Lityumun Metabolik Yan Etkileri

Lityum 19. yüzyıldan bu yana tıpta kullanılan alkali bir iyondur. Lityumun psikiyatrik rahatsızlıklarda kullanımının yaygınlaşması ile birlikte yan etkilerin de gözlenmeye başlaması lityum kullanımı konusunda çekinceler doğurmuştur. Tüm bu çekincelere karşın lityumun bipolar bozukluk başta olmak üzere duygudurum bozukluklarında vazgeçilmez ilaçlardan birisidir. Lityumun halen özellikle bipolar bozuklukta altın standart sağaltım olarak kabul edilmesi yan etkilerinin iyi tanınması gerekliliğini de beraberinde getirmiştir. Lityumun süregen kullanımında çeşitli organ sistemleri üzerine olan etkileri iyi bilinmektedir. Bu yazıda metabolik yan etkiler olarak tiroid ve paratiroid bezleri ile vücut ağırlığı üzerine etkileri ve böbrekler üzerine olan etkilerinden söz edilirken bu yan etkilerin olası etki düzenekleri, klinik bulguları, olası risk etmenleri ve bu yan etkilere yönelik önlemler üzerinde durulacaktır. Lityumun tiroid üzerinde gözlenen en sık yan etkisi hipotiroididir. Klinik ve biyokimyasal özellikler bakımından primer hipotiroidi ile aynı özelliklere sahiptir ve en sık subklinik hipotiroidi olarak karşımıza çıkmaktadır. Hipotiroidi, subklinik de olsa sağaltıma yanıtsızlık veya yetersiz yanıtla ilişkili olabilir ve hızlı döngülük için bir risk etmeni olarak gösterilmektedir. Bu özellikleri nedeniyle hipotiroidi, şiddeti ne olursa olsun izleme alınmalı ve klinik hipotiroidi varlığında tiroid hormonu ile tedavi edilmelidir. Lityuma bağlı kilo artışı tedavi uyumunu bozmakta ve ruhsal rahatsızlığın seyrini olumsuz etkilemektedir. Kilo artışına bağlı gelişen diyabet, hipertansiyon, iskemik kalp hastalığı ve inme riskinde artış diğer sorun odaklarını oluşturmaktadır. Bu nedenlerle lityuma başlamadan önce risk etmenlerinin belirlenmesi, kilo takibi, beslenme alışkanlıklarının düzenlenmesi ve egzersiz programlarının önerilmesi önem taşımaktadır. Lityum kullanımı konusunda en çok sorun yaratan yan etkilerden birisi de böbrek işlev bozukluğudur. Lityuma bağlı gelişen böbrek işlevlerindeki bozulmanın çok önemli bir kısmı poliüri ve polidipsi ile karakterize nefrojen diyabetes insipidus şeklinde karşımıza çıkmaktadır. Nefrojen diayabetes insipidus, lityumun toplayıcı tübüller seviyesinde su ve sodyumun emilimini etkileyerek idrar konsantrasyon yeteneğini bozması sonucu gelişmektedir. Lityum kullanırken gelişebilecek böbrek hasarının önlenebilmesi için böbrek işlevlerinin yakın takibi önemlidir. Bununla birlikte lityum zehirlenmesi ataklarının böbrek hasarı riskini artırabileceğinden serum lityum düzeylerinin izlemi de büyük önem taşımaktadır. Sonuç olarak, lityum özellikle duygudurum bozukluklarında halen vazgeçilmezliğini korumaktadır. Bu kadar önemli bir tedavinin hastalardan esirgenmemesi için klinisyenlerin lityumun yan etkileri konusunda güncel bilgilere sahip olması ve gerekli önlemlerin alınması gerekmektedir.

