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Lithium for schizophrenia revisited: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Clinicians frequently use lithium to augment antipsychotic medication in schizophrenia. Therefore, we undertook a systematic review and meta-analysis of the use of lithium in the treatment of schizophrenia. DATA SOURCES AND STUDY SELECTION: Randomized controlled trials examining lithium (as a sole or an adjunctive compound) in participants with schizophrenia or related disorders were searched in the register of the Cochrane Schizophrenia Group. No language restrictions were applied. The Boolean phrase [lithium* or lithicarb or eskalith or lithobid or lithane or cibalith-s or quilonum or hypnorex] was used to locate articles. The search strategy initially identified 90 references. The authors of the included studies were contacted to obtain original patient data. The data were combined in a meta-analysis. The main outcome parameters were the number of patients with a clinically significant response and the number of patients leaving the studies early. RESULTS: The meta-analysis includes 20 studies (N = 611). The evidence shows that lithium as a sole agent is ineffective in the treatment of schizophrenia. Eleven trials examined the augmentation of antipsychotics with lithium. More patients who received lithium augmentation than those who received antipsychotics alone were classified as responders. However, the superiority was not consistent across different response thresholds, and when patients with prominent affective symptoms were excluded from the analysis, the advantage of lithium augmentation was not significant (p =.07). Significantly more patients taking lithium left the trials early, suggesting a lower acceptability of lithium augmentation compared with that of taking antipsychotics alone. CONCLUSION: Despite some evidence in favor of lithium augmentation, the overall results are inconclusive. A large trial of lithium augmentation of antipsychotic medications will be required in order to detect a benefit of small effect size in patients with schizophrenia who lack affective symptoms.

Affective Symptoms↗

Bovine inositol monophosphatase: development of a continuous fluorescence assay of enzyme activity.

This paper describes a continuous assay for the enzyme inositol monophosphatase which has been developed using a new substrate, the fluorescent compound 4-methylumbelliferyl phosphate. The hydrolysis of the phosphate group from this compound can be readily detected by a resultant large red shift in the emission spectrum from 390-450 nm. The kinetic constants for the enzyme using this new substrate are described.

Animals↗

Flavor-illness aversions: potentiation of odor by taste with toxin but not shock in rats.

Potentiation of odor by taste in rats was tested in a variety of situations. In three experiments, almond odor and saccharin taste were presented either as a single conditioned stimulus (CS) or as a compound CS and followed by either toxic lithium chloride or footshock. Extinction tests with the almond and saccharin components were then given. In single CS-toxin experiments, taste was more effective than odor, and after compound conditioning, the taste component potentiated the odor component. Conversely, in single CS-shock experiments, odor was more effective than taste, and after compound conditioning, no potentiation was observed. Rather, interference effects were observed. In Experiments 1 and 2, the addition of taste disrupted odor CS-shock conditioning, and in Experiment 3, odor interfered with taste CS-shock conditioning. Visceral feedback is apparently a necessary unconditioned stimulus for the potentiation of odor by taste. These data support the neural convergence and gating hypothesis of flavor aversion conditioning.

Animals↗

Synthesis and reactivity of dipole-stabilized but unchelated alpha-aminoorganolithiums.

Two N-methyl-5-lithio-2-pyrrolidinones have been prepared by tin-lithium exchange. These two alpha-aminoorganolithium compounds that are stabilized by an amide dipole, but not by chelation to the amide carbonyl. Both constitute test cases for comparing the stability and reactivity of "dipole-stabilized" and "unstabilized" alpha-aminoorganolithiums. We find that active methylene protons interfere with the reaction, so geminal disubstitution alpha to the amide carbonyl was necessary to suppress side reactions. These species do not react as efficiently as unstabilized alpha-aminoorganolithiums, or even as well as chelated dipole-stabilized alpha-aminoorganolithiums, toward typical electrophiles. The tin-lithium exchange to form these species was also not as facile as with other alpha-aminoorganostannanes.

Chromatography, Thin Layer↗

Li+ cation coordination in [Li2(CF3SO3)2(diglyme)] and [Li3(C2F3O2)3(diglyme)].

