine volume could not be ascribed to alterations in glomerular filtration rate or proximal tubular resorption but could be accounted for entirely by lowered resorption of water in the distal tubules. We concluded that no change of lithium citrate dose is required when patients so treated are given additional neuroleptic or tricyclic antidepressant drugs.

Adult↗
PubMed1986

Lithium treatment and blood pressure.

The average systolic and diastolic blood pressures of 377 manic-depressive patients were not significantly different before and during lithium treatment. Before the treatment blood pressure was slightly but significantly lower in spring and fall than in winter and summer; during lithium treatment the seasonal variations disappeared.

Adult↗
PubMed1986

A comparison of DSM-III and ICD-8 diagnoses for major affective disorders and the use of biological markers for depression.

The aims of the present study were to investigate the value of adding DSM-III diagnosis and Newcastle Scale Rating to the ICD-8 diagnosis currently used and to investigate the association between Dexamethasone Suppression Test (DST) and the Thyrotropine Releasing Hormone- Thyroid Stimulating Hormone (TRH-TSH) test and the three classification systems for depression. Twenty-six depressed in-patients were included, 17 women and 9 men, with a mean age of 51.5 years. Fourteen patients were psychotic depressed. DST and Newcastle Scale Rating were performed on 18 patients and TRH-TSH test was performed on 16 patients. The addition of DSM-III diagnosis on the 4-digit level did not have any value compared to the ICD-8 diagnosis. However, DSM-III diagnosis on the 5-digit level added important clinical information which corresponded better to Newcastle Scale scores and DST and TRH-TSH test results than ICD-8 diagnosis. The main advantage of the DSM-III classification of depression on the 5-digit level compared to ICD-8 concerns depression on the border between psychosis and neurosis. In clinical practice there is a risk of underestimating the severity of a depression if ICD-8/9 is used as the only criterion for severity. This may have tragic consequences for the patient. This study suggests that rating of the depression on the Newcastle Scale or provision of a DSM-III diagnosis on the 5-digit level are valuable assessment procedures of severity.

Adult↗
PubMed1986

The renal lithium clearance and its correlations with other biological variables: observations in a large group of physically healthy persons.

The lithium clearance (CLi) is a measure of the delivery of fluid from the proximal tubules to the loop of Henle. We determined the correlations between CLi and a number of variables on 350 occasions in 164 physically healthy persons in lithium treatment for manic-depressive illness. CLi was significantly correlated (p less than 0.001) with sex, age, body surface, urine flow, sodium clearance, potassium clearance, serum lithium concentration, and lithium dosage. Correlations with sex, age and body surface lost statistical significance when the renal variables and the surface were divided by creatinine clearance; these correlations are indirect and caused by common correlations with the filtration rate. The findings show that the fractional delivery of fluid from the proximal tubules is independent of sex, age and body surface. Correlations with urine flow, serum lithium, and lithium dosage could be explained by circumstances connected with the lithium treatment. These variables do not seem to affect CLi. It is concluded that factors which should be taken into account if the assessment of lithium clearance values include the creatinine clearance, the sodium clearance, and the potassium clearance.

Adult↗