Handbook of Lithium Therapy, 1980

As a medical student in the 1930s, I remember well that a very clear line of distinction was drawn between physical illness and mental illness. Physical illness resulted from pathology which could be identified and studied in detail and the cause could often be deduced. Treatment thus was often specific and based upon a proper appreciation of underlying basic science. Mental illness, on the other hand, could not, it was believed, be based upon identifiable changes in basic science. It was literally 'all in the mind' and, occurring in the absence of causes that could be identified, analysed and remedied, had no treatment that could in any way be called specific. N ow it is all too easy, in Medicine, for a doctor to become so immersed in a specialty that he fails to notice how his colleagues in other specialties are faring and, through laziness, to miss advances even of fundamental importance in fields other than those in which he himself works. As a consultant surgeon, after W orId War II, although I realized the importance of keeping in touch with those medical specialties which appeared to have a common interface with my own surgical interests, such as general medi­ cine, gastro-enterology, hepatology and endocrinology, it did not occur to me that there was any pressing need to ask what was new in Psychological Medicine.

I Introduction.- 1 The place of lithium in biological psychiatry.- II The clinical uses of lithium.- 2 Lithium in the acute treatment of mania.- 3 Lithium in the acute treatment of depression.- 4 Lithium in the prophylactic treatment of recurrent affective disorders.- 5 Special cases of affective disorder and their treatment with lithium.- 6 Inappropriate use of lithium in the treatment of reactive depressive cycles.- 7 Lithium therapy in combination with other forms of treatment.- 8 The psychiatric uses of lithium outside manic-depressive illness.- 9 The range of non-psychiatric uses of lithium.- 10 The relative efficacies of lithium and alternative modes of treatment.- III Factors determining therapeutic outcome.- 11 Acceptance of lithium therapy by the patient.- 12 Rejection of lithium maintenance therapy by the patient.- 13 Recurrences of manic-depressive episodes during lithium treatment.- 14 Predicting lithium responders and non-responders: physiological indicators.- 15 Predicting lithium responders and non-responders: psychological indicators.- 16 Predicting lithium responders and non-responders: illness indicators.- 17 Predicting lithium responders and non-responders: familial indicators..- 18 Lithium non-responders and their treatment.- IV The routine of lithium therapy.- 19 The context of lithium therapy.- 20 Physiological functions monitored in association with lithium therapy.- 21 Monitoring lithium dose levels: estimation of lithium in blood.- 22 Monitoring lithium dose levels: clinical aspects of serum lithium estimation.- 23 Monitoring lithium dose levels: estimation of lithium in urine.- 24 Monitoring lithium dose levels: estimation of lithium in saliva.- 25 Atomic spectrometric methods and techniques for the determination of lithium in biological materials: fundamental principles and recent advances.- 26 Requirements of an ideal lithium preparation.- 27 The choice of an appropriate lithium preparation.- 28 Lithium preparations currently available.- 29 Minimum serum lithium levels for effective prophylaxis.- 30 Social and psychological supportive measures during lithium therapy.- 31 Terminating lithium treatment.- V Contra-indications, side-effects and toxicity.- 32 Absolute and relative contra-indications to lithium treatment.- 33 The pattern of lithium side-effects and toxic reactions in the course of lithium therapy.- 34 Neural and neuromuscular side-effects of lithium.- 35 Endocrine side-effects of lithium.- 36 Cardiovascular side-effects of lithium.- 37 Haematological side-effects of lithium.- 38 Renal side-effects of lithium.- 39 Electrolyte and water balance side-effects of lithium.- 40 Bone side-effects of lithium.- 41 Cutaneous side-effects of lithium.- 42 Social and psychological implications of lithium.- 43 Immunological side-effects of lithium.- 44 Side-effects: miscellaneous.- 45 The recognition and management of lithium intoxication.- VI Special groups of patients.- 46 Lithium treatment of children and adolescents.- 47 Lithium treatment of the elderly.- 48 Lithium treatment of women during pregnancy and in the post-delivery period.- VII Sources of information about lithium therapy.- 49 Searching the lithium literature.- 50 A survey of books about lithium.