The title compounds, poly[[[bis(2-methoxyethyl) ether]lithium(I)]-di-mu(3)-trifluoromethanesulfonato-lithium(I)], [Li(2)(CF(3)SO(3))(2)(C(6)H(14)O(3))](n), and poly[[[bis(2-methoxyethyl) ether]lithium(I)]-di-mu(3)-trifluoroacetato-dilithium(I)-mu(3)-trifluoroacetato], [Li(3)(C(2)F(3)O(2))(3)(C(6)H(14)O(3))](n), consist of one-dimensional polymer chains. Both structures contain five-coordinate Li(+) cations coordinated by a tridentate diglyme [bis(2-methoxyethyl) ether] molecule and two O atoms, each from separate anions. In both structures, the [Li(diglyme)X(2)](-) (X is CF(3)SO(3) or CF(3)CO(2)) fragments are further connected by other Li(+) cations and anions, creating one-dimensional chains. These connecting Li(+) cations are coordinated by four separate anions in both compounds. The CF(3)SO(3)(-) and CF(3)CO(2)(-) anions, however, adopt different forms of cation coordination, resulting in differences in the connectivity of the structures and solvate stoichiometries.

Journal Article↗

Flexural strength and fracture toughness of Dicor glass-ceramic after embedment modification.

Previous studies on the surface properties of Dicor castable glass-ceramic have shown the formation of a specific crystalline phase at the glass-ceramic/embedment interface. If this phase is not removed by grinding, it leads to an undesirable strength decrease. The aims of this study were: (1) to determine the nature of this surface layer, (2) to promote the formation of a different crystalline phase at the surface with the intention of improving the properties of the glass-ceramic, by modification of the composition of the Dicor ceramming embedment, and (3) to evaluate the fracture toughness and flexural strength of Dicor glass-ceramic after embedment modification. Modifications were made to the embedment by incorporation of 2.5 wt% of lithium fluoride and ceramming at various temperatures. X-ray diffraction was used to determine the crystalline nature of the surface layer. Fracture toughness was investigated by the indentation technique. The maximum bi-axial stresses were calculated after the samples were fractured in water on a ball-on-ring fixture at 0.5 mm/min. With the recommended embedment and ceramming cycle, the crystalline phase constituting the ceram layer was a calcium magnesium silicate CaMg(SiO3)2 (diopside). The crystalline composition of the ceram layer was successfully modified by addition of 2.5 wt% lithium fluoride to the embedment. This promoted the crystallization of mica in the ceram layer and increased the fracture toughness of the glass-ceramic when the ceramming temperature was 950 or 975 degrees C. The flexural strength was significantly increased when the ceramming temperature was 1000 degrees C.

Aluminum↗

Enantioselective synthesis of primary 1-(aryl)alkylamines by nucleophilic 1,2-addition of organolithium reagents to hydroxyoxime ethers and application to asymmetric synthesis of G-protein-coupled receptor ligands.

(E)-Arylaldehyde oxime ethers bearing a (1S)-2-hydroxy-1-phenylethyl or (2R)-1-hydroxy-2-phenylethyl group as a chiral auxiliary, both derived from a single precursor, methyl (R)-mandelate, underwent nucleophilic addition with organolithium reagents via six-membered chelates to give the diastereomerically enriched (R)- and (S)-adducts, respectively, which, after chiral auxiliary removal by reductive N-O bond cleavage, led to the corresponding (R)- and (S)-1-(aryl)ethylamines. This organolithium addition protocol using methyllithium was applied in an enantiodivergent fashion to the preparation of both enantiomers of 1-(2-hydroxyphenyl)ethylamine, which has been previously used as an efficient chiral auxiliary for the synthesis of natural products in this laboratory. The synthetic utility of this methodology involving diastereoselective methyl addition was demonstrated by further application to the asymmetric synthesis of a new type of calcium receptor agonist (calcimimetics), (R)-(+)-NPS R-568 and its thio analogue. Furthermore, diastereoselective vinylation was accomplished by application of the hydroxy oxime ether-based protocol using vinyllithium, which allowed the development of the enantioselective synthesis of the NK-1 receptor antagonists, (+)-CP-99,994 and (+)-CP-122,721.

Amines↗

Potentiation of odor by taste in rats: tests of some nonassociative factors.

