Drugs employed in the treatment of alcoholism: rat data suggest they are unnecessarily severe

A tacit assumption, which has often been made by practitioners of both chemical aversion therapy (CAT) and deterrent therapy of alcoholism, is that efficacy of a drug depends mainly on how noxious it is. We conducted two experiments which challenge this assumption. These experiments compared five noxious drugs employed in the treatment of alcoholism, with lithium, in regard to their ability to reduce rats' drinking of a familiar, readily consumed, ethanol (10% v/v) solution. In both experiments, the dose of lithium was equivalent, in terms of body weight, to the largest daily recommended human dose: the dose of each of the five, noxious drugs was twice this equivalent. In the first experiment, the CAT drugs emetine, ipecac and succinylcholine were compared with lithium: in the second, the deterrent therapy drugs citrated calcium carbimide and disulfiram were compared. Despite the use of comparatively smaller doses of lithium, none of the noxious drugs administered in either experiment produced stronger ethanol aversions than lithium. This supports the use of lithium in CAT, and suggests that unnecessarily noxious drugs are being used in the treatment of alcoholism.     

Lithium therapy for mania and depression

The literature on lithium carbonate was reviewed for clues to the processes involved in mania. Lithium has proved effective therapeutically and prophylactically for mania and depressive disorders. Children and adolescents as well as adults tolerate lithium well. Side effects rarely are serious enough to necessitate having lithium therapy. Some success with schizophrenia and schizoaffective disorders has broadened the scope of lithium's therapeutic efficacy but also blunted the expectation for a direct relationship between lithium and the processes involved in mania. Research points to neurotransmitters as contributing to the etiology and symptom pattern of mania.     

Chemical aversion treatment of alcoholism: Lithium as the aversive agent

Animal work indicating flavour aversion produced by chemical aversion therapy (CAT) with lithium might be effective in the treatment of alcoholism led to this treatment being given to 25 patients. The abstinence rate six months later of 36% was significantly better than the 12% rate for an equivalent group of patients, treated with a disulfuram-like drinking deterrent, calcium carbimide. The rate for the CAT group improves to 47% if 8 patients are excluded who did not develop sickness reactions to lithium. CAT with lithium appears safe given proper medical precautions.     

The "good enough" mood stabilizer: a review of the clinical evidence

A growing family of medications is used for mood stabilization in bipolar disorder. These medications fall into two broad categories according to likely mechanisms of action. Within the categories, specific drugs may vary in their efficacy for different phases of the disorder. The first category, including lithium, anticonvulsants, and some novel treatments, appears to have mechanisms related to intracellular second messengers. These medications have more pronounced antimanic than antidepressant effects, except for lamotrigine, which has antidepressant effects without precipitating mania. The second group of mood stabilizers is the atypical antipsychotics, which act through dopamine and other monoamines. Olanzapine and in all likelihood other drugs in the class possess marked, acute antimanic properties and possible antidepressant properties, but require further study before they can be used as routine options in long-term care. It is clear that the advent of multiple mood stabilizer candidates has not yet led to a single ideal therapy for bipolar disorder, but rather to options that can be flexibly tailored to the lifetime needs of individual patients, in sequences or combinations, and perhaps in conjunction with other classes of psychotropics.     

New applications of lithium therapy

Several placebo-controlled double-blind studies have indicated that lithium sometimes augments antidepressants, converting nonresponding patients to responders. Lithium therapy has also benefitted some schizoaffective patients and some alcoholics. Side effects are minimal. Mechanisms involved in lithium's effectiveness have not yet been discovered.     

Therapieresistente Depression bei älteren Patienten

Antidepressive monotherapy using selective serotonin reuptake inhibitors leads to satisfactory remission in the first 4 weeks of therapy in only 40?% of clearly depressive patients. After unsatisfactory therapy with serotonin reuptake inhibitors the change to dual antidepressants is most common. An unsatisfactory response also to this second attempt at therapy is referred to as therapy resistance. Therapy resistant depression can necessitate changing to other antidepressants, such as classical cyclic antidepressants. Therapy attempts with atypical antidepressants, such as buproprion or mirtazapin or monotherapy with a monoamine oxidase inhibitor can be carried out; however, success of therapy in severely depressive patients still remains unsatisfactory in at least 20?% of cases even after several pharmacological approaches and even after psychotherapy or augmentation strategies (e.g. lithium and antipsychotics). It is less probable that bipolar depression will respond to antidepressive therapy than recurrent unipolar depression.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

Seasonally-related inpatient admission of affective patients

Over a period of four years, 316 emotionally disordered patients were inspected for the frequency of seasonally conditioned hospitalisation, considering however solely the most recent prior hospitalisation within the four-year period. A cautious interpretation of the results would suggest significant differences in the seasonal frequency of emotional disorders that have resulted in hospitalisation. Manic depressive disorders, endogenous depression, and involutional depressions treated in hospital occur with the greatest frequency in autumn. These results suggest the possibility of employing thymoleptic treatment, notably to effect an influence on biorhythms, for instance, lithium, deprivation of sleep, and bright-light therapy.     

