home *** CD-ROM | disk | FTP | other *** search
Unknown | 1992-06-05 | 315.6 KB |
open in:
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| 80 0e 00 00 30 31 00 00 | 00 01 1c 14 00 00 86 12 |....01..|........|
|00000030| 00 00 30 32 00 00 00 01 | a2 26 00 00 bc 0b 00 00 |..02....|.&......|
|00000040| 30 33 00 00 00 01 5e 32 | 00 00 aa 0a 00 00 30 34 |03....^2|......04|
|00000050| 00 00 00 01 08 3d 00 00 | 5e 0a 00 00 30 35 00 00 |.....=..|^...05..|
|00000060| 00 01 66 47 00 00 52 0a | 00 00 30 36 00 00 00 01 |..fG..R.|..06....|
|00000070| b8 51 00 00 55 0c 00 00 | 30 37 00 00 00 01 0d 5e |.Q..U...|07.....^|
|00000080| 00 00 92 0b 00 00 30 38 | 00 00 00 01 9f 69 00 00 |......08|.....i..|
|00000090| a2 0d 00 00 30 39 00 00 | 00 01 41 77 00 00 b3 15 |....09..|..Aw....|
|000000a0| 00 00 31 30 00 00 00 01 | f4 8c 00 00 9c 0d 00 00 |..10....|........|
|000000b0| 31 31 00 00 00 01 90 9a | 00 00 21 17 00 00 31 32 |11......|..!...12|
|000000c0| 00 00 00 01 b1 b1 00 00 | e2 0a 00 00 31 33 00 00 |........|....13..|
|000000d0| 00 01 93 bc 00 00 56 0d | 00 00 31 34 00 00 00 01 |......V.|..14....|
|000000e0| e9 c9 00 00 ca 0a 00 00 | 31 35 00 00 00 01 b3 d4 |........|15......|
|000000f0| 00 00 26 0e 00 00 31 36 | 00 00 00 01 d9 e2 00 00 |..&...16|........|
|00000100| 85 0b 00 00 31 37 00 00 | 00 01 5e ee 00 00 e8 0b |....17..|..^.....|
|00000110| 00 00 31 38 00 00 00 01 | 46 fa 00 00 fb 0b 00 00 |..18....|F.......|
|00000120| 31 39 00 00 00 01 41 06 | 01 00 f5 0c 00 00 32 30 |19....A.|......20|
|00000130| 00 00 00 01 36 13 01 00 | 7c 0e 00 00 32 31 00 00 |....6...||...21..|
|00000140| 00 01 b2 21 01 00 46 0b | 00 00 32 32 00 00 00 01 |...!..F.|..22....|
|00000150| f8 2c 01 00 0d 0d 00 00 | 32 33 00 00 00 01 05 3a |.,......|23.....:|
|00000160| 01 00 4a 0c 00 00 32 34 | 00 00 00 01 4f 46 01 00 |..J...24|....OF..|
|00000170| 02 0d 00 00 32 35 00 00 | 00 01 51 53 01 00 55 0e |....25..|..QS..U.|
|00000180| 00 00 32 36 00 00 00 01 | a6 61 01 00 af 10 00 00 |..26....|.a......|
|00000190| 32 37 00 00 00 01 55 72 | 01 00 fc 0c 00 00 32 38 |27....Ur|......28|
|000001a0| 00 00 00 01 51 7f 01 00 | 9e 0d 00 00 32 39 00 00 |....Q...|....29..|
|000001b0| 00 01 ef 8c 01 00 42 0d | 00 00 33 30 00 00 00 01 |......B.|..30....|
|000001c0| 31 9a 01 00 5f 0d 00 00 | 33 31 00 00 00 01 90 a7 |1..._...|31......|
|000001d0| 01 00 e8 0b 00 00 33 32 | 00 00 00 01 78 b3 01 00 |......32|....x...|
|000001e0| 83 0c 00 00 33 33 00 00 | 00 01 fb bf 01 00 28 0a |....33..|......(.|
|000001f0| 00 00 33 34 00 00 00 01 | 23 ca 01 00 bb 0b 00 00 |..34....|#.......|
|00000200| 33 35 00 00 00 01 de d5 | 01 00 41 0e 00 00 33 36 |35......|..A...36|
|00000210| 00 00 00 01 1f e4 01 00 | 05 0b 00 00 33 37 00 00 |........|....37..|
|00000220| 00 01 24 ef 01 00 74 0d | 00 00 33 38 00 00 00 01 |..$...t.|..38....|
|00000230| 98 fc 01 00 f1 0c 00 00 | 33 39 00 00 00 01 89 09 |........|39......|
|00000240| 02 00 db 0a 00 00 34 30 | 00 00 00 01 64 14 02 00 |......40|....d...|
|00000250| bd 0c 00 00 34 31 00 00 | 00 01 21 21 02 00 70 0b |....41..|..!!..p.|
|00000260| 00 00 34 32 00 00 00 01 | 91 2c 02 00 a7 0e 00 00 |..42....|.,......|
|00000270| 34 33 00 00 00 01 38 3b | 02 00 1a 0b 00 00 34 34 |43....8;|......44|
|00000280| 00 00 00 01 52 46 02 00 | a6 0d 00 00 34 35 00 00 |....RF..|....45..|
|00000290| 00 01 f8 53 02 00 13 0a | 00 00 34 36 00 00 00 01 |...S....|..46....|
|000002a0| 0b 5e 02 00 28 0b 00 00 | 34 37 00 00 00 01 33 69 |.^..(...|47....3i|
|000002b0| 02 00 06 0b 00 00 34 38 | 00 00 00 01 39 74 02 00 |......48|....9t..|
|000002c0| 63 0c 00 00 34 39 00 00 | 00 01 9c 80 02 00 47 0b |c...49..|......G.|
|000002d0| 00 00 35 30 00 00 00 01 | e3 8b 02 00 eb 0b 00 00 |..50....|........|
|000002e0| 35 31 00 00 00 01 ce 97 | 02 00 de 0b 00 00 35 32 |51......|......52|
|000002f0| 00 00 00 01 ac a3 02 00 | 24 0c 00 00 35 33 00 00 |........|$...53..|
|00000300| 00 01 d0 af 02 00 bf 0a | 00 00 35 34 00 00 00 01 |........|..54....|
|00000310| 8f ba 02 00 6d 0a 00 00 | 35 35 00 00 00 01 fc c4 |....m...|55......|
|00000320| 02 00 ca 0b 00 00 35 36 | 00 00 00 01 c6 d0 02 00 |......56|........|
|00000330| 1e 0c 00 00 35 37 00 00 | 00 01 e4 dc 02 00 78 0d |....57..|......x.|
|00000340| 00 00 35 38 00 00 00 01 | 5c ea 02 00 0e 0c 00 00 |..58....|\.......|
|00000350| 35 39 00 00 00 01 6a f6 | 02 00 90 0d 00 00 36 30 |59....j.|......60|
|00000360| 00 00 00 01 fa 03 03 00 | 22 0b 00 00 36 31 00 00 |........|"...61..|
|00000370| 00 01 1c 0f 03 00 f0 0f | 00 00 36 32 00 00 00 01 |........|..62....|
|00000380| 0c 1f 03 00 b6 0e 00 00 | 36 33 00 00 00 01 c2 2d |........|63.....-|
|00000390| 03 00 42 0d 00 00 36 34 | 00 00 00 01 04 3b 03 00 |..B...64|.....;..|
|000003a0| e9 0a 00 00 36 35 00 00 | 00 01 ed 45 03 00 0a 0c |....65..|...E....|
|000003b0| 00 00 36 36 00 00 00 01 | f7 51 03 00 c3 0a 00 00 |..66....|.Q......|
|000003c0| 36 37 00 00 00 01 ba 5c | 03 00 e8 0b 00 00 36 38 |67.....\|......68|
|000003d0| 00 00 00 01 a2 68 03 00 | b3 0c 00 00 36 39 00 00 |.....h..|....69..|
|000003e0| 00 01 55 75 03 00 94 0a | 00 00 37 30 00 00 00 01 |..Uu....|..70....|
|000003f0| e9 7f 03 00 96 0f 00 00 | 37 31 00 00 00 01 7f 8f |........|71......|
