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PsycARTICLES - Effects of Lithium Carbonate on the Memory and Motor Speed of Bipolar Outpatients

PsycARTICLES - Effects of Lithium Carbonate on the Memory and Motor Speed of Bipolar Outpatients

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Lithium has negative effects on both motor speed and memory recall by affecting the sodium pumps of the body.
Lithium has negative effects on both motor speed and memory recall by affecting the sodium pumps of the body.

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Published by: dr_finch511 on Mar 11, 2010
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3/1/10 1:10 PMPsycARTICLES - Effects of Lithium Carbonate on the Memory and Motor Speed of Bipolar OutpatientsPage 1 of 13http://psycnet.apa.org/index.cfm?fa=fulltext.printArticle&jcode=abn&vol=96&issue=1&format=HTML&page=64&language=eng
Journal of Abnormal PsychologyFebruary 1987, Vol. 96, No. 1, 64–69
Effects of Lithium Carbonate on the Memoryand Motor Speed of Bipolar Outpatients
Eric D. Shaw, Peter E. Stokes, J. John Mann, Alan Z. A. Manevitz
AUTHOR AFFILIATIONS
Eric D. ShawPayne Whitney Clinic,Department of Psychiatry, New YorkHospital-Cornell MedicalCenter, New York, NewYorkPeter E. StokesPayne Whitney Clinic,Department of Psychiatry, New YorkHospital-Cornell MedicalCenter, New York, NewYorkJ. John MannPayne Whitney Clinic,Department of Psychiatry, New YorkHospital-Cornell MedicalCenter, New York, NewYorkAlan Z. A. ManevitzPayne Whitney Clinic,Department of Psychiatry, New YorkHospital-Cornell MedicalCenter, New York, New
 
3/1/10 1:10 PMPsycARTICLES - Effects of Lithium Carbonate on the Memory and Motor Speed of Bipolar OutpatientsPage 2 of 13http://psycnet.apa.org/index.cfm?fa=fulltext.printArticle&jcode=abn&vol=96&issue=1&format=HTML&page=64&language=eng
Abstract
York
© 1987 American Psychological Association
CITATION
Shaw, E. D., Stokes, P. E., Mann, J. J., & Manevitz, A. Z. (1987). Effects of lithium carbonate on the memory andmotor speed of bipolar outpatients.
 Journal of Abnormal Psychology 
,
96
, 64-69. doi: 10.1037/0021-843X.96.1.64
doi:
10.1037/0021-843X.96.1.64
 
We examined the effect of lithium on the memory and motor speed of 22 outpatients with affective disordersin remission. Patients were assessed weekly over a 5-week period starting at their current lithium dosage,twice during administration of a blind placebo, and twice after their lithium was blindly reinstated. Motorspeed was assessed using the finger tapping test. Memory was assessed using the Buschke selectivereminding protocol. Mood was assessed at each session to ensure remitted status by clinical interview, theHamilton Rating Scale for Depression, the Longitudinal Rating of Manic States Scale, and a subjective statequestionnaire. Weekly blood samples were also drawn to assess plasma lithium level by means of atomicabsorption spectrophotometry. The results indicated that lithium had a significant detrimental effect onmemory and motor speed: Performance improved when lithium was discontinued and declined when lithiumwas reintroduced. The implications for patient management and diagnosis in bipolar disorder are discussed. Memory impairment has been reported anecdotally as the leading side-effect complaint of patients withaffective disorders on lithium prophylaxis (McCreadie & Morrison, 1985) and the primary reason why thesepatients discontinue treatment (Jamison & Akiskal, 1983). As with memory, other neuropsychological sideeffects of lithium treatment, such as problems with concentration and coordination, have been reportedanecdotally (Jamison & Akiskal, 1983), but experimental investigations of their existence have yieldedequivocal results. Experimental demonstration of lithium's specific neuropsychological side effects would haveimplications for patient diagnosis, psychoeducation, compliance, and management and might also lead tofurther understanding of the therapeutic mechanisms associated with lithium's prophylactic efficacy.A number of authors have noted the detrimental effects of lithium on the verbal memory of normalvolunteers (Judd, Hubbard, Janowsky, Huey, & Takanashi, 1979 ; Karinol, Dalton, & Lader, 1978 ; Kropf & Muller-Oerlinghausen, 1979) and psychiatric patients (Christodoulou, Kokkevi, Lykouras, Stefanis, & Papadimitrou, 1981 ; Reus, Targum, Weingartner, & Post, 1979). Their consistent findings suggest thatlithium either inhibits the efficiency of transfer of verbal material from short-term to long-term storage orthe efficiency of retrieval of this material from long-term storage. Methodological challenges to these findingsincluded heterogenous clinical populations often diagnosed by uncertain criteria, wide variations in patientages and lithium levels, and the use of questionable control groups. The most serious methodological concernin this research has been the affective stability of patient groups assessed on and off lithium. The failure of reserchers to control for affective state has confounded positive results linking lithium level to memorydifficulties and prevented a clearer understanding of the nature of the memory impairment.
 
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
Method
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.
 
Subjects
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 (
SD
= 5.8) years with a rangefrom 1 to 20 years, at a mean lifetime level of 0.80 (
SD
= 0.23) millimoles per liter (mmol/l) with a rangefrom 0.40 to 1.20 mmol/l. Their mean age was 51.2 (
SD
= 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.
Measures
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, 

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