CLINICAL, LABORATORY AND NEUROLOGICAL ASSESSMENT OF LITHIUM TOXICITY IN PATIENTS WITH BIPOLAR DISORDERS.
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Keywords
Lithium toxicity, bipolar disorder, serum lithium levels, cognitive impairment, renal dysfunction, thyroid dysfunction, Montreal Cognitive Assessment (MoCA)
Abstract
Objective: This study aimed to evaluate the clinical, laboratory, and neurological outcomes of lithium toxicity in patients with bipolar disorder. The primary objective was to assess the severity and frequency of lithium toxicity symptoms in relation to serum lithium levels. Secondary objectives included examining the long-term effects on cognitive function, renal and thyroid health, and the correlation between toxicity severity and hospitalization rates.
Methods: This was a prospective cohort study conducted at Abbasi Shaheed Hospital Karachi, Pakistan from 1st January, 2023 to December 31st, 2023. A total of 120 patients with bipolar disorder on lithium therapy for at least six months were recruited, with 112 completing the study. Participants were assessed for toxicity severity, cognitive function using the Montreal Cognitive Assessment (MoCA), renal function (serum creatinine), and thyroid function (TSH). Outcomes were analyzed using SPSS 27.0, with statistical significance set at p < 0.05 and 95% confidence intervals reported.
Results: Of the 112 participants, 59.8% exhibited mild toxicity, 29.5% moderate toxicity, and 10.7% severe toxicity. Serum lithium levels were significantly associated with toxicity severity (p < 0.001). Cognitive impairments were more pronounced in the moderate and severe groups, with MoCA scores significantly lower (p < 0.01). Renal impairment was observed in 19.6% of participants, and 13.4% exhibited thyroid dysfunction. Severe toxicity cases had a longer mean hospital stay of 12.6 days compared to mild cases (p < 0.001).
Conclusion: Lithium toxicity in bipolar disorder patients is significantly associated with higher serum lithium levels, leading to cognitive, renal, and thyroid dysfunctions. These findings emphasize the importance of regular monitoring of lithium levels and organ function to prevent severe outcomes. This research supports the need for tailored lithium management strategies to improve patient safety and long-term treatment outcomes in clinical practice.
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