|00000400| 03 00 63 0c 00 00 37 32 | 00 00 00 01 e2 9b 03 00 |..c...72|........|
|00000410| ce 0c 00 00 37 33 00 00 | 00 01 b0 a8 03 00 c7 0f |....73..|........|
|00000420| 00 00 37 34 00 00 00 01 | 77 b8 03 00 71 0a 00 00 |..74....|w...q...|
|00000430| 37 35 00 00 00 01 e8 c2 | 03 00 8c 0b 00 00 37 36 |75......|......76|
|00000440| 00 00 00 01 74 ce 03 00 | 08 0f 00 00 37 37 00 00 |....t...|....77..|
|00000450| 00 01 7c dd 03 00 eb 0b | 00 00 37 38 00 00 00 01 |..|.....|..78....|
|00000460| 67 e9 03 00 ab 0d 00 00 | 37 39 00 00 00 01 12 f7 |g.......|79......|
|00000470| 03 00 ab 0a 00 00 38 30 | 00 00 00 01 bd 01 04 00 |......80|........|
|00000480| 36 0b 00 00 38 31 00 00 | 00 01 f3 0c 04 00 50 0d |6...81..|......P.|
|00000490| 00 00 38 32 00 00 00 01 | 43 1a 04 00 d7 09 00 00 |..82....|C.......|
|000004a0| 38 33 00 00 00 01 1a 24 | 04 00 c4 0d 00 00 38 34 |83.....$|......84|
|000004b0| 00 00 00 01 de 31 04 00 | ed 0d 00 00 38 35 00 00 |.....1..|....85..|
|000004c0| 00 01 cb 3f 04 00 87 0a | 00 00 38 36 00 00 00 01 |...?....|..86....|
|000004d0| 52 4a 04 00 22 0c 00 00 | 38 37 00 00 00 01 74 56 |RJ.."...|87....tV|
|000004e0| 04 00 0b 10 00 00 38 38 | 00 00 00 01 7f 66 04 00 |......88|.....f..|
|000004f0| fb 09 00 00 38 39 00 00 | 00 01 7a 70 04 00 09 0e |....89..|..zp....|
|00000500| 00 00 39 30 00 00 00 01 | 83 7e 04 00 9d 0b 00 00 |..90....|.~......|
|00000510| 39 31 00 00 00 01 20 8a | 04 00 19 0b 00 00 39 32 |91.... .|......92|
|00000520| 00 00 00 01 39 95 04 00 | 94 0b 00 00 39 33 00 00 |....9...|....93..|
|00000530| 00 01 cd a0 04 00 9e 0b | 00 00 39 34 00 00 00 01 |........|..94....|
|00000540| 6b ac 04 00 8b 09 00 00 | 39 35 00 00 00 01 f6 b5 |k.......|95......|
|00000550| 04 00 a2 0a 00 00 39 36 | 00 00 00 01 98 c0 04 00 |......96|........|
|00000560| 02 0c 00 00 39 37 00 00 | 00 01 9a cc 04 00 a4 0a |....97..|........|
|00000570| 00 00 39 38 00 00 00 01 | 3e d7 04 00 5b 0c 00 00 |..98....|>...[...|
|00000580| 39 39 00 00 00 01 99 e3 | 04 00 e4 0a 00 00 00 00 |99......|........|
|00000590| 00 00 00 00 7d ee 04 00 | 00 00 00 00 24 55 6e 69 |....}...|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 33 34 30 30 7d |que_ID{Y|RB03400}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 54 72 65 61 74 6d 65 |..$Title|{Treatme|
|000005c0| 6e 74 20 6f 66 20 49 6d | 69 70 72 61 6d 69 6e 65 |nt of Im|ipramine|
|000005d0| 2d 52 65 73 69 73 74 61 | 6e 74 20 52 65 63 75 72 |-Resista|nt Recur|
|000005e0| 72 65 6e 74 20 44 65 70 | 72 65 73 73 69 6f 6e 3a |rent Dep|ression:|
|000005f0| 20 20 49 49 2e 20 41 6e | 20 4f 70 65 6e 0d 0a 43 | II. An| Open..C|
|00000600| 6c 69 6e 69 63 61 6c 20 | 54 72 69 61 6c 20 6f 66 |linical |Trial of|
|00000610| 20 4c 69 74 68 69 75 6d | 20 41 75 67 6d 65 6e 74 | Lithium| Augment|
|00000620| 61 74 69 6f 6e 7d 0d 0a | 24 41 75 74 68 6f 72 7b |ation}..|$Author{|
|00000630| 0d 0a 54 68 61 73 65 2c | 20 4d 45 0d 0a 4b 75 70 |..Thase,| ME..Kup|
|00000640| 66 65 72 2c 20 44 4a 0d | 0a 46 72 61 6e 6b 2c 20 |fer, DJ.|.Frank, |
|00000650| 45 0d 0a 4a 61 72 72 65 | 74 74 2c 20 44 42 7d 0d |E..Jarre|tt, DB}.|
|00000660| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 55 6e |.$Affili|ation{Un|
|00000670| 69 76 20 6f 66 20 50 69 | 74 74 73 62 75 72 67 68 |iv of Pi|ttsburgh|
|00000680| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 4a 20 43 6c |}..$Jour|nal{J Cl|
|00000690| 69 6e 20 50 73 79 63 68 | 69 61 74 72 79 7d 0d 0a |in Psych|iatry}..|
|000006a0| 24 56 6f 6c 75 6d 65 7b | 35 30 7d 0d 0a 24 50 61 |$Volume{|50}..$Pa|
|000006b0| 67 65 7b 34 31 33 2d 34 | 31 37 7d 0d 0a 24 44 61 |ge{413-4|17}..$Da|
|000006c0| 74 65 7b 31 39 38 39 7d | 0d 0a 24 59 42 56 6f 6c |te{1989}|..$YBVol|
|000006d0| 7b 31 39 39 31 20 59 65 | 61 72 20 42 6f 6f 6b 20 |{1991 Ye|ar Book |
|000006e0| 6f 66 20 50 73 79 63 68 | 69 61 74 72 79 20 61 6e |of Psych|iatry an|
|000006f0| 64 20 41 70 70 6c 69 65 | 64 20 4d 65 6e 74 61 6c |d Applie|d Mental|
|00000700| 20 48 65 61 6c 74 68 7d | 0d 0a 24 43 68 61 70 74 | Health}|..$Chapt|
|00000710| 65 72 7b 37 2d 32 32 7d | 0d 0a 24 59 42 45 64 69 |er{7-22}|..$YBEdi|
|00000720| 74 6f 72 7b 44 72 73 2e | 20 54 61 6c 62 6f 74 74 |tor{Drs.| Talbott|
|00000730| 2c 20 46 72 61 6e 63 65 | 73 2c 20 46 72 65 65 64 |, France|s, Freed|
|00000740| 6d 61 6e 2c 20 4d 65 6c | 74 7a 65 72 2c 20 50 65 |man, Mel|tzer, Pe|
|00000750| 72 72 79 2c 20 53 63 68 | 6f 77 61 6c 74 65 72 2c |rry, Sch|owalter,|
|00000760| 20 61 6e 64 0d 0a 59 75 | 64 6f 66 73 6b 79 7d 0d | and..Yu|dofsky}.|
|00000770| 0a 24 54 61 62 6c 65 7b | 7d 0d 0a 24 43 6f 6d 6d |.$Table{|}..$Comm|
|00000780| 65 6e 74 61 74 6f 72 7b | 7d 0d 0a 0d 0a 43 6f 70 |entator{|}....Cop|
|00000790| 79 72 69 67 68 74 20 28 | 43 29 20 59 65 61 72 20 |yright (|C) Year |
|000007a0| 42 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |Book Med|ical Pub|
|000007b0| 6c 69 73 68 65 72 73 2c | 20 49 6e 63 2e 20 31 39 |lishers,| Inc. 19|
|000007c0| 39 31 0d 0a 0d 0a 31 39 | 39 31 20 59 65 61 72 20 |91....19|91 Year |
|000007d0| 42 6f 6f 6b 20 6f 66 20 | 50 73 79 63 68 69 61 74 |Book of |Psychiat|
|000007e0| 72 79 20 61 6e 64 20 41 | 70 70 6c 69 65 64 20 4d |ry and A|pplied M|