Anahtar Kelimeler:

Lityum, Yan Etkiler, Tiroid, Paratiroid, Kilo Artışı, Böbrek İşlevleri

Metabolic Side Effects of Lithium

Lithium is an alkaline ion being used since 19th century. After its widespread use in psychiatric disorders, observed side effects caused skepticism about its therapeutic efficacy. Despite several disadvantages, lithium is one of the indispensible drugs used in affective disorders, especially in bipolar disorder. It became a necessity for physicians to recognize its side effects since lithium is still accepted as a gold standard in the treatment of bipolar disorder. Adverse effects of chronic administration of lithium on several organ systems are widely known. In this article metabolic effects of lithium on thyroid and parathyroid glands, body mass index and kidneys will be discussed along with their mechanisms, clinical findings, possible risk factors and treatment. One of the most common side effect of lithium is hypothyroidism. It has the same clinical and biochemical properties as primary hypothyroidism and observed as subclinical hypothyroidism in the first place. Hypothyroidism, even its subclinical form, may be associated with non-response or inadequate response and is indicated as a risk factor for development of rapid cycling bipolar disorder. Therefore, hypothyroidism should be screened no matter how severe it is and should be treated with thyroid hormone in the presence of clinical hypothyroidism. Weight gain due to lithium administration disturbs the compliance to treatment and negatively affects the course of the illness. Increased risk for diabetes, hypertension, ischemic heart disease and stroke because of weight gain constitute other centers of problem. Indeed, it is of importance to determine the risk factors before treatment, to follow up the weight, to re-organize nutritional habits and to schedule exercises. Another frequent problematic side effect of lithium treatment is renal dysfunction which clinically present as nephrogenic diabetes insipidus with the common symptoms of polyuria and polydipsia. Nephrogenic diabetes insipidus develops because of urinary concentration defects due to the detrimental effects of lithium on re-absorption of water and sodium at the level of collector tubules. Close screening of renal functions is very important in the prevention of renal damage during treatment with lithium. Moreover, it is also of importance to screen serum lithium levels as lithium intoxication episodes may increase the risk of renal failure. As a conclusion lithium still preserves its indispensability in affective disorders. Clinicians should have current knowledge about the side effects of lithium and take preventive measures to apply such an important treatment to the patients.

Keywords:

Lithium, Side Effects, Thyroid, Parathyroid, Weight Gain, Renal Functions,

PDF

___

Young AH, Hammond JM. Lithium in mood disorders: Increasing evidence base, declining use? Br J Psychiatry 2007; 191:474-476.
El-Mallakh RS, Jefferson JW. Prethymoleptic use of lithium. Am J Psychiatry 1999; 156:129.
Jefferson JW, Greist JH. Lithium. Kaplan and Sadock’s comprehensive textbook of psychiatry, 8. ed.. Ed. Sadock BJ, Sadock VA. Philadelphia, PA, ABD. 2007; pp.2839- 2850
Corcoran AC, Taylor RD, Page IH. Lithium poisoning from the use of salt substitutes. J Am Med Assoc 1949; 139:685-688.
Schou M. The early European lithium studies. Aust NZJ Psychiatry 1999; 33 Suppl: S39-47.
Livingstone C, Rampes H. Lithium: A review of its metabolic adverse effects. J Psychopharmacol 2006; 20:347-355.
Bocchetta A, Mossa P, Velluzzi F, Mariotti S, Zompo MD, Loviselli A. Ten-year follow- up of thyroid function in lithium patients. J Clin Psychopharmacol 2001; 21:594-598.
Frye MA, Denicoff KD, Bryan AL, Smith-Jackson EE, Ali SO, Luckenbaugh D et al. Association between lower serum free T4 and greater mood instability and depression in lithium-maintained bipolar patients. Am J Psychiatry 1999; 156:1909
Lazarus JH. The effects of lithium therapy on thyroid and thyrotropin-releasing hormone. Thyroid 1998; 8:909-913.
Kleiner J, Altshuler L, Hendrick V, Hershman JM. Lithium-induced subclinical hypothyroidism: Review of the literature and guidelines for treatment. J Clin Psychiatry 1999; 60:249-255.
