Clinical factors associated with lithium response in bipolar disorders.
Identifieur interne : 000D63 ( Main/Corpus ); précédent : 000D62; suivant : 000D64Clinical factors associated with lithium response in bipolar disorders.
Auteurs : Sarah Sportiche ; Pierre Alexis Geoffroy ; Clara Brichant-Petitjean ; Sebastien Gard ; Jean-Pierre Khan ; Jean-Michel Azorin ; Chantal Henry ; Marion Leboyer ; Bruno Etain ; Jan Scott ; Frank BellivierSource :
- The Australian and New Zealand journal of psychiatry [ 1440-1614 ] ; 2017.
English descriptors
- KwdEn :
- MESH :
- chemical , pharmacology : Antimanic Agents, Lithium Compounds.
- drug therapy : Bipolar Disorder.
- methods : Outcome Assessment, Health Care.
- physiopathology : Bipolar Disorder.
- Adult, Female, Humans, Male, Middle Aged.
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.
DOI: 10.1177/0004867416664794
PubMed: 27557821
Links to Exploration step
pubmed:27557821Le document en format XML
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</affiliation>
<affiliation><nlm:affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>5 Université Paris Descartes, UMR-S 1144, Paris, France.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Brichant Petitjean, Clara" sort="Brichant Petitjean, Clara" uniqKey="Brichant Petitjean C" first="Clara" last="Brichant-Petitjean">Clara Brichant-Petitjean</name>
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<author><name sortKey="Khan, Jean Pierre" sort="Khan, Jean Pierre" uniqKey="Khan J" first="Jean-Pierre" last="Khan">Jean-Pierre Khan</name>
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<affiliation><nlm:affiliation>8 Université de Lorraine, Nancy, France.</nlm:affiliation>
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<author><name sortKey="Azorin, Jean Michel" sort="Azorin, Jean Michel" uniqKey="Azorin J" first="Jean-Michel" last="Azorin">Jean-Michel Azorin</name>
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<affiliation><nlm:affiliation>10 EA 3279-Self-perceived Health Assessment Research Unit, School of Medicine, Timone University, Marseille, France.</nlm:affiliation>
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<author><name sortKey="Henry, Chantal" sort="Henry, Chantal" uniqKey="Henry C" first="Chantal" last="Henry">Chantal Henry</name>
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<affiliation><nlm:affiliation>12 Institut Pasteur, Unité Perception et Mémoire, Paris, France.</nlm:affiliation>
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<author><name sortKey="Leboyer, Marion" sort="Leboyer, Marion" uniqKey="Leboyer M" first="Marion" last="Leboyer">Marion Leboyer</name>
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<author><name sortKey="Etain, Bruno" sort="Etain, Bruno" uniqKey="Etain B" first="Bruno" last="Etain">Bruno Etain</name>
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<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Scott, Jan" sort="Scott, Jan" uniqKey="Scott J" first="Jan" last="Scott">Jan Scott</name>
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<affiliation><nlm:affiliation>14 Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Bellivier, Frank" sort="Bellivier, Frank" uniqKey="Bellivier F" first="Frank" last="Bellivier">Frank Bellivier</name>
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<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
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<affiliation><nlm:affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</nlm:affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Clinical factors associated with lithium response in bipolar disorders.</title>
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<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
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<affiliation><nlm:affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</nlm:affiliation>
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<affiliation><nlm:affiliation>5 Université Paris Descartes, UMR-S 1144, Paris, France.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Brichant Petitjean, Clara" sort="Brichant Petitjean, Clara" uniqKey="Brichant Petitjean C" first="Clara" last="Brichant-Petitjean">Clara Brichant-Petitjean</name>
<affiliation><nlm:affiliation>1 Inserm, U1144, Paris, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</nlm:affiliation>
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</affiliation>
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<author><name sortKey="Gard, Sebastien" sort="Gard, Sebastien" uniqKey="Gard S" first="Sebastien" last="Gard">Sebastien Gard</name>
<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>6 Hôpital Charles Perrens, Centre Expert Bipolaire, Pôle de Psychiatrie Générale Universitaire, Bordeaux, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Khan, Jean Pierre" sort="Khan, Jean Pierre" uniqKey="Khan J" first="Jean-Pierre" last="Khan">Jean-Pierre Khan</name>
<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>7 Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Centre Psychothérapique de Nancy-Laxou, Nancy, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>8 Université de Lorraine, Nancy, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Azorin, Jean Michel" sort="Azorin, Jean Michel" uniqKey="Azorin J" first="Jean-Michel" last="Azorin">Jean-Michel Azorin</name>
<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>9 Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, Marseille, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>10 EA 3279-Self-perceived Health Assessment Research Unit, School of Medicine, Timone University, Marseille, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Henry, Chantal" sort="Henry, Chantal" uniqKey="Henry C" first="Chantal" last="Henry">Chantal Henry</name>
<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>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.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>12 Institut Pasteur, Unité Perception et Mémoire, Paris, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Leboyer, Marion" sort="Leboyer, Marion" uniqKey="Leboyer M" first="Marion" last="Leboyer">Marion Leboyer</name>
<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
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</affiliation>
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<author><name sortKey="Etain, Bruno" sort="Etain, Bruno" uniqKey="Etain B" first="Bruno" last="Etain">Bruno Etain</name>
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</affiliation>
<affiliation><nlm:affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Scott, Jan" sort="Scott, Jan" uniqKey="Scott J" first="Jan" last="Scott">Jan Scott</name>
<affiliation><nlm:affiliation>13 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>14 Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Bellivier, Frank" sort="Bellivier, Frank" uniqKey="Bellivier F" first="Frank" last="Bellivier">Frank Bellivier</name>
<affiliation><nlm:affiliation>1 Inserm, U1144, Paris, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>3 Fondation FondaMental, Créteil, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</nlm:affiliation>
</affiliation>
</author>
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<series><title level="j">The Australian and New Zealand journal of psychiatry</title>
<idno type="eISSN">1440-1614</idno>
