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Table 2 Reasons for lithium discontinuation

From: Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study

 

Total, n (%)

Type of disorder, n (%)

Agent, na (%)

 

BPAD 1/SZD

BPAD2/ Other

Doctor

Patient

Episodes, n

561

253

308

225

334

Psychiatric reasons

 Total

249 (44.4)

97 (38.3)

152 (49.4)**

81 (36.0)

167 (50.0)**

 Non-adherence

121 (21.6)

65 (25.7)

56 (18.2)*

26 (11.6)

95 (28.4)***

  Fear for adverse effects

17 (3.0)

6 (2.4)

11 (3.6)

2 (0.9)

15 (4.5)*

  Not agreeing with diagnosis

6 (1.1)

5 (2.0)

1 (0.3)

0 (0)

6 (1.8)*

  Refusing medication

34 (6.1)

23 (9.1)

11 (3.6)**

0 (0)

34 (10.2)***

  Feeling subjectively well

26 (4.6)

12 (4.7)

14 (4.5)

0 (0)

26 (7.8)***

  Not adhering to monitoring

38 (6.8)

19 (7.5)

19 (6.2)

24 (10.7)

14 (4.2)**

 Perceived or actual lack of effectiveness

116 (20.7)

25 (9.9)

91 (29.5)***

46 (20.4)

69 (20.7)

 Intentional Li intoxication

5 (0.9)

0 (0)

5 (1.6)*

5 (2.2)

0 (0)**

 Other reasonsb

22 (3.9)

13 (5.1)

9 (2.9)

11 (4.9)

11 (3.3)

Physical health reasons

 Total

68 (12.1)

36 (14.2)

31 (10.1)

53 (23.6)

17 (4.2)***

 Unintentional Li intoxication

11 (2.0)

6 (2.4)

5 (1.6)

10 (4.4)

1 (0.3)**

 Increase of Li concentration

30 (5.3)

19 (7.5)

11 (3.6)*

28 (12.4)

2 (0.6)***

 Pregnancy or planned pregnancy

15 (2.7)

5 (2.0)

10 (3.2)

5 (2.2)

10 (3.0)

 Physical health problemc

12 (2.1)

6 (2.4)

6 (1.9)

11 (4.9)

1 (0.3)***

Adverse effects

 Total

350 (62.4)

164 (64.8)

186 (60.4)

142 (63.1)

207 (62.0)

Kidneys and urinary tract

  Creatinine increase, Li-nephropathy

51 (9.1)

37 (14.6)

14 (4.5)***

44 (19.6)

7 (2.1)***

  Nephrogenic DI, polyuria, polydipsia

52 (9.3)

27 (10.7)

25 (8.1)

25 (11.1)

27 (8.1)

Endocrine system

 TSH increase, hypothyroidism

11 (2.0)

4 (1.6)

7 (2.3)

6 (2.7)

5 (1.5)

CNS

 Tremor

61 (10.9)

32 (12.6)

29 (9.4)

27 (12.0)

34 (10.2)

 Dizziness

12 (2.1)

4 (1.6)

8 (2.6)

6 (2.7)

6 (1.8)

 Headache

8 (1.4)

1 (0.4)

7 (2.3)

2 (0.9)

6 (1.8)

 Restless legs

5 (0.9)

2 (0.8)

3 (1.0)

2 (0.9)

3 (0.9)

Psychological adverse effects

 Emotional blunting

31 (5.5)

9 (3.6)

22 (7.1)

2 (0.9)

29 (8.7)***

 Irritability/anxiety

12 (2.1)

2 (0.8)

10 (3.2)*

4 (1.8)

8 (2.4)

 Other, not specified

20 (3.6)

7 (2.8)

13 (4.2)

5 (2.2)

15 (4.5)

Cognitive adverse effects

 Fatigue

30 (5.3)

11 (4.3)

19 (6.2)

13 (5.8)

17 (5.1)

 Imoaired concentration

17 (3.0)

3 (1.2)

14 (4.5)*

11 (4.9)

6 (1.8)*

 Impaired memory

8 (1.4)

1 (0.4)

7 (2.3)

6 (2.7)

2 (0.6)*

Gastrointestinal tract

 Diarrhoea

71 (12.7)

33 (13.0)

38 (12.3)

21 (9.3)

50 (15.0)*

 Nausea

24 (4.3)

6 (2.4)

18 (5.8)*

7 (3.1)

17 (5.1)

 Stomach ache

10 (1.8)

4 (1.6)

6 (1.9)

0 (0)

10 (3.0)**

 Other, not specified

7 (1.2)

2 (0.8)

5 (1.6)

2 (0.8)

5 (1.6)

Skin

 Psoriasis

10 (1.8)

6 (2.4)

4 (1.3)

6 (2.7)

4 (1.2)

 Acne

8 (1.4)

4 (1.6)

4 (1.3)

3 (1.3)

5 (1.5)

Other

 Weight gain

41 (7.3)

19 (7.5)

22 (7.1)

12 (5.3)

29 (8.7)

 Edema

19 (3.4)

10 (4.0)

9 (2.9)

8 (3.6)

10 (3.0)

 Muscle weakness

13 (2.3)

6 (2.4)

7 (2.3)

7 (3.1)

6 (1.8)

 Xerostomia

5 (0.9)

2 (0.8)

3 (1.0)

1 (0.4)

4 (1.2)

 Other adverse effectsb

64 (11.4)

29 (11.5)

35 (11.4)

27 (12.0)

37 (11.1)

  1. n number, BPAD bipolar affective disorder, SZD schizoaffective disorder, Other unspecified or otherwise specified bipolar affective disorder, DI diabetes insipidus
  2. an = 559, data missing in 2 (0.4%) episodes; bfrequency less than five episodes; ci.e. comorbidities as dementia, chronic heart failure, cancer, non-lithium related chronic kidney disease, *p < 0.05, **p < 0.01, ***p < 0.001