|000007f0| 65 6e 74 61 6c 20 48 65 | 61 6c 74 68 0d 0a 0d 0a |ental He|alth....|
|00000800| 43 68 61 70 74 65 72 20 | 37 20 2d 2d 20 50 73 79 |Chapter |7 -- Psy|
|00000810| 63 68 6f 70 68 61 72 6d | 61 63 6f 6c 6f 67 79 0d |chopharm|acology.|
|00000820| 0a 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |...-----|--------|
|00000830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000870| 2d 0d 0a 54 72 65 61 74 | 6d 65 6e 74 20 6f 66 20 |-..Treat|ment of |
|00000880| 49 6d 69 70 72 61 6d 69 | 6e 65 2d 52 65 73 69 73 |Imiprami|ne-Resis|
|00000890| 74 61 6e 74 20 52 65 63 | 75 72 72 65 6e 74 20 44 |tant Rec|urrent D|
|000008a0| 65 70 72 65 73 73 69 6f | 6e 3a 20 20 49 49 2e 20 |epressio|n: II. |
|000008b0| 41 6e 20 4f 70 65 6e 20 | 43 6c 69 6e 69 63 61 6c |An Open |Clinical|
|000008c0| 0d 0a 54 72 69 61 6c 20 | 6f 66 20 4c 69 74 68 69 |..Trial |of Lithi|
|000008d0| 75 6d 20 41 75 67 6d 65 | 6e 74 61 74 69 6f 6e 0d |um Augme|ntation.|
|000008e0| 0a 0d 0a 54 68 61 73 65 | 20 4d 45 3b 20 4b 75 70 |...Thase| ME; Kup|
|000008f0| 66 65 72 20 44 4a 3b 20 | 46 72 61 6e 6b 20 45 3b |fer DJ; |Frank E;|
|00000900| 20 4a 61 72 72 65 74 74 | 20 44 42 0d 0a 28 55 6e | Jarrett| DB..(Un|
|00000910| 69 76 20 6f 66 20 50 69 | 74 74 73 62 75 72 67 68 |iv of Pi|ttsburgh|
|00000920| 29 0d 0a 4a 20 43 6c 69 | 6e 20 50 73 79 63 68 69 |)..J Cli|n Psychi|
|00000930| 61 74 72 79 20 35 30 3a | 34 31 33 2d 34 31 37 2c |atry 50:|413-417,|
|00000940| 20 31 39 38 39 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1989..-|--------|
|00000950| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000960| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000990| 2d 2d 2d 2d 2d 0d 0a 0d | 0a 41 62 73 74 72 61 63 |-----...|.Abstrac|
|000009a0| 74 0d 0a 0d 0a 20 20 20 | 20 20 41 64 64 69 6e 67 |t.... | Adding|
|000009b0| 20 6c 69 74 68 69 75 6d | 20 73 61 6c 74 73 20 6d | lithium| salts m|
|000009c0| 61 79 20 69 6d 70 72 6f | 76 65 20 74 72 65 61 74 |ay impro|ve treat|
|000009d0| 6d 65 6e 74 20 72 65 73 | 70 6f 6e 73 65 73 20 69 |ment res|ponses i|
|000009e0| 6e 20 64 65 70 72 65 73 | 73 69 6f 6e 73 20 74 68 |n depres|sions th|
|000009f0| 61 74 0d 0a 68 61 76 65 | 20 6e 6f 74 20 72 65 73 |at..have| not res|
|00000a00| 70 6f 6e 64 65 64 20 74 | 6f 20 74 72 69 63 79 63 |ponded t|o tricyc|
|00000a10| 6c 69 63 20 61 6e 74 69 | 64 65 70 72 65 73 73 61 |lic anti|depressa|
|00000a20| 6e 74 73 2e 20 20 54 68 | 65 20 65 66 66 65 63 74 |nts. Th|e effect|
|00000a30| 69 76 65 6e 65 73 73 20 | 6f 66 20 6c 69 74 68 69 |iveness |of lithi|
|00000a40| 75 6d 0d 0a 61 75 67 6d | 65 6e 74 61 74 69 6f 6e |um..augm|entation|
|00000a50| 20 77 61 73 20 65 76 61 | 6c 75 61 74 65 64 20 69 | was eva|luated i|
|00000a60| 6e 20 61 6e 20 6f 70 65 | 6e 2d 6c 61 62 65 6c 20 |n an ope|n-label |
|00000a70| 73 74 75 64 79 20 6f 66 | 20 32 30 20 6f 75 74 70 |study of| 20 outp|
|00000a80| 61 74 69 65 6e 74 73 20 | 77 69 74 68 0d 0a 72 65 |atients |with..re|
|00000a90| 63 75 72 72 65 6e 74 20 | 6d 61 6a 6f 72 20 64 65 |current |major de|
|00000aa0| 70 72 65 73 73 69 6f 6e | 20 77 68 6f 20 68 61 64 |pression| who had|
|00000ab0| 20 6e 6f 74 20 72 65 73 | 70 6f 6e 64 65 64 20 74 | not res|ponded t|
|00000ac0| 6f 20 31 32 20 6f 72 20 | 6d 6f 72 65 20 77 65 65 |o 12 or |more wee|
|00000ad0| 6b 73 20 6f 66 0d 0a 69 | 6d 69 70 72 61 6d 69 6e |ks of..i|mipramin|
|00000ae0| 65 20 74 68 65 72 61 70 | 79 20 61 6e 64 20 70 73 |e therap|y and ps|
|00000af0| 79 63 68 6f 74 68 65 72 | 61 70 79 2e 0d 0a 20 20 |ychother|apy... |
|00000b00| 20 20 20 49 6d 69 70 72 | 61 6d 69 6e 65 20 77 61 | Imipr|amine wa|
|00000b10| 73 20 67 69 76 65 6e 20 | 69 6e 20 61 20 6d 65 61 |s given |in a mea|
|00000b20| 6e 20 64 6f 73 65 20 6f | 66 20 32 35 36 20 6d 67 |n dose o|f 256 mg|
|00000b30| 2f 64 61 79 2e 20 20 4f | 6e 6c 79 20 31 20 70 61 |/day. O|nly 1 pa|
|00000b40| 74 69 65 6e 74 0d 0a 72 | 65 73 70 6f 6e 64 65 64 |tient..r|esponded|
|00000b50| 20 64 75 72 69 6e 67 20 | 74 68 65 20 66 69 72 73 | during |the firs|
|00000b60| 74 20 77 65 65 6b 20 6f | 66 20 74 72 65 61 74 6d |t week o|f treatm|
|00000b70| 65 6e 74 2e 20 20 48 6f | 77 65 76 65 72 2c 20 74 |ent. Ho|wever, t|
|00000b80| 68 65 20 63 75 6d 75 6c | 61 74 69 76 65 0d 0a 72 |he cumul|ative..r|
|00000b90| 65 73 70 6f 6e 73 65 20 | 72 61 74 65 20 72 6f 73 |esponse |rate ros|
|00000ba0| 65 20 74 6f 20 36 35 25 | 20 64 75 72 69 6e 67 20 |e to 65%| during |
|00000bb0| 74 68 65 20 36 2d 77 65 | 65 6b 20 63 6c 69 6e 69 |the 6-we|ek clini|
|00000bc0| 63 61 6c 20 74 72 69 61 | 6c 2e 20 20 54 68 65 20 |cal tria|l. The |
|00000bd0| 69 6d 70 72 6f 76 65 6d | 65 6e 74 0d 0a 69 6e 20 |improvem|ent..in |
|00000be0| 70 61 74 69 65 6e 74 73 | 20 72 65 63 65 69 76 69 |patients| receivi|
|00000bf0| 6e 67 20 6c 69 74 68 69 | 75 6d 20 61 75 67 6d 65 |ng lithi|um augme|
|00000c00| 6e 74 61 74 69 6f 6e 20 | 77 61 73 20 73 69 67 6e |ntation |was sign|
|00000c10| 69 66 69 63 61 6e 74 6c | 79 20 67 72 65 61 74 65 |ificantl|y greate|
|00000c20| 72 20 74 68 61 6e 20 74 | 68 61 74 0d 0a 6f 63 63 |r than t|hat..occ|
|00000c30| 75 72 72 69 6e 67 20 69 | 6e 20 61 20 68 69 73 74 |urring i|n a hist|
