Table 2.
Reasons for lithium discontinuation
| 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) |
n number, BPAD bipolar affective disorder, SZD schizoaffective disorder, Other unspecified or otherwise specified bipolar affective disorder, DI diabetes insipidus
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