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Lithium response and psychoses: a double-blind, placebo-controlled study.

D L Garver, J Hirschowitz, R Fleishmann

Psychiatry Research

|May 1, 1984

Summary

Lithium treatment effectively induced remission in a subset of psychotic patients with specific red blood cell (RBC)/lithium ratio variants. This study confirms lithium

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Area of Science:

Psychiatry and Pharmacology
Neuroscience and Neurobiology

Background:

Previous observations suggested lithium can induce remission in psychosis, particularly in schizophreniform disorders and patients with specific red blood cell (RBC)/lithium ratios.
The spontaneous nature versus treatment effect of lithium-induced remission remained unclear.

Purpose of the Study:

To rigorously assess whether observed psychotic remissions are a direct consequence of lithium treatment.
To differentiate lithium's therapeutic effect from spontaneous remission or placebo response in a preselected patient group.

Main Methods:

A double-blind, placebo-controlled study was conducted on 16 psychotic patients.
Patients were preselected based on RBC/lithium ratio variants and/or DSM-III schizophreniform diagnosis.
A crossover design compared lithium treatment periods with placebo treatment periods.

Main Results:

Four out of fifteen patients achieved essentially full and sustained remission of psychosis during lithium treatment.
These four patients showed significantly greater improvement during lithium periods compared to placebo periods (p < 0.02).
Fifteen patients did not achieve sustained improvement spontaneously or during placebo treatment in the initial 14 days.

Conclusions:

Lithium treatment demonstrated a significant and specific therapeutic effect in a subset of preselected psychotic patients.
Sustained response to lithium in this population occurred at least four times more frequently than spontaneous remission.
The findings support lithium's efficacy in specific psychotic conditions characterized by RBC/lithium ratio variants.

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