|00000c40| 6f 72 69 63 61 6c 20 63 | 6f 6e 74 72 6f 6c 20 67 |orical c|ontrol g|
|00000c50| 72 6f 75 70 20 6f 66 20 | 69 6d 69 70 72 61 6d 69 |roup of |imiprami|
|00000c60| 6e 65 2d 72 65 73 69 73 | 74 61 6e 74 20 70 61 74 |ne-resis|tant pat|
|00000c70| 69 65 6e 74 73 0d 0a 72 | 65 63 65 69 76 69 6e 67 |ients..r|eceiving|
|00000c80| 20 63 6f 6e 74 69 6e 75 | 65 64 20 74 72 65 61 74 | continu|ed treat|
|00000c90| 6d 65 6e 74 20 77 69 74 | 68 20 74 68 65 20 69 6d |ment wit|h the im|
|00000ca0| 69 70 72 61 6d 69 6e 65 | 2d 70 73 79 63 68 6f 74 |ipramine|-psychot|
|00000cb0| 68 65 72 61 70 79 20 63 | 6f 6d 62 69 6e 61 74 69 |herapy c|ombinati|
|00000cc0| 6f 6e 2e 0d 0a 20 20 20 | 20 20 54 68 65 20 75 74 |on... | The ut|
|00000cd0| 69 6c 69 74 79 20 6f 66 | 20 61 20 36 2d 77 65 65 |ility of| a 6-wee|
|00000ce0| 6b 20 74 72 69 61 6c 20 | 6f 66 20 6c 69 74 68 69 |k trial |of lithi|
|00000cf0| 75 6d 20 61 75 67 6d 65 | 6e 74 61 74 69 6f 6e 20 |um augme|ntation |
|00000d00| 69 6e 20 6f 75 74 70 61 | 74 69 65 6e 74 73 20 77 |in outpa|tients w|
|00000d10| 69 74 68 0d 0a 72 65 73 | 69 73 74 61 6e 74 20 64 |ith..res|istant d|
|00000d20| 65 70 72 65 73 73 69 6f | 6e 20 69 73 20 73 75 70 |epressio|n is sup|
|00000d30| 70 6f 72 74 65 64 2e 20 | 20 49 74 20 69 73 20 73 |ported. | It is s|
|00000d40| 74 69 6c 6c 20 6e 6f 74 | 20 63 6c 65 61 72 20 77 |till not| clear w|
|00000d50| 68 65 74 68 65 72 20 74 | 68 65 20 65 66 66 69 63 |hether t|he effic|
|00000d60| 61 63 79 0d 0a 6f 66 20 | 6c 69 74 68 69 75 6d 20 |acy..of |lithium |
|00000d70| 61 75 67 6d 65 6e 74 61 | 74 69 6f 6e 20 77 61 73 |augmenta|tion was|
|00000d80| 20 63 61 75 73 65 64 20 | 62 79 20 61 20 74 72 75 | caused |by a tru|
|00000d90| 65 20 70 6f 74 65 6e 74 | 69 61 74 69 6f 6e 20 65 |e potent|iation e|
|00000da0| 66 66 65 63 74 2c 20 61 | 20 70 72 69 6d 61 72 79 |ffect, a| primary|
|00000db0| 0d 0a 61 6e 74 69 64 65 | 70 72 65 73 73 61 6e 74 |..antide|pressant|
|00000dc0| 20 65 66 66 65 63 74 20 | 62 79 20 6c 69 74 68 69 | effect |by lithi|
|00000dd0| 75 6d 2c 20 6f 72 20 61 | 20 63 6f 6d 62 69 6e 61 |um, or a| combina|
|00000de0| 74 69 6f 6e 20 6f 66 20 | 74 68 65 73 65 2e 0d 0a |tion of |these...|
|00000df0| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|00000e00| 0d 0a 20 20 20 20 20 41 | 74 20 74 68 65 20 65 6e |.. A|t the en|
|00000e10| 64 20 6f 66 20 36 20 77 | 65 65 6b 73 2c 20 6c 69 |d of 6 w|eeks, li|
|00000e20| 74 68 69 75 6d 20 61 75 | 67 6d 65 6e 74 61 74 69 |thium au|gmentati|
|00000e30| 6f 6e 20 77 61 73 20 68 | 65 6c 70 66 75 6c 20 69 |on was h|elpful i|
|00000e40| 6e 20 61 70 70 72 6f 78 | 69 6d 61 74 65 6c 79 0d |n approx|imately.|
|00000e50| 0a 36 35 25 20 6f 66 20 | 70 61 74 69 65 6e 74 73 |.65% of |patients|
|00000e60| 20 77 68 6f 20 66 61 69 | 6c 65 64 20 74 6f 20 72 | who fai|led to r|
|00000e70| 65 73 70 6f 6e 64 20 61 | 64 65 71 75 61 74 65 6c |espond a|dequatel|
|00000e80| 79 20 74 6f 20 69 6d 69 | 70 72 61 6d 69 6e 65 20 |y to imi|pramine |
|00000e90| 61 6c 6f 6e 65 2e 20 20 | 49 6e 0d 0a 63 6f 6e 74 |alone. |In..cont|
|00000ea0| 72 61 73 74 2c 20 74 68 | 65 72 65 20 68 61 76 65 |rast, th|ere have|
|00000eb0| 20 62 65 65 6e 20 6f 74 | 68 65 72 20 72 65 70 6f | been ot|her repo|
|00000ec0| 72 74 73 20 73 75 67 67 | 65 73 74 69 6e 67 20 74 |rts sugg|esting t|
|00000ed0| 68 61 74 20 61 6e 20 61 | 63 75 74 65 20 72 65 73 |hat an a|cute res|
|00000ee0| 70 6f 6e 73 65 20 69 73 | 0d 0a 74 79 70 69 63 61 |ponse is|..typica|
|00000ef0| 6c 20 6f 66 20 73 75 63 | 63 65 73 73 66 75 6c 20 |l of suc|cessful |
|00000f00| 6c 69 74 68 69 75 6d 20 | 61 75 67 6d 65 6e 74 61 |lithium |augmenta|
|00000f10| 74 69 6f 6e 2e 20 20 48 | 6f 77 65 76 65 72 2c 20 |tion. H|owever, |
|00000f20| 74 68 65 20 6c 6f 6e 67 | 20 74 69 6d 65 20 75 6e |the long| time un|
|00000f30| 74 69 6c 20 61 0d 0a 63 | 6c 69 6e 69 63 61 6c 20 |til a..c|linical |
|00000f40| 72 65 73 70 6f 6e 73 65 | 20 69 73 20 6f 62 73 65 |response| is obse|
|00000f50| 72 76 65 64 20 72 61 69 | 73 65 73 20 74 68 65 20 |rved rai|ses the |
|00000f60| 71 75 65 73 74 69 6f 6e | 20 6f 66 20 77 68 65 74 |question| of whet|
|00000f70| 68 65 72 20 74 68 69 73 | 20 69 73 20 73 69 6d 70 |her this| is simp|
|00000f80| 6c 79 20 61 6e 0d 0a 61 | 6e 74 69 64 65 70 72 65 |ly an..a|ntidepre|
|00000f90| 73 73 61 6e 74 20 72 65 | 73 70 6f 6e 73 65 20 74 |ssant re|sponse t|
|00000fa0| 6f 20 6c 69 74 68 69 75 | 6d 2e 20 20 49 6e 64 65 |o lithiu|m. Inde|
|00000fb0| 65 64 2c 20 63 6f 6e 73 | 69 73 74 65 6e 74 20 77 |ed, cons|istent w|
|00000fc0| 69 74 68 20 74 68 65 0d | 0a 61 6e 74 69 64 65 70 |ith the.|.antidep|
|00000fd0| 72 65 73 73 61 6e 74 20 | 63 6f 6e 63 65 70 74 20 |ressant |concept |
|00000fe0| 74 68 65 20 61 75 74 68 | 6f 72 73 20 73 75 67 67 |the auth|ors sugg|
|00000ff0| 65 73 74 20 74 68 61 74 | 20 61 66 74 65 72 20 61 |est that| after a|
|00001000| 20 63 6c 69 6e 69 63 61 | 6c 20 72 65 73 70 6f 6e | clinica|l respon|
|00001010| 73 65 20 68 61 73 0d 0a | 6f 63 63 75 72 72 65 64 |se has..|occurred|
|00001020| 20 69 74 20 6d 61 79 20 | 62 65 20 70 72 75 64 65 | it may |be prude|
|00001030| 6e 74 20 66 69 72 73 74 | 20 74 6f 20 64 69 73 63 |nt first| to disc|