Terao T, Oga T, Nozaki S, Ohta A, Otsubo Y, Yamamoto S et al. Possible inhibitory effect of lithium on peripheral conversion of thyroxine to triiodothyronine: A prospective study. Int Clin Psychopharmacol 1995; 10:103-105.
Kusalic M, Engelsmann F. Effect of lithium maintenance therapy on thyroid and parathyroid function. J Psychiatry Neurosci 1999; 24:227-233.
Henry C. Lithium side-effects and predictors of hypothyroidism in patients with bipolar disorder: Sex differences. J Psychiatry Neurosci 2002; 27:104-107.
Kirov G. Thyroid disorders in lithium-treated patients. J Affect Disord 1998; 50:33-40.
Johnston AM, Eagles JM. Lithium-associated clinical hypothyroidism. Prevalence and risk factors. Br J Psychiatry 1999; 175:336-339.
Gracious BL, Findling RL, Seman C, Youngstrom EA, Demeter CA, Calabrese JR. Elevated thyrotropin in bipolar youths prescribed both lithium and divalproex sodium. J Am Acad Child Adolesc Psychiatry 2004; 43:215-220.
Bocchetta A, Bernardi F, Burrai C, Pedditzi M, Loviselli A, Velluzzi F, et al. The course of thyroid abnormalities during lithium treatment: A two-year follow-up study. Acta Psychiatr Scand 1992; 86:38-41.
Deodhar SD, Singh B, Pathak CM, Sharan P, Kulhara P et al. Thyroid functions in lithium-treated psychiatric patients: A cross-sectional study. Biol Trace Elem Res 1999; 67:151-163.
Gyulai L, Bauer M, Bauer MS, Garcia-Espana F, Cnaan A, Whybrow PC. Thyroid hypofunction in patients with rapid-cycling bipolar disorder after lithium challenge. Biol Psychiatry 2003; 53:899-905.
Rapaport MH, Schmidt ME, Risinger R, Manji H. The effects of prolonged lithium exposure on the immune system of normal control subjects: Serial serum soluble interleukin-2 receptor and antithyroid antibody measurements. Biol Psychiatry 1994; 35:761-766.
Loviselli A, Bocchetta A, Mossa P, Velluzzi F, Bernardi F, del Zompo M et al. Value of thyroid echography in the long-term follow-up of lithium-treated patients. Neuropsychobiology 1997; 36:37-41.
Kupka RW, Nolen WA, Post RM, McElroy SL, Altshuler LL, Denicoff KD et al. High rate of autoimmune thyroiditis in bipolar disorder: Lack of association with lithium exposure. Biol Psychiatry 2002; 51:305-311.
Schiemann U, Hengst K. Thyroid echogenicity in manic-depressive patients receiving lithium therapy. J Affect Disord 2002; 70:85-90.
Tasevski V, Benn D, King M, Luttrell B, Simpson A et al. Mitogenic effect of lithium in frtl-5 cells can be reversed by blocking de novo cholesterol synthesis and subsequent signal transduction. Thyroid 2000; 10:305-311.
Bocchetta A, Bernardi F, Pedditzi M, Loviselli A, Velluzzi F, Martino E et al. Thyroid abnormalities during lithium treatment. Acta Psychiatr Scand 1991; 83:193-198.
Frassetto F, Tourneur Martel F, Barjhoux CE, Villier C, Bot BL, Vincent F et al. Goiter in a newborn exposed to lithium in utero. Ann Pharmacother 2002; 36:1745-1748.
Temple R, Berman M, Robbins J, Wolff J. The use of lithium in the treatment of thyrotoxicosis. J Clin Invest 1972; 51:2746-2756.
Kristensen O, Andersen HH, Pallisgaard G. Lithium carbonate in the treatment of thyrotoxicosis. A controlled trial. Lancet 1976; 1:603-605.
Barclay ML, Brownlie BE, Turner JG, Wells JE. Lithium associated thyrotoxicosis: A report of 14 cases, with statistical analysis of incidence. Clin Endocrinol 1994; 40:759- 764.
