Objective

Lithium is the mainstay for bipolar disorder (BD) treatment in adults, but evidence in youths is limited. We used data from the Course and Outcome of Bipolar Youth (COBY) study to assess whether lithium vs other mood-stabilizing medication (OMS) was associated with improved outcomes, including mood symptoms and suicidality.

Method

COBY is a naturalistic, longitudinal study of 413 youths, 7 to 17.11 years old at intake, with BD. At each visit, medication exposure, psychiatric symptoms, and psychosocial function over the preceding follow-up period were assessed using the Adolescent Longitudinal Interval Follow-Up Evaluation. Using mixed models, we determined whether participants taking lithium vs OMS (but not lithium) differed regarding mood symptoms, suicidality, psychosocial function, hospitalization, aggression, and substance use.

Results

A total of 340 participants contributed 2,638 six-month follow-up periods (886 lithium, 1,752 OMS), over a mean follow-up of 10 years. During lithium (vs OMS) follow-up periods, participants were older, less likely to have lifetime anxiety, and less likely to be on antidepressants (p values<.005). After covariate adjustment, the lithium group (vs OMS) had half as many suicide attempts (p = .03), fewer depressive symptoms (p = .004), less psychosocial impairment (p = .003), and less aggression (p = .0004). Similar findings were observed in the subgroup of follow-up periods in which participants were <18 years old.

Conclusion

Findings are consistent with adult studies, showing that lithium is associated with decreased suicidality, less depression, and better psychosocial functioning. Given the paucity of evidence regarding lithium in children and adolescents, these findings have important clinical implications for the pharmacological management of youths with BD.

中文翻译：

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锂与其他情绪稳定药物在一项对被诊断患有双相情感障碍的青年的纵向研究中的比较。

客观的

锂是成人双相情感障碍 (BD) 治疗的主要药物，但在年轻人中的证据有限。我们使用来自双相青年的课程和结果 (COBY) 研究的数据来评估锂与其他情绪稳定药物 (OMS) 是否与改善的结果有关，包括情绪症状和自杀倾向。

方法

COBY 是一项自然主义的纵向研究，对 413 名 7 至 17.11 岁的 BD 青年进行了研究。在每次就诊时，使用青少年纵向间隔随访评估评估前一随访期间的药物暴露、精神症状和社会心理功能。使用混合模型，我们确定服用锂盐的参与者与服用 OMS（但不服用锂盐）的参与者在情绪症状、自杀倾向、社会心理功能、住院治疗、攻击性和物质使用方面是否存在差异。

结果

共有 340 名参与者参与了 2,638 次六个月的随访（886 次锂离子治疗，1,752 次 OMS），平均随访时间为 10 年。在锂 (vs OMS) 随访期间，参与者年龄较大，不太可能有终生焦虑症，也不太可能服用抗抑郁药（p值 <.005）。协变量调整后，锂剂组（与 OMS 相比）的自杀企图 减少了一半 ( p = .03)、抑郁症状更少 ( p  = .004)、心理社会障碍更少 ( p  = .003) 和攻击性更少 ( p  = .0004）。在参与者年龄小于 18 岁的随访期亚组中也观察到了类似的结果。

结论

结果与成人研究一致，表明锂与自杀率降低、抑郁症减少和社会心理功能更好有关。鉴于缺乏关于儿童和青少年锂的证据，这些发现对青少年 BD 的药物管理具有重要的临床意义。