|00001040| 6f 6e 74 69 6e 75 65 20 | 74 68 65 20 74 72 69 63 |ontinue |the tric|
|00001050| 79 63 6c 69 63 20 61 6e | 74 69 64 65 70 72 65 73 |yclic an|tidepres|
|00001060| 73 61 6e 74 0d 0a 61 6e | 64 20 73 75 62 73 65 71 |sant..an|d subseq|
|00001070| 75 65 6e 74 6c 79 20 64 | 69 73 63 6f 6e 74 69 6e |uently d|iscontin|
|00001080| 75 65 20 6c 69 74 68 69 | 75 6d 2e 0d 0a 20 20 20 |ue lithi|um... |
|00001090| 20 20 49 6e 20 74 68 69 | 73 20 73 74 75 64 79 20 | In thi|s study |
|000010a0| 74 68 65 20 70 61 74 69 | 65 6e 74 73 20 65 78 61 |the pati|ents exa|
|000010b0| 6d 69 6e 65 64 20 77 65 | 72 65 20 74 68 6f 73 65 |mined we|re those|
|000010c0| 20 77 68 6f 20 68 61 64 | 20 6d 6f 72 65 20 74 68 | who had| more th|
|000010d0| 61 6e 20 31 32 20 77 65 | 65 6b 73 0d 0a 6f 66 20 |an 12 we|eks..of |
|000010e0| 74 72 65 61 74 6d 65 6e | 74 20 77 69 74 68 20 70 |treatmen|t with p|
|000010f0| 73 79 63 68 6f 74 68 65 | 72 61 70 79 20 61 6e 64 |sychothe|rapy and|
|00001100| 20 69 6d 69 70 72 61 6d | 69 6e 65 20 61 6e 64 20 | imipram|ine and |
|00001110| 77 68 6f 20 77 65 72 65 | 20 6e 6f 6e 72 65 73 70 |who were| nonresp|
|00001120| 6f 6e 64 65 72 73 20 74 | 6f 0d 0a 74 68 69 73 20 |onders t|o..this |
|00001130| 74 72 65 61 74 6d 65 6e | 74 2e 20 20 54 68 65 79 |treatmen|t. They|
|00001140| 20 77 65 72 65 20 74 68 | 65 6e 20 74 72 65 61 74 | were th|en treat|
|00001150| 65 64 20 77 69 74 68 20 | 6c 69 74 68 69 75 6d 20 |ed with |lithium |
|00001160| 61 75 67 6d 65 6e 74 61 | 74 69 6f 6e 2e 20 20 54 |augmenta|tion. T|
|00001170| 68 65 73 65 0d 0a 72 65 | 73 75 6c 74 73 20 73 68 |hese..re|sults sh|
|00001180| 6f 75 6c 64 20 62 65 20 | 69 6e 74 65 72 70 72 65 |ould be |interpre|
|00001190| 74 65 64 20 77 69 74 68 | 20 63 61 75 74 69 6f 6e |ted with| caution|
|000011a0| 20 66 6f 72 20 73 65 76 | 65 72 61 6c 20 72 65 61 | for sev|eral rea|
|000011b0| 73 6f 6e 73 2e 20 20 46 | 69 72 73 74 2c 20 74 68 |sons. F|irst, th|
|000011c0| 65 0d 0a 61 75 74 68 6f | 72 73 20 75 73 65 64 20 |e..autho|rs used |
|000011d0| 61 6e 20 6f 70 65 6e 20 | 6c 61 62 65 6c 20 6d 65 |an open |label me|
|000011e0| 74 68 6f 64 2c 20 77 68 | 69 63 68 20 69 6e 63 72 |thod, wh|ich incr|
|000011f0| 65 61 73 65 73 20 74 68 | 65 20 70 6f 73 73 69 62 |eases th|e possib|
|00001200| 69 6c 69 74 79 20 6f 66 | 20 70 61 74 69 65 6e 74 |ility of| patient|
|00001210| 0d 0a 61 6e 64 20 63 6c | 69 6e 69 63 69 61 6e 20 |..and cl|inician |
|00001220| 65 78 70 65 63 74 61 74 | 69 6f 6e 73 20 70 6f 73 |expectat|ions pos|
|00001230| 69 74 69 76 65 6c 79 20 | 69 6e 66 6c 75 65 6e 63 |itively |influenc|
|00001240| 69 6e 67 20 74 68 65 20 | 6f 75 74 63 6f 6d 65 20 |ing the |outcome |
|00001250| 6f 66 20 74 68 65 20 63 | 6c 69 6e 69 63 61 6c 0d |of the c|linical.|
|00001260| 0a 74 72 69 61 6c 2e 20 | 20 53 65 63 6f 6e 64 2c |.trial. | Second,|
|00001270| 20 74 68 65 20 6c 65 6e | 67 74 68 20 61 6e 64 20 | the len|gth and |
|00001280| 69 6e 74 65 6e 73 69 74 | 79 20 6f 66 20 74 68 65 |intensit|y of the|
|00001290| 20 70 61 74 69 65 6e 74 | 73 27 20 70 72 65 76 69 | patient|s' previ|
|000012a0| 6f 75 73 20 74 72 69 61 | 6c 73 20 6f 66 0d 0a 74 |ous tria|ls of..t|
|000012b0| 72 65 61 74 6d 65 6e 74 | 20 77 69 74 68 20 74 72 |reatment| with tr|
|000012c0| 69 63 79 63 6c 69 63 73 | 20 61 6e 64 20 70 73 79 |icyclics| and psy|
|000012d0| 63 68 6f 74 68 65 72 61 | 70 79 20 6d 61 79 20 68 |chothera|py may h|
|000012e0| 61 76 65 20 72 65 64 75 | 63 65 64 20 74 68 65 20 |ave redu|ced the |
|000012f0| 6f 70 74 69 6d 61 6c 0d | 0a 72 65 73 70 6f 6e 73 |optimal.|.respons|
|00001300| 65 20 72 61 74 65 20 6f | 62 73 65 72 76 65 64 20 |e rate o|bserved |
|00001310| 77 69 74 68 20 6c 69 74 | 68 69 75 6d 20 61 75 67 |with lit|hium aug|
|00001320| 6d 65 6e 74 61 74 69 6f | 6e 2e 20 20 54 68 65 20 |mentatio|n. The |
|00001330| 61 75 74 68 6f 72 73 20 | 77 65 72 65 0d 0a 65 6e |authors |were..en|
|00001340| 74 68 75 73 69 61 73 74 | 69 63 20 61 62 6f 75 74 |thusiast|ic about|
|00001350| 20 74 68 69 73 20 61 70 | 70 72 6f 61 63 68 20 6e | this ap|proach n|
|00001360| 6f 74 20 6f 6e 6c 79 20 | 62 65 63 61 75 73 65 20 |ot only |because |
|00001370| 6f 66 20 74 68 65 20 36 | 35 25 20 72 65 73 70 6f |of the 6|5% respo|
|00001380| 6e 73 65 20 72 61 74 65 | 0d 0a 6f 62 73 65 72 76 |nse rate|..observ|
|00001390| 65 64 20 69 6e 20 74 68 | 65 69 72 20 73 65 72 69 |ed in th|eir seri|
|000013a0| 65 73 20 62 75 74 20 61 | 6c 73 6f 20 62 65 63 61 |es but a|lso beca|
|000013b0| 75 73 65 20 6c 69 74 68 | 69 75 6d 20 77 61 73 20 |use lith|ium was |
|000013c0| 77 65 6c 6c 20 74 6f 6c | 65 72 61 74 65 64 20 77 |well tol|erated w|
|000013d0| 69 74 68 20 66 65 77 0d | 0a 64 69 66 66 69 63 75 |ith few.|.difficu|
|000013e0| 6c 74 20 73 69 64 65 20 | 65 66 66 65 63 74 73 2e |lt side |effects.|
|000013f0| 2d 2d 44 2e 58 2e 20 46 | 72 65 65 64 6d 61 6e 2c |--D.X. F|reedman,|
|00001400| 20 4d 2e 44 2e 2c 20 61 | 6e 64 20 42 2e 48 2e 20 | M.D., a|nd B.H. |
|00001410| 47 75 7a 65 2c 20 4d 2e | 44 2e 0d 0a 24 55 6e 69 |Guze, M.|D...$Uni|
|00001420| 71 75 65 5f 49 44 7b 59 | 52 42 30 33 34 30 31 7d |que_ID{Y|RB03401}|
|00001430| 0d 0a 24 54 69 74 6c 65 | 7b 52 61 70 69 64 20 43 |..$Title|{Rapid C|