Ten commandments for long-term maintenance of acceptable self-help skills for persons who are hard-core stutterers

Hard-core stutterers require long-term self-help maintenance skills. In spite of how successful the laboratory achievement of fluency skills is, it is inevitable that some stuttering either remains or returns after termination of therapy. Most successful programs develop self-help skills so that the severe stutterer can continue to generate acceptable speech. This maintenance program is intended to complement any therapy and integrates the stutterers self-help skills into his or her life-style.     

A flavor paired with lithium chloride blocks the formation of a pentobarbital-lithium chloride association

Thirsty rats were used in order to determine whether a vinegar solution, which had been paired with an injection of lithium chloride, could block the formation of an association between a pentobarbital- and a lithium chloride-induced state. During phase 1 the rats in the blocking group had a 2.0% vinegar solution paired with an injection of 240 mg/kg of lithium chloride, during phase 2 these rats were reexposed to the vinegar prior to each injection of 20 mg/kg of pentobarbital and 240 mg/kg of lithium chloride, and during phase 3 these rats were given access to a novel 0.75% saccharin solution and were injected with pentobarbital after saccharin removal. Animals with this history did not form an association between the pentobarbital- and lithium chloride-induced states during phase 2 as evidenced by their refusal to consume the saccharin solution over repeated pairings of saccharin with pentobarbital during phase 3. Control groups that received forward pairings of pentobarbital and lithium chloride, in the absence of a previously conditioned vinegar solution during phase 2, formed an association between pentobarbital and lithium chloride. These findings indicate that drug states and flavors can interfere with each others' capacity to predict the occurrence of lithium chloride.     

Commentary on “Trauma to the Psyche and Soma”

This case report addresses assessment and treatment considerations for a patient suffering from posttraumatic stress disorder (PTSD) in the context of mild traumatic brain injury and ongoing pain. Management of this case is based on the application of evidence-based therapy, and of cognitive behaviour therapy, for PTSD reduction. Assessment and treatment approaches recognize that delivery of treatment requires modification to allow exposure therapy for individuals who are partially amnesic of their traumatic experience. Further, administering exposure and cognitive therapy for patients with cognitive impairment requires specific means of treatment delivery to allow adequate compliance with therapy tasks. This case highlights that evidence-based approaches can be usefully applied to complex presentations but they may require modifications that recognize obstacles associated with comorbid conditions.     

Mediated conditioning and retrospective revaluation with LiCl then flavour pairings

It is becoming accepted that the associative strength of a cue can change in its absence, despite this being difficult to explain using existing theories of Pavlovian conditioning. To investigate the influence of timing on learning about the representation of an absent cue, lithium chloride (LiCl) or a flavour previously paired with LiCl was presented in a distinctive context that had previously been paired with a neutral target flavour. The former treatment produced an aversion to the target flavour whether the LiCl was presented 10 min before, or immediately after, exposure to the context. However, presenting the flavour associate of LiCl created an aversion to the target flavour only if it had been presented 10 min after LiCl during initial training. This pattern of results cannot be explained in the terms of a simple timing account, and it is proposed that an explanation will require different associative rules operating in simultaneous and successive training schedules.     

On the need for structurally competent counselling and psychotherapy: Neoliberal ideology,disability and the psy disciplines

This article highlights and problematises the psy disciplines' articulations with neoliberalism, with a particular focus upon disability and upon counselling and psychotherapy. Recent years have witnessed burgeoning scholarly interest in the potential complicities of the psy professions in a neoliberal agenda of individualisation, pathologisation and responsibilisation of human suffering. Such complicities are, in state therapy settings, driven by a growing need for these professions to offer cost-effective, evidence-based interventions to secure funding in an increasingly competitive market. Whilst the entwining of neoliberal ideology with therapy practices may be innocuous for some, it is contended that disabled people may be at particular risk of harm. A case is then made for training and practice to foreground structural competency, an awareness of how therapy encounters and client concerns are shaped by socio-structural factors, including, but not limited to, politics and political ideology. This would require not only an appreciation of the sociopolitical context in which therapy unfolds and its indubitable shaping of subjectivities, but also greater recognition of disability as a source of social inequity and oppression, as opposed to an individual phenomenon. Moreover, structural competency would require theoretical and demographic diversity in training and practice, which, in turn, would necessitate identifying and addressing barriers to inclusion for disabled people. Points raised are deemed of particular importance given the emergence of long COVID.     

Determination of lithium in serum and saliva of patients with manic-depressive disorder

The slight therapeutic breadth involved means that manic depressive lithium prophylaxis may call for life-long routine management. The lithium/serum-level checks required hitherto are here compared with a non-invasive method, that of determining the lithium level from a mixture of the patient's saliva, a method involving no danger that will eventually assume considerable importance.     

