Relapse in patients with shifting RDC diagnoses treated with lithium alone

After a research diagnostic interview with 60 chronic outpatients clinically diagnosed as schizophrenic, the authors identified four patients who by retrospective history had had affective episodes at one time in their life and schizophrenic episodes at another. Lithium was substituted for antipsychotic medications and the patients were followed for 13 months. Two patients relapsed on lithium alone, one relapsed on no medications and one did well on lithium alone. The phenomenology observed in the three relapsing cases included: 1) RDC mania; 2) rapid onset with confusion; 3) sexually regressive behavior; and 4) improvement with reinitiation of antipsychotic medication. Caution is advised in the use of lithium alone for patients fitting this diagnostic description.