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A systematic review and meta-analysis of clinical predictors of lithium response in bipolar disorder

Hui, TP; Kandola, A; Shen, L; Lewis, G; Osborn, DPJ; Geddes, J; Hayes, JF; (2019) A systematic review and meta-analysis of clinical predictors of lithium response in bipolar disorder. Acta Psychiatrica Scandinavica 10.1111/acps.13062. (In press). Green open access

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Abstract

OBJECTIVE: To determine clinical predictors of lithium response in bipolar disorder. METHODS: Systematic review of studies examining clinical predictors of lithium response was conducted. Meta-analyses were performed when ≥2 studies examined the same potential predictor. RESULTS: A total of 71 studies, including over 12,000 patients, identified 6 predictors of good response: mania-depression-interval sequence (odds ratio (OR): 4.27; 95%CI: 2.61, 6.97; p<0.001), absence of rapid cycling (OR for rapid cycling: 0.30; 95%CI: 0.17, 0.53; p<0.001), absence of psychotic symptoms (OR for psychotic symptoms: 0.52; 95%CI: 0.34, 0.79; p=0.002), family history of bipolar disorder (OR: 1.61; 95%CI: 1.03, 2.52; p=0.036), shorter pre-lithium illness duration (standardized mean difference (SMD): -0.26; 95%CI: -0.41, -0.12; p<0.001), later age of onset (SMD: 0.17; 95%CI: 0.02, 0.36; p=0.029). Additionally, higher body mass index was associated with poor response in two studies (SMD: -0.61; 95%CI: -0.90, -0.32; p<0.001). There was weak evidence for number of episodes prior to lithium treatment (SMD: -0.42; 95%CI: -0.84, -0.01; p=0.046), number of hospitalisations before lithium (SMD: -0.40; 95%CI: -0.81, 0.01; p=0.055) and family history of lithium response (OR: 10.28.; 95%CI: 0.66, 161.26; p=0.097). CONCLUSIONS: The relative importance of these clinical characteristics should be interpreted with caution due to potential biases and confounding. This article is protected by copyright.

Type: Article
Title: A systematic review and meta-analysis of clinical predictors of lithium response in bipolar disorder
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/acps.13062
Publisher version: https://doi.org/10.1111/acps.13062
Language: English
Additional information: © 2019 The Authors Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/).
Keywords: bipolar disorder, clinical aspects, lithium
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10077668
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