|00001440| 79 63 6c 69 6e 67 20 42 | 69 70 6f 6c 61 72 20 41 |ycling B|ipolar A|
|00001450| 66 66 65 63 74 69 76 65 | 20 44 69 73 6f 72 64 65 |ffective| Disorde|
|00001460| 72 3a 20 20 49 49 2e 20 | 54 72 65 61 74 6d 65 6e |r: II. |Treatmen|
|00001470| 74 20 6f 66 20 52 65 66 | 72 61 63 74 6f 72 79 0d |t of Ref|ractory.|
|00001480| 0a 52 61 70 69 64 20 43 | 79 63 6c 69 6e 67 20 57 |.Rapid C|ycling W|
|00001490| 69 74 68 20 48 69 67 68 | 2d 44 6f 73 65 20 4c 65 |ith High|-Dose Le|
|000014a0| 76 6f 74 68 79 72 6f 78 | 69 6e 65 3a 20 20 41 20 |vothyrox|ine: A |
|000014b0| 50 72 65 6c 69 6d 69 6e | 61 72 79 20 53 74 75 64 |Prelimin|ary Stud|
|000014c0| 79 7d 0d 0a 24 41 75 74 | 68 6f 72 7b 0d 0a 42 61 |y}..$Aut|hor{..Ba|
|000014d0| 75 65 72 2c 20 4d 53 0d | 0a 57 68 79 62 72 6f 77 |uer, MS.|.Whybrow|
|000014e0| 2c 20 50 43 7d 0d 0a 24 | 41 66 66 69 6c 69 61 74 |, PC}..$|Affiliat|
|000014f0| 69 6f 6e 7b 55 6e 69 76 | 20 6f 66 20 50 65 6e 6e |ion{Univ| of Penn|
|00001500| 73 79 6c 76 61 6e 69 61 | 7d 0d 0a 24 4a 6f 75 72 |sylvania|}..$Jour|
|00001510| 6e 61 6c 7b 41 72 63 68 | 20 47 65 6e 20 50 73 79 |nal{Arch| Gen Psy|
|00001520| 63 68 69 61 74 72 79 7d | 0d 0a 24 56 6f 6c 75 6d |chiatry}|..$Volum|
|00001530| 65 7b 34 37 7d 0d 0a 24 | 50 61 67 65 7b 34 33 35 |e{47}..$|Page{435|
|00001540| 2d 34 34 30 7d 0d 0a 24 | 44 61 74 65 7b 31 39 39 |-440}..$|Date{199|
|00001550| 30 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 39 31 20 |0}..$YBV|ol{1991 |
|00001560| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 50 73 79 |Year Boo|k of Psy|
|00001570| 63 68 69 61 74 72 79 20 | 61 6e 64 20 41 70 70 6c |chiatry |and Appl|
|00001580| 69 65 64 20 4d 65 6e 74 | 61 6c 20 48 65 61 6c 74 |ied Ment|al Healt|
|00001590| 68 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 37 2d 32 |h}..$Cha|pter{7-2|
|000015a0| 33 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |3}..$YBE|ditor{Dr|
|000015b0| 73 2e 20 54 61 6c 62 6f | 74 74 2c 20 46 72 61 6e |s. Talbo|tt, Fran|
|000015c0| 63 65 73 2c 20 46 72 65 | 65 64 6d 61 6e 2c 20 4d |ces, Fre|edman, M|
|000015d0| 65 6c 74 7a 65 72 2c 20 | 50 65 72 72 79 2c 20 53 |eltzer, |Perry, S|
|000015e0| 63 68 6f 77 61 6c 74 65 | 72 2c 20 61 6e 64 0d 0a |chowalte|r, and..|
|000015f0| 59 75 64 6f 66 73 6b 79 | 7d 0d 0a 24 54 61 62 6c |Yudofsky|}..$Tabl|
|00001600| 65 7b 7d 0d 0a 24 43 6f | 6d 6d 65 6e 74 61 74 6f |e{}..$Co|mmentato|
|00001610| 72 7b 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |r{}....C|opyright|
|00001620| 20 28 43 29 20 59 65 61 | 72 20 42 6f 6f 6b 20 4d | (C) Yea|r Book M|
|00001630| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|00001640| 73 2c 20 49 6e 63 2e 20 | 31 39 39 31 0d 0a 0d 0a |s, Inc. |1991....|
|00001650| 31 39 39 31 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1991 Yea|r Book o|
|00001660| 66 20 50 73 79 63 68 69 | 61 74 72 79 20 61 6e 64 |f Psychi|atry and|
|00001670| 20 41 70 70 6c 69 65 64 | 20 4d 65 6e 74 61 6c 20 | Applied| Mental |
|00001680| 48 65 61 6c 74 68 0d 0a | 0d 0a 43 68 61 70 74 65 |Health..|..Chapte|
|00001690| 72 20 37 20 2d 2d 20 50 | 73 79 63 68 6f 70 68 61 |r 7 -- P|sychopha|
|000016a0| 72 6d 61 63 6f 6c 6f 67 | 79 0d 0a 0d 0a 2d 2d 2d |rmacolog|y....---|
|000016b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000016c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000016d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000016e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000016f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 52 61 70 |--------|---..Rap|
|00001700| 69 64 20 43 79 63 6c 69 | 6e 67 20 42 69 70 6f 6c |id Cycli|ng Bipol|
|00001710| 61 72 20 41 66 66 65 63 | 74 69 76 65 20 44 69 73 |ar Affec|tive Dis|
|00001720| 6f 72 64 65 72 3a 20 20 | 49 49 2e 20 54 72 65 61 |order: |II. Trea|
|00001730| 74 6d 65 6e 74 20 6f 66 | 20 52 65 66 72 61 63 74 |tment of| Refract|
|00001740| 6f 72 79 20 52 61 70 69 | 64 0d 0a 43 79 63 6c 69 |ory Rapi|d..Cycli|
|00001750| 6e 67 20 57 69 74 68 20 | 48 69 67 68 2d 44 6f 73 |ng With |High-Dos|
|00001760| 65 20 4c 65 76 6f 74 68 | 79 72 6f 78 69 6e 65 3a |e Levoth|yroxine:|
|00001770| 20 20 41 20 50 72 65 6c | 69 6d 69 6e 61 72 79 20 | A Prel|iminary |
|00001780| 53 74 75 64 79 0d 0a 0d | 0a 42 61 75 65 72 20 4d |Study...|.Bauer M|
|00001790| 53 3b 20 57 68 79 62 72 | 6f 77 20 50 43 0d 0a 28 |S; Whybr|ow PC..(|
|000017a0| 55 6e 69 76 20 6f 66 20 | 50 65 6e 6e 73 79 6c 76 |Univ of |Pennsylv|
|000017b0| 61 6e 69 61 29 0d 0a 41 | 72 63 68 20 47 65 6e 20 |ania)..A|rch Gen |
|000017c0| 50 73 79 63 68 69 61 74 | 72 79 20 34 37 3a 34 33 |Psychiat|ry 47:43|
|000017d0| 35 2d 34 34 30 2c 20 31 | 39 39 30 0d 0a 2d 2d 2d |5-440, 1|990..---|
|000017e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001800| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00001830| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|00001840| 54 68 65 72 65 20 69 73 | 20 63 75 72 72 65 6e 74 |There is| current|
|00001850| 6c 79 20 6e 6f 20 73 61 | 74 69 73 66 61 63 74 6f |ly no sa|tisfacto|
|00001860| 72 79 20 74 72 65 61 74 | 6d 65 6e 74 20 66 6f 72 |ry treat|ment for|
|00001870| 20 72 61 70 69 64 2d 63 | 79 63 6c 69 6e 67 20 62 | rapid-c|ycling b|