Flavor aversions produced by contingent drug injection: Relative effectiveness of apomorphine, emetine, and lithium

Shortly after rats began drinking saccharin solution, different groups of them were injected with different doses of apomorphine, emetine, or lithium. A control group was not injected at all. Six days later, the rats were given free access to saccharin solution and to water. Aversions to saccharin solution were obtained in all injected groups and tended to become more pronounced as the dose level increased. At similar dose levels, lithium produced the most pronounced aversions, apomorphine produced the weakest aversions, and emetine was intermediate. A follow-up study with squirrel monkeys confirmed that lithium produces more pronounced aversions than either emetine or apomorphine. From these results, it seems worthwhile to try lithium in the chemical aversion treatment of alcoholism.     

The Class Method in the treatment of Psychotic Patients

Contrary to traditional thinking, a review of the recent literature has suggested that bipolar patients can be treated in homogeneous therapy groups in conjunction with concomitant lithium management. Important psychodynamic and interpersonal features are reviewed that have received empirical support and have enhanced our understanding of these patients. Goals for bipolar groups include educating patients on the nature of the disease, helping them learn ways of coping with its symptoms, and encouraging them to discuss relevant psychodynamic and interpersonal issues. To achieve these goals, therapists have used techniques involving education, support, and facilitation of group discussions. Further clinical and empirical work needs to be done to evaluate the effectiveness and process of these bipolar groups, particularly in the inpatient setting.     

Suicidal behavior and prophylactic lithium treatment of major mood disorders: a review of reviews

This paper briefly summarizes and discusses at length two recent reviews. Their main findings were the following: (1) During prophylactic lithium treatment the overall mortality of patients with major mood disorders was much lower than in such patients in general. (2) The frequency of suicidal acts was many times lower in patients on lithium than in patients not on lithium. The limitations of the studies reviewed and the difficulty of interpreting their findings are discussed. It is concluded that prophylactic lithium treatment is indicated in patients with major mood disorders who are at high risk of committing suicide, that is, those with severe depressions or depressions with persistent suicidal thoughts or with suicide attempts in the past.     

Psychoanalysis and Family Systems Revisited: the Old,Old Story?

This paper explores some commonalities in the current state of psychoanalysis and family therapy in Britain. It argues that there have been social changes within Britain that have increased the popularity of the practices and concepts of psychotherapy and counselling. The methods and ideas of psychoanalysis seem to be the major influence in this process which is manifest, for the most part, within private therapy and counselling and in the universities. It appears that family therapists and the institutes of psychoanalysis act as if unaware of this pragmatic acceptance of psychoanalytic thinking. The two disciplines of family therapy and psychoanalysis remain organizationally and conceptually disassociated from each other despite the two subjects having considerable overlap, plying adjacent trades and using theoretical ideas which show considerable parallels. The paper proposes that postmodern thinking is, potentially, an evolving link between the two forms of thinking and therapy but that the theories of both psychoanalysis and family therapy require empirical evaluation.     

Commentary on reviews of “outcome” studies of family and marital psychotherapy

Reviews of the outcome literature in family and marital therapy are critically evaluated. The literature is equivocal in regard to the effectiveness of family therapy, particularly in comparison to alternative forms of treatment, so that statements to the effect that family therapy has demonstrated its general efficacy would not appear to be justified. Problems are identified which require solution before the efficacy of family therapy can be demonstrated.Paper presented at the 45th annual conference of the American Association for Marriage and Family Therapy, Chicago, Illinois, October 31, 1987.     

Na+,K(+)-ATPase activity is reduced in hippocampus of rats submitted to an experimental model of depression: effect of chronic lithium treatment and possible involvement in learning deficits

This study was undertaken to verify the effects of chronic stress and lithium treatments on the hippocampal Na+,K(+)-ATPase activity of rats, as well as to investigate the effects of stress interruption and post-stress lithium treatment on this enzyme activity and on spatial memory. Two experiments were carried out; in the first experiment, adult male Wistar rats were divided into two groups: control and submitted to a chronic variate stress paradigm, and subdivided into treated or not with LiCl. After 40 days of treatment, rats were killed, and Na+,K(+)-ATPase activity was determined. In the second experiment, rats were stressed during 40 days, and their performance was evaluated in the Water Maze task. The stressed group was then subdivided into four groups, with continued or interrupted stress treatment and treated or not with lithium for 30 additional days. After a second evaluation of performance in the Water Maze, rats were killed and Na+,K(+)-ATPase activity was also measured. Results showed an impairment in Na+,K(+)-ATPase activity and in Water Maze performance of chronically stressed rats, which were prevented by lithium treatment and reversed by lithium treatment and by stress interruption. These results suggest that the modulation of Na+,K(+)-ATPase activity may be one of the mechanisms of action of lithium in the treatment of mood disorders.