<imprint><date when="2017" type="published">2017</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term>
<term>Antimanic Agents (pharmacology)</term>
<term>Bipolar Disorder (drug therapy)</term>
<term>Bipolar Disorder (physiopathology)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Lithium Compounds (pharmacology)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Outcome Assessment, Health Care (methods)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="pharmacology" xml:lang="en"><term>Antimanic Agents</term>
<term>Lithium Compounds</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Bipolar Disorder</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Outcome Assessment, Health Care</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Bipolar Disorder</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Female</term>
<term>Humans</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>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.</p>
</div>
</front>
</TEI>
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<DateCompleted><Year>2017</Year>
<Month>07</Month>
<Day>19</Day>
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<DateRevised><Year>2019</Year>
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<Day>10</Day>
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<Issue>5</Issue>
<PubDate><Year>2017</Year>
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<Title>The Australian and New Zealand journal of psychiatry</Title>
<ISOAbbreviation>Aust N Z J Psychiatry</ISOAbbreviation>
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<ArticleTitle>Clinical factors associated with lithium response in bipolar disorders.</ArticleTitle>
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<Abstract><AbstractText Label="BACKGROUND" NlmCategory="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.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="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.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="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.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="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.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Sportiche</LastName>
<ForeName>Sarah</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>1 Inserm, U1144, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Geoffroy</LastName>
<ForeName>Pierre Alexis</ForeName>
<Initials>PA</Initials>
<AffiliationInfo><Affiliation>1 Inserm, U1144, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>5 Université Paris Descartes, UMR-S 1144, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Brichant-Petitjean</LastName>
<ForeName>Clara</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>1 Inserm, U1144, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gard</LastName>
<ForeName>Sebastien</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>6 Hôpital Charles Perrens, Centre Expert Bipolaire, Pôle de Psychiatrie Générale Universitaire, Bordeaux, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Khan</LastName>
<ForeName>Jean-Pierre</ForeName>
<Initials>JP</Initials>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>7 Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Centre Psychothérapique de Nancy-Laxou, Nancy, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>8 Université de Lorraine, Nancy, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Azorin</LastName>
<ForeName>Jean-Michel</ForeName>
<Initials>JM</Initials>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>9 Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, Marseille, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>10 EA 3279-Self-perceived Health Assessment Research Unit, School of Medicine, Timone University, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Henry</LastName>
<ForeName>Chantal</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>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.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>12 Institut Pasteur, Unité Perception et Mémoire, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Leboyer</LastName>
<ForeName>Marion</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>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.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Etain</LastName>
<ForeName>Bruno</ForeName>
<Initials>B</Initials>
<AffiliationInfo><Affiliation>1 Inserm, U1144, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Scott</LastName>
<ForeName>Jan</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>13 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>14 Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK.</Affiliation>
</AffiliationInfo>
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<ForeName>Frank</ForeName>
<Initials>F</Initials>
<AffiliationInfo><Affiliation>1 Inserm, U1144, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>2 AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>3 Fondation FondaMental, Créteil, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>4 Université Paris Diderot and Sorbonne Paris Cité, UMR-S 1144, Paris, France.</Affiliation>
</AffiliationInfo>
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<Language>eng</Language>
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<ArticleDate DateType="Electronic"><Year>2016</Year>
<Month>08</Month>
<Day>23</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>England</Country>
<MedlineTA>Aust N Z J Psychiatry</MedlineTA>
<NlmUniqueID>0111052</NlmUniqueID>
<ISSNLinking>0004-8674</ISSNLinking>
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<MeshHeading><DescriptorName UI="D018692" MajorTopicYN="N">Antimanic Agents</DescriptorName>
<QualifierName UI="Q000494" MajorTopicYN="Y">pharmacology</QualifierName>
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<MeshHeading><DescriptorName UI="D001714" MajorTopicYN="N">Bipolar Disorder</DescriptorName>
<QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName>
<QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D018020" MajorTopicYN="N">Lithium Compounds</DescriptorName>
<QualifierName UI="Q000494" MajorTopicYN="Y">pharmacology</QualifierName>
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<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D017063" MajorTopicYN="N">Outcome Assessment, Health Care</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName>
</MeshHeading>
</MeshHeadingList>
<KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Bipolar disorder</Keyword>
<Keyword MajorTopicYN="N">alcohol misuse</Keyword>
<Keyword MajorTopicYN="N">clinical predictors</Keyword>
<Keyword MajorTopicYN="N">lithium response</Keyword>
<Keyword MajorTopicYN="N">mixed state</Keyword>
</KeywordList>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2016</Year>
<Month>8</Month>
<Day>26</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline"><Year>2017</Year>
<Month>7</Month>
<Day>20</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez"><Year>2016</Year>
<Month>8</Month>
<Day>26</Day>
<Hour>6</Hour>
<Minute>0</Minute>
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</History>
<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">27557821</ArticleId>
<ArticleId IdType="pii">0004867416664794</ArticleId>
<ArticleId IdType="doi">10.1177/0004867416664794</ArticleId>
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