Lithium for schizophrenia revisited: A systematic review and meta-analysis of randomized controlled trials

Leucht, S., Kissling, W. and McGrath, J. (2004) Lithium for schizophrenia revisited: A systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Psychiatry, 65 2: 177-186. doi:10.4088/JCP.v65n0206


Author Leucht, S.
Kissling, W.
McGrath, J.
Title Lithium for schizophrenia revisited: A systematic review and meta-analysis of randomized controlled trials
Journal name Journal of Clinical Psychiatry   Check publisher's open access policy
ISSN 0160-6689
Publication date 2004-01-01
Sub-type Article (original research)
DOI 10.4088/JCP.v65n0206
Volume 65
Issue 2
Start page 177
End page 186
Total pages 10
Editor J. S. Shelton
M. M. Waters
Place of publication USA
Publisher Physicians Postgraduate Press Inc
Collection year 2004
Language eng
Subject C1
321021 Psychiatry
730211 Mental health
Abstract Background: Clinicians frequently use lithium to augment antipsychotic medication in schizophrenia. Therefore, we undertook a systematic review and meta-analysis of the use of lithium in the treatment of schizophrenia. Data sources and study selection: Randomized controlled trials examining lithium (as a sole or an adjunctive compound) in participants with schizophrenia or related disorders were searched in the register of the Cochrane Schizophrenia Group. No language restrictions were applied. The Boolean phrase [lithium* or lithicarb or eskalith or lithobid or lithane or cibalith-s or quilonum or hypnorex] was used to locate articles. The search strategy initially identified 90 references. The authors of the included studies were contacted to obtain original patient data. The data were combined in a meta-analysis. The main outcome parameters were the number of patients with a clinically significant response and the number of patients leaving the studies early. Results: The meta-analysis includes 20 studies (N = 611). The evidence shows that lithium as a sole agent is ineffective in the treatment of schizophrenia. Eleven trials examined the augmentation of antipsychotics with lithium. More patients who received lithium augmentation than those who received antipsychotics alone were classified as responders. However, the superiority was not consistent across different response thresholds, and when patients with prominent affective symptoms were excluded from the analysis, the advantage of lithium augmentation was not significant (p = .07). Significantly more patients taking lithium left the trials early, suggesting a lower acceptability of lithium augmentation compared with that of taking antipsychotics alone. Conclusion: Despite some evidence in favor of lithium augmentation, the overall results are inconclusive. A large trial of lithium augmentation of antipsychotic medications will be required in order to detect a benefit of small effect size in patients with schizophrenia who lack affective symptoms.
Keyword Psychiatry
Psychology, Clinical
Double-blind Crossover
Tardive-dyskinesia
Schizo-affectives
Placebo
Chlorpromazine
Carbonate
Efficacy
Augmentation
Neuroleptics
Haloperidol
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2005 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 15:16:07 EST