|00001880| 69 70 6f 6c 61 72 0d 0a | 61 66 66 65 63 74 69 76 |ipolar..|affectiv|
|00001890| 65 20 64 69 73 6f 72 64 | 65 72 2e 20 20 41 20 73 |e disord|er. A s|
|000018a0| 74 72 75 63 74 75 72 65 | 64 20 74 72 65 61 74 6d |tructure|d treatm|
|000018b0| 65 6e 74 20 70 72 6f 74 | 6f 63 6f 6c 20 77 61 73 |ent prot|ocol was|
|000018c0| 20 64 65 76 65 6c 6f 70 | 65 64 20 74 6f 20 61 73 | develop|ed to as|
|000018d0| 73 65 73 73 0d 0a 74 68 | 65 20 75 73 65 20 6f 66 |sess..th|e use of|
|000018e0| 20 68 69 67 68 2d 64 6f | 73 65 20 6c 65 76 6f 74 | high-do|se levot|
|000018f0| 68 79 72 6f 78 69 6e 65 | 20 69 6e 20 72 61 70 69 |hyroxine| in rapi|
|00001900| 64 20 63 79 63 6c 69 6e | 67 20 62 69 70 6f 6c 61 |d cyclin|g bipola|
|00001910| 72 20 70 61 74 69 65 6e | 74 73 20 77 68 6f 73 65 |r patien|ts whose|
|00001920| 0d 0a 63 6c 69 6e 69 63 | 61 6c 20 61 6e 64 20 74 |..clinic|al and t|
|00001930| 68 79 72 6f 69 64 20 6d | 65 61 73 75 72 65 73 20 |hyroid m|easures |
|00001940| 77 65 72 65 20 77 65 6c | 6c 20 63 68 61 72 61 63 |were wel|l charac|
|00001950| 74 65 72 69 7a 65 64 2e | 0d 0a 20 20 20 20 20 45 |terized.|.. E|
|00001960| 6c 65 76 65 6e 20 70 61 | 74 69 65 6e 74 73 20 77 |leven pa|tients w|
|00001970| 69 74 68 20 73 79 6d 70 | 74 6f 6d 73 20 72 65 66 |ith symp|toms ref|
|00001980| 72 61 63 74 6f 72 79 20 | 74 6f 20 74 68 65 69 72 |ractory |to their|
|00001990| 20 63 75 72 72 65 6e 74 | 20 6d 65 64 69 63 61 74 | current| medicat|
|000019a0| 69 6f 6e 0d 0a 72 65 67 | 69 6d 65 6e 20 77 65 72 |ion..reg|imen wer|
|000019b0| 65 20 65 6e 74 65 72 65 | 64 20 69 6e 74 6f 20 74 |e entere|d into t|
|000019c0| 68 65 20 6f 70 65 6e 20 | 74 72 69 61 6c 2e 20 20 |he open |trial. |
|000019d0| 48 69 67 68 2d 64 6f 73 | 65 20 6c 65 76 6f 74 68 |High-dos|e levoth|
|000019e0| 79 72 6f 78 69 6e 65 20 | 73 6f 64 69 75 6d 20 77 |yroxine |sodium w|
|000019f0| 61 73 0d 0a 61 64 64 65 | 64 20 74 6f 20 61 20 73 |as..adde|d to a s|
|00001a00| 74 61 62 6c 65 20 72 65 | 67 69 6d 65 6e 20 6f 66 |table re|gimen of|
|00001a10| 20 74 68 6f 73 65 20 6d | 65 64 69 63 61 74 69 6f | those m|edicatio|
|00001a20| 6e 73 2e 20 20 41 74 20 | 62 61 73 65 6c 69 6e 65 |ns. At |baseline|
|00001a30| 2c 20 61 6c 6c 20 70 61 | 74 69 65 6e 74 73 0d 0a |, all pa|tients..|
|00001a40| 73 68 6f 77 65 64 20 74 | 68 65 20 72 61 70 69 64 |showed t|he rapid|
|00001a50| 20 63 79 63 6c 69 6e 67 | 20 70 61 74 74 65 72 6e | cycling| pattern|
|00001a60| 20 61 6e 64 20 77 65 72 | 65 20 61 73 73 65 73 73 | and wer|e assess|
|00001a70| 65 64 20 70 72 6f 73 70 | 65 63 74 69 76 65 6c 79 |ed prosp|ectively|
|00001a80| 20 74 68 72 6f 75 67 68 | 20 61 74 0d 0a 6c 65 61 | through| at..lea|
|00001a90| 73 74 20 31 20 61 66 66 | 65 63 74 69 76 65 20 65 |st 1 aff|ective e|
|00001aa0| 70 69 73 6f 64 65 2e 20 | 20 54 68 65 20 64 6f 73 |pisode. | The dos|
|00001ab0| 61 67 65 20 6f 66 20 6c | 65 76 6f 74 68 79 72 6f |age of l|evothyro|
|00001ac0| 78 69 6e 65 20 61 64 64 | 65 64 20 61 74 20 62 61 |xine add|ed at ba|
|00001ad0| 73 65 6c 69 6e 65 20 77 | 61 73 0d 0a 69 6e 63 72 |seline w|as..incr|
|00001ae0| 65 61 73 65 64 20 75 6e | 74 69 6c 20 74 68 65 20 |eased un|til the |
|00001af0| 70 61 74 69 65 6e 74 73 | 20 73 68 6f 77 65 64 20 |patients| showed |
|00001b00| 61 20 63 6c 69 6e 69 63 | 61 6c 20 72 65 73 70 6f |a clinic|al respo|
|00001b10| 6e 73 65 20 6f 72 20 68 | 61 64 20 73 69 64 65 20 |nse or h|ad side |
|00001b20| 65 66 66 65 63 74 73 0d | 0a 74 68 61 74 20 70 72 |effects.|.that pr|
|00001b30| 65 63 6c 75 64 65 64 20 | 66 75 72 74 68 65 72 20 |ecluded |further |
|00001b40| 69 6e 63 72 65 61 73 65 | 2e 20 20 53 63 6f 72 65 |increase|. Score|
|00001b50| 73 20 6f 6e 20 64 65 70 | 72 65 73 73 69 76 65 20 |s on dep|ressive |
|00001b60| 61 6e 64 20 6d 61 6e 69 | 63 20 73 79 6d 70 74 6f |and mani|c sympto|
|00001b70| 6d 0d 0a 72 61 74 69 6e | 67 20 73 63 61 6c 65 73 |m..ratin|g scales|
|00001b80| 20 64 72 6f 70 70 65 64 | 20 73 69 67 6e 69 66 69 | dropped| signifi|
|00001b90| 63 61 6e 74 6c 79 20 77 | 68 69 6c 65 20 74 68 65 |cantly w|hile the|
|00001ba0| 20 70 61 74 69 65 6e 74 | 73 20 74 6f 6f 6b 20 6c | patient|s took l|
|00001bb0| 65 76 6f 74 68 79 72 6f | 78 69 6e 65 2e 0d 0a 54 |evothyro|xine...T|
|00001bc0| 68 65 20 69 6d 70 72 6f | 76 65 6d 65 6e 74 20 77 |he impro|vement w|
|00001bd0| 61 73 20 63 61 75 73 65 | 64 20 62 79 20 61 20 63 |as cause|d by a c|
|00001be0| 6c 65 61 72 20 72 65 73 | 70 6f 6e 73 65 20 6f 66 |lear res|ponse of|
|00001bf0| 20 64 65 70 72 65 73 73 | 69 76 65 20 73 79 6d 70 | depress|ive symp|
|00001c00| 74 6f 6d 73 20 69 6e 20 | 31 30 0d 0a 70 61 74 69 |toms in |10..pati|
|00001c10| 65 6e 74 73 20 61 6e 64 | 20 6d 61 6e 69 63 20 73 |ents and| manic s|
|00001c20| 79 6d 70 74 6f 6d 73 20 | 69 6e 20 35 20 6f 66 20 |ymptoms |in 5 of |
|00001c30| 37 20 70 61 74 69 65 6e | 74 73 20 64 69 73 70 6c |7 patien|ts displ|
|00001c40| 61 79 69 6e 67 20 74 68 | 65 6d 20 61 74 20 62 61 |aying th|em at ba|
|00001c50| 73 65 6c 69 6e 65 2e 0d | 0a 46 6f 75 72 20 70 61 |seline..|.Four pa|
|00001c60| 74 69 65 6e 74 73 20 74 | 68 65 6e 20 75 6e 64 65 |tients t|hen unde|
|00001c70| 72 77 65 6e 74 20 61 20 | 73 69 6e 67 6c 65 2d 20 |rwent a |single- |
