Side effects of chronic lithium therapy in Hong Kong Chinese: an ethnopsychiatric perspective

A biocultural study of the side effects of chronic lithium treatment among 70 Hong Kong Chinese psychiatric patients, using a self-report 33-item checklist and semi-structured interviews, revealed an imperfect correspondence between biomedically prescribed and culturally endorsed psychotropic side effects. Although polydipsia and polyuria (47%) were the biomedically most 'real' side effects, they were not usually regarded as bothersome or translated into metaphors to express undesirable side effects. Complaints such as tiredness (38%), drowsiness (36%) and poor memory (31%) were also common but their frequency was significantly lower than that of normal control subjects. The item 'loss of creativity' had no conceptual equivalent in Chinese and was usually misinterpreted. As no patient was aware that lithium was a metal, the side effect 'metallic taste' was variously labelled. Contrary to Western findings, complaints of 'missing of highs', loss of assertiveness and fear of weight gain were rarely encountered. Active elicitation was required for indigenous complaints, with 38% of patients considering lithium to cause mild "hotness." This was readily neutralized by drinking more water which had a "cooling" effect. Expectedly, concurrent neuroleptics and antidepressants amplified most lithium side effects. This study affirms Western data on the biomedically universalizable effects of chronic lithium treatment, but also supports the thesis that culturally constituted cognitive styles affect patients' recognition, labelling, experiencing and reporting the total drug effect. Further, it demonstrates that the lived experience and clinical negotiation of lithium associated side effects reproduce, authenticate, and at times critique, core cultural and moral premises of Western and Chinese societies.