Byrne AP, Delaney WJ. Regression of thyrotoxic ophthalmopathy following lithium withdrawal. Can J Psychiatry 1993; 38:635-637.
Oakley PW, Dawson AH, Whyte IM. Lithium: Thyroid effects and altered renal handling. J Toxicol Clin Toxicol 2000; 38:333-337.
Carmaciu CD, Anderson CS, Lawton CA. Thyrotoxicosis after complete or partial lithium withdrawal in two patients with bipolar affective disorder. Bipolar Disord 2003; 5:381-384.
Garfinkel PE, Ezrin C, Stancer HC. Hypothyroidism and hyperparathyroidism associated with lithium. Lancet 1973; 2:331-332.
Dalan R, Leow MK, Jong M. Multiple endocrinopathies associated with lithium therapy. Endocr Pract 2007; 13:758-763.
Wilting I, Souverein PC, Nolen WA, Egberts AC, Heerdink ER. Changes in outpatient lithium treatment in the Netherlands during 1996-2005. J Affect Disord 2008; 111:94- 99.
Heath H, 3rd, Hodgson SF, Kennedy MA. Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community. N Engl J Med 1980; 302:189-193.
Nordenstrom J, Elvius M, Bagedahl-Strindlund M, Zhao B, Torring O. Biochemical hyperparathyroidism and bone mineral status in patients treated long-term with lithium. Metabolism 1994; 43:1563-1567.
Bendz H, Sjodin I, Toss G, Berglund K. Hyperparathyroidism and long-term lithium therapy--a cross-sectional study and the effect of lithium withdrawal. J Intern Med 1996; 240:357-365.
Christiansen C, Baastrup PC, Lindgreen P, Transbol I. Endocrine effects of lithium: Ii. 'primary' hyperparathyroidism. Acta Endocrinol 1978; 88:528-534.
McIntosh WB, Horn EH, Mathieson LM, Sumner D. The prevalence, mechanism and clinical significance of lithium-induced hypercalcaemia. Med Lab Sci 1987; 44:115- 118.
McHenry CR, Stenger DB, Racke F. Investigation of calcium-induced hydrolysis of phosphoinositides in normal and lithium-treated parathyroid cells. Am J Surg 1995; 170:484-487.
Riccardi D, Gamba G. The many roles of the calcium-sensing receptor in health and disease. Arch Med Res 1999; 30:436-448.
Haden ST, Stoll AL, McCormick S, Fuleihan Ge-H. Alterations in parathyroid dynamics in lithium-treated subjects. J Clin Endocrinol Metab 1997; 82:2844-2848.
Seely EW, Moore TJ, LeBoff MS, Brown EM. A single dose of lithium carbonate acutely elevates intact parathyroid hormone levels in humans. Acta Endocrinol 1989; 121:174-176.
Brown EM. Lithium induces abnormal calcium-regulated PTH release in dispersed bovine parathyroid cells. J Clin Endocrinol Metab 1981; 52:1046-1048.
Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S. Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume. J Clin Endocrinol Metab 1989; 68:654-660.
Awad SS, Miskulin J, Thompson N. Parathyroid adenomas versus four-gland hyperplasia as the cause of primary hyperparathyroidism in patients with prolonged lithium therapy. World J Surg 2003; 27:486-488.
Rizwan MM, Perrier ND. Long-term lithium therapy leading to hyperparathyroidism: A case report. Perspect Psychiatr Care 2009; 45:62-65.
Wolf ME, Moffat M, Mosnaim J, Dempsey S. Lithium therapy, hypercalcemia, and hyperparathyroidism. Am J Ther 1997; 4:323-325.
Carney S, Jackson P. Acute lithium administration impairs the action of parathyroid hormone on rat renal calcium, magnesium and phosphate transport. Clin Exp Pharmacol Physiol 1998; 25:795-799.