The contribution of nonassociative neophobia and sensitization to the potentiation of odor by taste in rats was tested in three experiments. In Experiment 1, neophobia for almond odor (O), saccharin taste (T), and odor-taste compound (OT) cues was tested before and after noncontingent lithium chloride poisoning and compared with conditioned aversions produced by OT-LiCl temporal pairing. The OT compound potentiated unconditioned neophobia, but there was no evidence of poison-enhanced neophobia, disinhibition of neophobia, or sensitization by noncontingent LiCl; temporal pairing produced aversions for the compound and its elements. In Experiment 2, generalization to a novel odor was tested after O-LiCl or compound OT-LiCl pairing. The potentiated odor aversion did not generalize to the novel odor; it was specific to the odor paired with taste and LiCl. In Experiment 3, potentiation of the odor component by a discriminant or nondiscriminant taste component was tested. Potentiation was evident only when a novel discriminant taste was in compound with odor prior to LiCl poisoning. These studies support an associative "indexing" hypothesis of the potentiation effect in rats.

Animals↗

The effect of lithium administration in animal models of depression: a short review.

The aim of this short review was to collate the data involving the effects of lithium alone, or in combination, with antidepressant drugs in several animal models of depression. It has been shown that lithium administration reduced immobility in the mouse forced swimming test when given 30 min, but not 45 min, before testing. Further studies indicated that this activity was probably a result of an activity on serotonin (5-HT) 1A and 1B receptor subtypes. Lithium treatment has been shown to reverse helpless behaviour in the learned helplessness model of depression after chronic treatment (30 days), where lithium was administered in the drinking water. Further studies showed that acute (5 days) administration of lithium failed to reverse behavioural deficits. In the olfactory bulbectomised rat model of depression, several immunological and enzymatic functions have been shown to be altered and these changes are regularised by antidepressant treatment as well as lithium administration for 15 days. Hypokinesia (reduced locomotor activity) is a phenomenon observed following immobilisation stress in rats. This behavioural deficit was attenuated by lithium together with a wide range of antidepressant drugs used in the treatment of unipolar depression at non-stimulant doses. In addition, a single administration of lithium slightly inhibited midbrain raphe lesion-induced muricidal behaviour (25%); however, repeated treatment (5 days) significantly attenuated this behavioural deficit. Lithium treatment has also been shown to reverse behavioural and biochemical deficits induced by reserpine together with those induced by acute administration of single intracerebroventricular (i.c.v.) dose of the Na, K-ATPase-inhibiting compound, ouabain. Long-term studies of lithium augmentation have not been performed, so that no clear recommendations for the duration of this therapy can be made. The points raised in this short review endorse the commencement of such studies.

Animals↗

[The research of new antidepressants: present orientations (author's transl)].

A number of promising antidepressant compounds are presently either being developed in the laboratory or are being tested clinically by pharmaceutical firms and universities around the world. New compounds are sought which will provide: 1. fewer side effects, particularly anticholinergic and cardiovascular effects; 2. more rapid onset of action than 7-10 days required of most antidepressants now used; 3. efficacy in a higher percentage of patients than the 65-70 per cent estimated to respond to currently available antidepressant therapies. Compounds now being investigated include: new tricyclics which are unlike those commonly in use; the tetracyclics; the salts of naturally occurring cations such as lithium and rubidium; and various chemically unrelated new compounds. In addition, several drugs currently being tested as anorectics seem promising for future antidepressant drugs research.

Animals↗

[Asymmetric reactions based on activation and structure control of molecule--asymmetric reaction of lithiated nucleophiles].

The methodology we developed relies on an external chiral coordinating reagent that forms a deaggregated chelate complex with organolithium reagents. Under the positive control of a chiral dimethyl ether of stilbenediol 4, an asymmetric conjugate addition reaction of organolithium reagents with unsaturated imines and esters proceeded successfully to yield the corresponding addition products with reasonably high stereoselectivity. The sense of stereochemistry is predictable based on a coordination model. The methodology has been extended to a catalytic asymmetric 1,2-addition reaction of organolithium reagents with imines. An enantiotopic group differentiating the opening of cyclohexene oxide with organolithium was also mediated by a chiral ligand. The asymmetric Horner-Wadsworth-Emmons reaction of phosphonates and Peterson reaction of alpha-silylester with 4-substituted cyclohexanone were another successful extension of the methodology. A three-component reagent of lithium ester enolate, lithium amide, and chiral diether reacts with imines to afford beta-lactam with reasonably high enantioselectivity. Tridentate aminoether ligands were also shown to affect the catalytic asymmetric addition of lithium ester enoaltes to imines, giving beta-lactams with high enantioselectivity. Asymmetric conjugate addition of lithium amide to enoates was mediated by a chiral diether ligand to give the beta-aminoester with high yield and enatioselectivity. The methodology has been successfully applied to an asymmetric synthesis of biologically potent compounds. Dihydrexidine, a promising anti-Parkinsonism candidate, and salsolidine, a representative isoquinoline alkaloid, have been synthesized using asymmetric addition reactions of organolithium reagents as the key steps.

