Untreated Episodes Research Articles

Is Lithium Still Worth Using? An Update of Selected Recent Research

The treatment of bipolar disorder has seen greater innovation in the past decade than at any other time since the introduction of lithium and the neuroleptics a half-century ago. The place of lithium in contemporary psychiatric therapeutics has become controversial, calling for the present overview of research findings pertaining to its use in treating patients with bipolar disorder. Lithium, by itself, typically is inadequate for rapid control of acute mania; antipsychotics, divalproex, or potent sedatives are commonly used, with or without lithium, for this purpose. The special usefulness of lithium lies in long-term prevention of recurrences of mania and bipolar depression and in reducing risk of suicidal behavior. Lithium also may be beneficial in recurrent unipolar depression and is an effective adjunct for treatment-resistant depression. Expectations that prolonged untreated bipolar illness, multiple episodes, rapid cycling, or retreatment following discontinuation might routinely lead to lithium nonresponsiveness, and the belief that lithium is too toxic for use during pregnancy, have not been borne out by research. Lithium retains a substantial share of prescriptions for bipolar disorder and is inexpensive. No other treatment has performed as well as lithium in as many aspects of long-term care of bipolar disorder patients, and despite some risks and limitations, lithium remains the standard against which all proposed alternatives are compared.

Treated versus Untreated Major Depressive Episodes

It is a plausible hypothesis that among treated cases of major depressive episodes (MDE) in the community, females will be overrepresented, episodes will be more severe, the course of the disorder will be more frequently chronic and the consequences in the depression more serious. This hypothesis was tested on the subjects of the Zürich cohort study, an enriched population sample (n = 591), which was examined 5 times between the ages of 20 and 35. We found a longitudinal prevalence rate for MDE of 20.2% (13.5% for males and 26.7% for females). 173 subjects met DSM-IV criteria for MDE and of those 66 (38%) had been treated for depression in the preceding 12-month period. 82% of the treated cases were females; in untreated subjects the sex ratio F/M was 1.2:1. Treated cases were found to be more severely depressed, they spent more days in depression over 1 year, experienced greater suffering and suffered more work and social impairment. However, in terms of family history of depression and age of onset, treated and untreated cases did not differ. Surprisingly, there was a trend to a more favorable course among treated subjects than in the untreated group. Compared with controls, untreated subjects demonstrated normal coping skills. The treated cases differed from both untreated subjects and controls in their aggression and neuroticism scores.

The balance of positive and negative affects in major depression: A further test of the states of mind model

The States of Mind (SOM) model provided a framework for assessing the balance between self-reported positive and negative affects in a sample of 39 outpatients with major depression and 43 healthy control subjects. The SOM model proposes that healthy functioning is characterized by an optimal balance of positive (P) and negative (N) cognitions or affects ( P/ ( P + N) ≈ 0.63), and that psychopathology is marked by deviations from the optimal balance. Research thus far has focused on the functional significance of cognitive rather than affective balance. Within this framework, we hypothesized that patients in untreated episodes of major depression would balance their positive and negative affects at the same level where depressed patients in other studies have balanced their positive and negative cognitions—namely, at P/ ( P + N) ≈ 0.37. Point and confidence interval (CI) estimation procedures yielded results ( mean = 0.35, 95% CI = 0.30 − 0.40) consistent with this hypothesis in a sample of 39 depressed male outpatients. Correlational analysis indicated that affect balance is inversely related to symptom severity as measured by self-report (Beck) and clinician-rating (Hamilton) scales.

Oral acyclovir for episodic treatment of recurrent genital herpes: Efficacy and safety

This multicenter double-blind study of 157 patients was designed to evaluate the safety and efficacy of a new dosage regimen of oral acyclovir (800 mg twice a day for 5 days) for the treatment of recurrent genital herpes. The new regimen was compared with the standard dosage of 200 mg given five times a day to patients treated for three consecutive episodes (one episode with physician-initiated therapy and two with patient-initiated therapy) and followed up for three untreated episodes. The new regimen was well tolerated and effective. In male patients it may be more effective than the standard regimen of 200 mg given five times a day to treat vesicles that are already present.

A magnetic resonance study of early schizophrenia.

Patients with untreated first schizophrenic episodes and others who had made varying degrees of recovery from such episodes were blindly compared with normal volunteers in terms of the periventricular appearances on spin echo magnetic resonance scans. Significant differences were not found.