McHenry CR, Rosen IB, Rotstein LE, Forbath N, Walfish PG. Lithiumogenic disorders of the thyroid and parathyroid glands as surgical disease. Surgery 1990; 108:1001- 1005.
Hundley JC, Woodrum DT, Saunders BD, Doherty GM, Gauger PG. Revisiting lithium- associated hyperparathyroidism in the era of intraoperative parathyroid hormone monitoring. Surgery 2005; 138:1027-1031.
Gregoor PS, de Jong GM. Lithium hypercalcemia, hyperparathyroidism, and cinacalcet. Kidney Int 2007; 71:470.
Szalat A, Mazeh H, Freund HR. Lithium-associated hyperparathyroidism: Report of four cases and review of the literature. Eur J Endocrinol 2009; 160:317-323.
Neal JM, Adrian DC. Recurrent acute primary hyperparathyroidism in an adult male patient. Endocr Pract 1996; 2:243-244.
Silverstone T, Romans S. Long term treatment of bipolar disorder. Drugs 1996; 51:367-382.
Goodwin FK, Jamison KR. Maintenance medical treatment. Manic-depressive illness. New York: Oxford University Press, 1990; pp.665–724.
Vestergaard P, Poulstrup I, Schou M. Prospective studies on a lithium cohort. 3. Tremor, weight gain, diarrhea, psychological complaints. Acta Psychiatr Scand 1988; 78:434-441.
Baptista T, Teneud L, Contreras Q, Alastre T, Burguera JL, de Burguera M et al. Lithium and body weight gain. Pharmacopsychiatry 1995; 28:35-44.
Mathew B, Rao JM, Sundari U. Lithium-induced changes in the body mass index. Acta Psychiatr Scand 1989; 80:538-540.
Vendsborg PB, Bech P, Rafaelsen OJ. Lithium treatment and weight gain. Acta Psychiatr Scand 1976; 53:139-147.
Sachs GS, Guille C. Weight gain associated with use of psychotropic medications. J Clin Psychiatry 1999; 60 Suppl 21:16-19.
Vieweg WV, Godleski LS, Hundley PL, Yank GR. Lithium, polyuria and abnormal diurnal weight gain in psychosis. Acta Psychiatr Scand 1988; 78:510-514.
Elmslie JL, Mann JI, Silverstone JT, Williams SM, Romans SE. Determinants of overweight and obesity in patients with bipolar disorder. J Clin Psychiatry 2001; 62:486-491.
Baptista T, Lacruz A, de Mendoza S, Guillen MM, Burguera JL, de Burguera M et al. Endocrine effects of lithium carbonate in healthy premenopausal women: Relationship with body weight regulation. Prog Neuropsychopharmacol Biol Psychiatry 2000; 24:1-16.
Campfield LA, Smith FJ, Burn P. The ob protein (leptin) pathway--a link between adipose tissue mass and central neural networks. Horm Metab Res 1996; 28:619-632.
Jin H, Meyer JM, Mudaliar S, Jeste DV. Impact of atypical antipsychotic therapy on leptin, ghrelin, and adiponectin. Schizophr Res 2008; 100:70-85.
Atmaca M, Kuloglu M, Tezcan E, Ustundag B. Weight gain and serum leptin levels in patients on lithium treatment. Neuropsychobiology 2002; 46:67-69.
Johnson RE, McFarland BH. Lithium use and discontinuation in a health maintenance organization. Am J Psychiatry 1996; 153:993-1000.
Fagiolini A, Frank E, Houck PR, Mallinger AG, Swartz HA, Buysse DJ et al. Prevalence of obesity and weight change during treatment in patients with bipolar I disorder. J Clin Psychiatry 2002; 63:528-533.
Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP et al. Lithium- induced nephrogenic diabetes insipidus: Renal effects of amiloride. Clin J Am Soc Nephrol 2008; 3:1324-1331.
Grunfeld JP, Rossier BC. Lithium nephrotoxicity revisited. Nat Rev Nephrol 2009; 5:270-276.
