3/1/10 1:10 PMPsycARTICLES - Effects of Lithium Carbonate on the Memory and Motor Speed of Bipolar OutpatientsPage 3 of 13http://psycnet.apa.org/index.cfm?fa=fulltext.printArticle&jcode=abn&vol=96&issue=1&format=HTML&page=64&language=eng
Previous studies have also attempted to document the effect of lithium on the visual-motor skills of patientand normal populations (Demers & Henninger, 1971 ; Judd et al., 1979 ; Squire, Judd, Janowsky, & Huey,1980). These investigations have concentrated almost exclusively on the deleterious effects of lithium onDigit Symbol subtest performance, and their findings have been hampered by methodological concernssimilar to those mentioned previously. In addition, the mixed nature of the neuropsychological functions thatcontribute to Digit Symbol performance make it difficult to interpret the source of these findings. Lithium'seffect may have been on motor speed, information-processing speed, short-term retrieval, or a combinationof functions that contribute to test performance.
Twenty-eight outpatients with major affective disorders who had been maintained on lithium prophylaxisparticipated. Informed consent was obtained after a discussion of the procedures. Twenty-two patients (12males, 10 females) completed the protocol; 6 were eliminated due to significant mood change thatthreatened their remitted status. Twenty of these patients had a Bipolar Disorder, predominantly Manic, 1had a Recurrent Depressive Disorder, and 1 had a Bipolar Disorder, Mixed, according to the criteria of thethird edition of the
Diagnostic and Statistical Manual of Mental Disorders
(American Psychiatric Association,1980). Patients had been maintained on lithium for a mean period of 9.4 (
= 5.8) years with a rangefrom 1 to 20 years, at a mean lifetime level of 0.80 (
= 0.23) millimoles per liter (mmol/l) with a rangefrom 0.40 to 1.20 mmol/l. Their mean age was 51.2 (
= 15.5) years with a range from 29 to 77 years.Patients had been hospitalized an average of 1.7 times during their lifetimes with a range from 0 to 9 times.Seven of these 22 patients were on medications in addition to lithium. None had had electroconvulsivetherapy within the last 9 years.Because of the potential risk of the placebo period, an effort was made to include only patients with alengthy history of psychiatric stability, without predictable psychosocial stressors during the evaluation, andwho had previously been off lithium without relapse for at least 3 weeks. Patients with a history of suicideattempts, violence, or other potentially damaging consequences to themselves or others were alsodiscouraged from participation.
Motor speed was measured by the use of the Finger Oscillation, or Tapping, Test (Halstead, 1947), the mostwidely used test of manual dexterity (Lezak, 1983 , p. 520). Subjects tapped a telegraph-like metered key(distributed by the Neuropsychology Laboratory of Ralph Reitan) for five 10-s trials, with a brief restbetween trials, starting with their dominant hand. The score for each hand was the average of the five trials.Dodril and Troupin (1975) demonstrated the test's sensitivity to variations in levels of medication such asdiphenyl-hydantonin (Dilantin) and its relative immunity from repeated measures practice effects.Memory was evaluated using the selective reminding protocol (Buschke, 1973 ; Buschke & Fuld, 1974). Thisprocedure for assessing verbal learning and memory has been widely used in repeated measures and otherdesigns to evaluate response to various drugs and therapies (Mohs, Davis, & Leverey, 1981 ; Yesavage,