Antiparkinson Agents↗

Towards a total synthesis of the new anticancer agent mensacarcin: synthesis of the carbocyclic core.

A synthesis of the carbocyclic core associated with the new anticancer agent mensacarcin (1) is reported. The strategy involves the synthesis of several novel highly substituted aromatic compounds, such as 12 and 23. The lithium derivative of 12 readily engages in a nucleophilic addition to benzaldehyde 4 to provide the diphenylcarbinol rac-15. The analogous benzyl ether rac-16 undergoes an intramolecular Heck reaction to provide the required tetrahydroanthracene rac-17, which can be transformed into the key tricyclic methyl ether rac-20. In a second approach, the lithium derivative of 21 is added to the hexasubstituted benzaldehyde 23 to give the diphenylcarbinol rac-35. Subsequent methylation to rac-36 followed by an intramolecular Heck reaction provides tricycle rac-37. Similarly, the oxidised compound 40 provides an electronically more suitable intramolecular Heck partner to afford compound 41. Further transformations of these substrates leads to rac-43, which incorporates the core structure of mensacarcin (1).

Anthracenes↗

Choline-containing compounds detected by proton magnetic resonance spectroscopy in the basal ganglia in bipolar disorder.

Choline-containing compounds (Cho) were examined by proton magnetic resonance spectroscopy (1H-MRS) in the left subcortical region, including basal ganglia, in 19 euthymic patients with bipolar disorder and 19 age-matched normal controls. Ten of the patients were treated with lithium; the remaining 9 were not treated with lithium for at least 30 d. The Cho to creatine + phosphocreatine (Cr) peak ratio in the bipolar patients (0.75 +/- 0.38 [mean +/- SD]) was higher than that in the normal controls (0.52 +/- 0.26, P < 0.05). There was no significant difference in the Cho:Cr peak ratio between patients treated with lithium (0.63 +/- 0.36) and without lithium (0.89 +/- 0.35). These results do not support the hypothesis that lithium increases the brain choline-containing compounds, but rather imply that membrane breakdown may occur in the basal ganglia of patients with bipolar disorder.

Adult↗

THE EFFECT OF MUCOSAL AND SEROSAL SOLUTION CATIONS ON BIOELECTRIC PROPERTIES OF THE ISOLATED TOAD BLADDER.

The spontaneous transtissue potential and the DC conductance of the isolated toad bladder were measured when the tissue was exposed to sulfate Ringer's solutions of modified ionic composition. Na(+) was replaced to varying extents by (C(2)H(5))(3)NH(+), (C(2)H(5))(4)N(+), Li(+), Cs(+), K(+), or Rb(+). Reversible and irreversible changes were observed. The reversible changes were consistent with equations derived from the Nernst-Planck diffusion equation, and gave the following functional description of the bladder: (a) the potential measurements were compatible with two membranes in series; (b) the mucosal surface was more permeable to Na(+) than to other monovalent cations; (c) the serosal surface was permeable to both K(+) and Na(+) but preferentially to K(+); (d) the rate of Na(+) diffusion across the mucosal membrane appeared to approach a maximum but two alternative interpretations are discussed; (e) the conductance data were consistent with the assumption of a constant concentration gradient for the penetrating ions within the membrane (Henderson's assumption) provided suitable hypotheses are made concerning the Na(+) distribution between the membrane surfaces and the bulk phases of the adjacent solutions; (f) the conductance and spontaneous potential data suggested that the mucosal membranes of a small fraction of the epithelial cells were more permeable than the mucosal membranes of the majority of these cells. The irreversible changes were almost entirely associated with cation substitution in the serosal solution. However, Li(+) produced an irreversible fall in voltage when added to either side of the tissue.

Ammonium Compounds↗