Laursen UH, Pihakaski-Maunsbach K, Kwon TH, Ostergaard Jensen E, Nielsen S, Maunsbach AB. Changes of rat kidney AQP2 and NA,K-ATPase mRNA expression in lithium-induced nephrogenic diabetes insipidus. Nephron Exp Nephrol 2004; 97:e1- 16.
Marples D, Christensen S, Christensen EI, Ottosen PD, Nielsen S. Lithium-induced downregulation of aquaporin-2 water channel expression in rat kidney medulla. J Clin Invest 1995; 95:1838-1845.
Bendz H, Aurell M, Balldin J, Mathe AA, Sjodin I. Kidney damage in long-term lithium patients: A cross-sectional study of patients with 15 years or more on lithium. Nephrol Dial Transplant 1994; 9:1250-1254.
Nielsen J, Kwon TH, Praetorius J, Kim YH, Frokiaer J, Knepper MA et al. Segment- specific enac downregulation in kidney of rats with lithium-induced ndi. Am J Physiol Renal Physiol 2003; 285:F1198-1209.
Boton R, Gaviria M, Batlle DC. Prevalence, pathogenesis, and treatment of renal dysfunction associated with chronic lithium therapy. Am J Kidney Dis 1987; 10:329- 345.
Waller DG, Edwards JG, Papasthatis-Papayanni S. A longitudinal assessment of renal function during treatment with lithium. Q J Med 1988; 68:553-558.
Coskunol H, Vahip S, Mees ED, Basci A, Bayindir O, Tuglular I. Renal side-effects of long-term lithium treatment. J Affect Disord 1997; 43:5-10.
Vestergaard P, Amdisen A. Lithium treatment and kidney function. A follow-up study of 237 patients in long-term treatment. Acta Psychiatr Scand 1981; 63:333-345.
DePaulo JR, Jr., Correa EI, Sapir DG. Renal function and lithium: A longitudinal study. Am J Psychiatry 1986; 143:892-895.
Johnson GF, Hunt GE, Duggin GG, Horvath JS, Tiller DJ. Renal function and lithium treatment: Initial and follow-up tests in manic-depressive patients. J Affect Disord 1984; 6:249-263.
Smigan L, Bucht G, von Knorring L, Perris C, Wahlin A. Long-term lithium treatment and renal functions. A prospective study. Neuropsychobiology 1984; 11:33-38.
Jorkasky DK, Amsterdam JD, Oler J, Braden G, Alvis R, Geheb M et al. Lithium- induced renal disease: A prospective study. Clin Nephrol 1988; 30:293-302.
Hetmar O, Povlsen UJ, Ladefoged J, Bolwig TG. Lithium: Long-term effects on the kidney. A prospective follow-up study ten years after kidney biopsy. Br J Psychiatry 1991; 158:53-58.
Kallner G, Petterson U. Renal, thyroid and parathyroid function during lithium treatment: Laboratory tests in 207 people treated for 1-30 years. Acta Psychiatr Scand 1995; 91:48-51.
Bucht G, Wahlin A. Renal concentrating capacity in long-term lithium treatment and after withdrawal of lithium. Acta Med Scand 1980; 207:309-314.
Bendz H. Kidney function in a selected lithium population. A prospective, controlled, lithium-withdrawal study. Acta Psychiatr Scand 1985; 72:451-463.
Bendz H, Sjodin I, Aurell M. Renal function on and off lithium in patients treated with lithium for 15 years or more. A controlled, prospective lithium-withdrawal study. Nephrol Dial Transplant 1996; 11:457-460.
Bedford JJ, Leader JP, Jing R, Walker LJ, Klein JD, Sands JM et al. Amiloride restores renal medullary osmolytes in lithium-induced nephrogenic diabetes insipidus. Am J Physiol Renal Physiol 2008; 294:F812-820.
Finch CK, Kelley KW, Williams RB. Treatment of lithium-induced diabetes insipidus with amiloride. Pharmacotherapy 2003; 23:546-550.
