Ümit Sertan ÇÖPOĞLU, Osman VIRIT, Haluk Asuman SAVAŞ, Ahmet ÜNAL, Feridun BÜLBÜL

Lityumun kırk yıldır sorunsuz kullanımı: Olgu sunumu

Lityumun psikiyatride adından söz ettirmeye başlaması ilk defa 1949 yılında John Cade’nin lityumu manik hastalarda denemesinin başarılı olması sonucudur. Daha sonra yapılan klinik çalışmalarda iki uçlu bozukluğun (İUB) koruyucu tedavisi ve manide lityumun etkinliği gösterilmiştir. Amerikan Gıda ve İlaç Dairesi (FDA) lityuma mani tedavisi için 1970’de, maniyi önlemede idame tedavi olarak 1974’de onay vermiştir. Lityum son tedavi kılavuzlarında akut manide, İUB idame ve İUB depresif dönem tedavilerinde halen birinci sıra tedavi seçeneği olarak yerini korumaktadır. Geniş kulanım alanına rağmen lityum dar bir tedavi aralığına sahiptir ve bununla ilişkili olarak birçok ciddi akut ve süreğen yan etki oluşabilmektedir. Nörolojik, endokrin, renal, dermatolojik, gastrointestinal ve kardiyovasküler sistemler değişik şiddette etkilenebilmektedir. Lityum zehirlenmesi durumu ise nörolojik sekelle, hatta ölümle sonuçlanabilmektedir. Bu yazıda ilaç yan etkisi olmadan sorunsuz bir şekilde kırk yıldır lityum ile tedavi edilen, yapılan laboratuvar ve görüntüleme incelemelerinde de herhangi bir anormallik saptanmayan bir İUB hastası sunulacaktır.

Anahtar Kelimeler:

iki uçlu bozukluk, tedavi, lityum

The usage of lithium for forty years without problem: a case report

Lithium’s first rise in psychiatry was in 1949 when John Cade tried lithium in manic patients successfully. Clinical research which conducted later on, showed the lithium’s effectivity in maintenance treatment of bipolar disorder (BD) and mania. On the other hand, U.S. Food and Drug Administration (FDA) approved lithium for mania treatment in 1970, and for maintenance treatment against mania in 1974. Lithium still keeps its importance as the first line treatment option in acute mania, maintenance treatment, and depressive episode of BD. However, despite this wide usage area, lithium has a narrow therapeutic index and as a result of this, a lot of serious acute and chronic side effects may occur. Neurologic, endocrine, renal, dermatologic, and gastrointestinal, and cardiovascular systems may be affected in different severities. Lithium intoxication may result in neurological sequela, even in death. In this article, a BD patient who has been treated with lithium for forty years without side effects, and who has been found to be normal in lab and monitoring examination will be reported.

Keywords:

bipolar disorder, treatment, lithium,

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Parker G. John Cade. Am J Psychiatry 2012;169:125-6.
Abhishekh HA, Faizan S. John Cade. Aust N Z J Psychiatry. 2012;46:68-9.
Jefferson JW, Greits JH. Biyolojik Tedaviler. Aydın H, Bozkurt A (çevirenler). In Kaplan & Sadock’s Compherensive Textbook of Psychiatry Volume III, 8 th ed. (Sadock BJ, Sadock VA editors). Baskı, Ankara: Güneş Kitabevi, 2007:2839-51.
Yatham LN, Kennedy SH, Schaffer A, Parikh SV, Beaulieu S, O’Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Young AH, Alda M, Milev R, Vieta E, Calabrese JR, Berk M, Ha K, Kapczinski F. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord. 2009;11:225-55.
Malhi GS, Tanious M, Das P, Berk M. The science and practice of lithium therapy. Aust N Z J Psychiatry. 2012;46:192-211.
Raja M. Lithium and Kidney, 60 Years Later. Curr Drug Saf 2011;6:291-03.
Stahl SM. Stahl’ın temel psikofarmakolojisi nörobilimsel ve pratik uygulamaları. Uzbay İT (Çeviri Ed) İstanbul Medikal Yayıncılık, İstanbul, 2012.
McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and metaanalysis. Lancet. 2012;25:721-28.
Singh LK, Nizamie SH, Akhtar S, Praharaj SK. Improving tolerability of lithium with a once-daily dosing schedule. Am J Ther. 2011;18:288-91.
Oliviera JL, Silva Junior GB, Abreu KL, Rocha Nde A, Franco LF, Araşjo SM, Daher Ede F. Lithium nephrotoxicity. Rev Assoc Med Bras. 2010;56:600-06.
Bendz H, Aurell M, Lanke J. A historical cohort study of kidney damage in long-term lithium patients: continued surveillance needed. Eur Psychiatry. 2001;16:199-06.
Bendz H, Aurell M. Drug-induced diabetes insipidus: incidence, prevention and management. Drug Saf. 1999;21:449-56.
Kalelioğlu T, Taşdemir A, Genç A, Genç ES, Özver İ, Yeşilbaş, Altınbaş K, Kurt E. Lityum tekli tedavisi alan hastaların hematolojik ve biyokimyasal değerlerinin incelenmesi. Journal of Mood Disorders. 2012;2:109-14.
Grandjean EM, Aubry JM. Lithium: updated human knowledge using an evidence-based approach: part III: clinical safety. CNS drugs. 2009;23:397-18.
Hagman A, Arnman K, Ryden L. Syncope caused by lithium treatment. Report on two cases and a prospective investigation of the prevalence of lithium-induced sinus node dysfunction. Acta Med Scand. 1979;205:467-71.
Thakur SC, Thakur SS, Chaube SK, Singh SP. Subchronic supplementation of lithium carbonate induces reproductive system toxicity in male rat. Reprod Toxicol. 2003;17:683-90.
Banerji TK, Maitra SK, Dey M, Hawkins HK. Gametogenic responses of the testis in spotted munia (Lonchura punctulata; Aves) to oral administration of lithium chloride. Endocr Res. 2001;27:345-56.
Namyniuk MA, Chaturvedi AK. Influence of chlorpromazine on motility and calcium uptake of boar sperm. Arch Int Pharmacodyn Ther. 1988;292:286-04.
Levin RM, Amsterdam JD, Winokur A, Wein AJ. Effects of psychotropic drugs on human sperm motility. Fertil Steril. 1981;36:503-06.
Yazıcı O, Çakır S. Unipolar mani: Ayrı bir antite mi, bir manik baskınlık özelliği mi? Türk Psikiyatri Dergisi. 2012;23:201-05.
Yazıcı O, Kora K, Üçok A, Tunalı D, Turan N. Predictors of lithium prophylaxis in bipolar patients. J Affect Disord. 1999;55:133-42.