Schou M, Amdisen A, Thomsen K, Vestergaard P, Hetmar O, Mellerup ET et al. Lithium treatment regimen and renal water handling: The significance of dosage pattern and tablet type examined through comparison of results from two clinics with different treatment regimens. Psychopharmacology 1982; 77:387-390.
Plenge P, Mellerup ET. Lithium and the kidney: Is one daily dose better than two? Compr Psychiatry 1986; 27:336-342.
O'Donovan C, Hawkes J, Bowen R. Effect of lithium dosing schedule on urinary output. Acta Psychiatr Scand 1993; 87:92-95.
Abraham G, Waldron JJ, Lawson JS. Are the renal effects of lithium modified by frequency of administration? Acta Psychiatr Scand 1995; 92:115-118.
Povlsen UJ, Hetmar O, Ladefoged J, Bolwig TG. Kidney functioning during lithium treatment: A prospective study of patients treated with lithium for up to ten years. Acta Psychiatr Scand 1992; 85:56-60.
Lepkifker E, Sverdlik A, Iancu I, Ziv R, Segev S, Kotler M. Renal insufficiency in long- term lithium treatment. J Clin Psychiatry 2004; 65:850-856.
Markowitz GS, Radhakrishnan J, Kambham N, Valeri AM, Hines WH, D'Agati VD. Lithium nephrotoxicity: A progressive combined glomerular and tubulointerstitial nephropathy. J Am Soc Nephrol 2000; 11:1439-1448.
Presne C, Fakhouri F, Noel L, Stengel B, Even C, Kreis H et al. Lithium-induced nephropathy: Rate of progression and prognostic factors. Kidney Int 2003; 64:585- 592.
Gitlin MJ. Lithium-induced renal insufficiency. J Clin Psychopharmacol 1993; 13:276
Hansen HE, Amdisen A. Lithium intoxication. (report of 23 cases and review of 100 cases from the literature). Q J Med 1978; 47:123-144.
Kehoe RF. A cross-sectional study of glomerular function in 740 unselected lithium patients. Acta Psychiatr Scand 1994; 89:68-71.
Schou M, Hansen HE, Thomsen K, Vestergaard P. Lithium treatment in Aarhus. 2. Risk of renal failure and of intoxication. Pharmacopsychiatry 1989; 22:101-103.
Harvey NS, Merriman S. Review of clinically important drug interactions with lithium. Drug Saf 1994; 10:455-463.
DasGupta K, Jefferson JW. The use of lithium in the medically ill. Gen Hosp Psychiatry 1990; 12:83-97.
Schou M. Forty years of lithium treatment. Arch Gen Psychiatry 1997; 54:9-13.
Tunalı D, Yazıcı O, Alagöl F, Oğuz H, Tanakol R. Lityumun tiroid işlevlerine etkisi. NöroPsikiyatri Arşivi 1998; 35:113-119.
Eşel E, Sofuoğlu S, Gönül AS, Turan MT, Baştürk M, Tutuş A ve ark. Bipolar hastalarda kısa ve uzun süreli lityum tedavisinin tiroid hormonları üzerin etkisi. Türk Psikiyatri Derg 2001; 12:195-202.
Turan MT, Eşel E, Tutuş A, Sofuoğlu S, Gönül AS. Bipolar bozukluğu olan hastalarda lityumun yol açtığı parathormon fonksiyon değişiklikleri. Klinik Psikofarmakoloji Bül- teni 2001; 11:96-100.
Turan MT, Eşel E, Tokgöz B, Aslan SS, Sofuoğlu S, Utaş C. İki uçlu duygudurum bo- zukluklu hastalarda kısa ve uzun süreli lityum tedavisinin böbrek fonksiyonları üzeri- ne etkisi. Klinik Psikofarmakoloji Bülteni 2001; 11:149-154.

ISSN: 1309-0658
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 2009
Yayıncı: Psikiyatride Güncel Yaklaşımlar

Arşiv