|00001c80| 6f 72 20 64 6f 75 62 6c | 65 2d 62 6c 69 6e 64 20 |or doubl|e-blind |
|00001c90| 73 75 62 73 74 69 74 75 | 74 69 6f 6e 2e 20 20 54 |substitu|tion. T|
|00001ca0| 68 72 65 65 0d 0a 72 65 | 6c 61 70 73 65 64 20 69 |hree..re|lapsed i|
|00001cb0| 6e 74 6f 20 64 65 70 72 | 65 73 73 69 6f 6e 20 20 |nto depr|ession |
|00001cc0| 6f 72 20 63 79 63 6c 69 | 6e 67 2e 20 20 50 72 65 |or cycli|ng. Pre|
|00001cd0| 76 69 6f 75 73 20 74 68 | 79 72 6f 69 64 20 73 74 |vious th|yroid st|
|00001ce0| 61 74 75 73 20 64 69 64 | 20 6e 6f 74 0d 0a 69 6e |atus did| not..in|
|00001cf0| 66 6c 75 65 6e 63 65 20 | 74 72 65 61 74 6d 65 6e |fluence |treatmen|
|00001d00| 74 20 72 65 73 70 6f 6e | 73 65 2e 20 20 53 75 70 |t respon|se. Sup|
|00001d10| 72 61 6e 6f 72 6d 61 6c | 20 63 69 72 63 75 6c 61 |ranormal| circula|
|00001d20| 74 69 6e 67 20 6c 65 76 | 65 6c 73 20 6f 66 20 66 |ting lev|els of f|
|00001d30| 72 65 65 0d 0a 74 68 79 | 72 6f 78 69 6e 65 20 77 |ree..thy|roxine w|
|00001d40| 65 72 65 20 6e 65 65 64 | 65 64 20 74 6f 20 69 6e |ere need|ed to in|
|00001d50| 64 75 63 65 20 74 68 65 | 20 63 6c 69 6e 69 63 61 |duce the| clinica|
|00001d60| 6c 20 72 65 73 70 6f 6e | 73 65 20 69 6e 20 39 20 |l respon|se in 9 |
|00001d70| 6f 66 20 74 68 65 20 31 | 30 0d 0a 72 65 73 70 6f |of the 1|0..respo|
|00001d80| 6e 64 65 72 73 2e 20 20 | 41 64 76 65 72 73 65 20 |nders. |Adverse |
|00001d90| 65 66 66 65 63 74 73 20 | 77 65 72 65 20 6d 69 6e |effects |were min|
|00001da0| 69 6d 61 6c 2e 20 20 54 | 68 65 72 65 20 77 65 72 |imal. T|here wer|
|00001db0| 65 20 6e 6f 20 73 69 67 | 6e 73 20 6f 72 20 73 79 |e no sig|ns or sy|
|00001dc0| 6d 70 74 6f 6d 73 20 6f | 66 0d 0a 6c 65 76 6f 74 |mptoms o|f..levot|
|00001dd0| 68 79 72 6f 78 69 6e 65 | 2d 69 6e 64 75 63 65 64 |hyroxine|-induced|
|00001de0| 20 68 79 70 65 72 6d 65 | 74 61 62 6f 6c 69 73 6d | hyperme|tabolism|
|00001df0| 2e 0d 0a 0d 0a 50 6f 73 | 74 2d 43 6f 6d 6d 65 6e |.....Pos|t-Commen|
|00001e00| 74 0d 0a 0d 0a 20 20 20 | 20 20 52 61 70 69 64 20 |t.... | Rapid |
|00001e10| 63 79 63 6c 69 6e 67 20 | 62 69 70 6f 6c 61 72 20 |cycling |bipolar |
|00001e20| 61 66 66 65 63 74 69 76 | 65 20 64 69 73 6f 72 64 |affectiv|e disord|
|00001e30| 65 72 20 69 73 20 6e 6f | 74 6f 72 69 6f 75 73 6c |er is no|toriousl|
|00001e40| 79 20 64 69 66 66 69 63 | 75 6c 74 20 74 6f 0d 0a |y diffic|ult to..|
|00001e50| 74 72 65 61 74 2e 20 53 | 65 76 65 72 61 6c 20 61 |treat. S|everal a|
|00001e60| 70 70 72 6f 61 63 68 65 | 73 20 68 61 76 65 20 62 |pproache|s have b|
|00001e70| 65 65 6e 20 70 72 6f 70 | 6f 73 65 64 2c 20 6e 6f |een prop|osed, no|
|00001e80| 74 20 61 6c 6c 20 6f 66 | 20 77 68 69 63 68 20 61 |t all of| which a|
|00001e90| 72 65 20 63 6f 6d 70 6c | 65 74 65 6c 79 0d 0a 73 |re compl|etely..s|
|00001ea0| 61 74 69 73 66 61 63 74 | 6f 72 79 2e 20 20 54 68 |atisfact|ory. Th|
|00001eb0| 69 73 20 72 65 70 6f 72 | 74 20 64 65 73 63 72 69 |is repor|t descri|
|00001ec0| 62 65 73 20 61 6e 20 61 | 70 70 72 6f 61 63 68 20 |bes an a|pproach |
|00001ed0| 74 68 61 74 20 6d 61 6b | 65 73 20 74 68 65 20 70 |that mak|es the p|
|00001ee0| 61 74 69 65 6e 74 73 0d | 0a 63 68 65 6d 69 63 61 |atients.|.chemica|
|00001ef0| 6c 6c 79 20 74 68 79 72 | 6f 74 6f 78 69 63 2e 20 |lly thyr|otoxic. |
|00001f00| 20 49 74 20 69 73 20 69 | 6e 74 65 72 65 73 74 69 | It is i|nteresti|
|00001f10| 6e 67 20 74 6f 20 6e 6f | 74 65 20 68 6f 77 65 76 |ng to no|te howev|
|00001f20| 65 72 2c 20 74 68 61 74 | 20 73 69 64 65 20 65 66 |er, that| side ef|
|00001f30| 66 65 63 74 73 0d 0a 77 | 65 72 65 20 6d 69 6e 69 |fects..w|ere mini|
|00001f40| 6d 61 6c 20 69 6e 20 74 | 68 69 73 20 70 6f 70 75 |mal in t|his popu|
|00001f50| 6c 61 74 69 6f 6e 2c 20 | 61 6e 64 20 74 68 65 72 |lation, |and ther|
|00001f60| 65 20 77 61 73 20 6e 6f | 20 65 76 69 64 65 6e 63 |e was no| evidenc|
|00001f70| 65 20 6f 66 20 6f 76 65 | 72 61 6c 6c 0d 0a 68 79 |e of ove|rall..hy|
|00001f80| 70 65 72 6d 65 74 61 62 | 6f 6c 69 73 6d 2e 20 20 |permetab|olism. |
|00001f90| 4c 65 76 6f 74 68 79 72 | 6f 78 69 6e 65 2c 20 77 |Levothyr|oxine, w|
|00001fa0| 68 65 6e 20 75 73 65 64 | 20 69 6e 20 68 69 67 68 |hen used| in high|
|00001fb0| 20 64 6f 73 65 73 2c 20 | 63 61 6e 20 69 6e 64 75 | doses, |can indu|
|00001fc0| 63 65 20 61 0d 0a 72 65 | 6d 69 73 73 69 6f 6e 20 |ce a..re|mission |
|00001fd0| 6f 66 20 62 6f 74 68 20 | 64 65 70 72 65 73 73 69 |of both |depressi|
|00001fe0| 76 65 20 61 6e 64 20 6d | 61 6e 69 63 20 73 79 6d |ve and m|anic sym|
|00001ff0| 70 74 6f 6d 73 20 69 6e | 20 70 61 74 69 65 6e 74 |ptoms in| patient|
|00002000| 73 20 77 69 74 68 20 72 | 61 70 69 64 20 63 79 63 |s with r|apid cyc|
|00002010| 6c 69 6e 67 0d 0a 62 69 | 70 6f 6c 61 72 20 61 66 |ling..bi|polar af|
|00002020| 66 65 63 74 69 76 65 20 | 64 69 73 6f 72 64 65 72 |fective |disorder|
|00002030| 2c 20 61 6e 64 20 69 74 | 20 61 70 70 65 61 72 73 |, and it| appears|
|00002040| 20 74 68 61 74 20 73 75 | 70 72 61 6e 6f 72 6d 61 | that su|pranorma|
|00002050| 6c 20 63 69 72 63 75 6c | 61 74 69 6e 67 20 6c 65 |l circul|ating le|
|00002060| 76 65 6c 73 0d 0a 6f 66 | 20 66 72 65 65 20 54 34 |vels..of| free T4|
|00002070| 20 61 72 65 20 6e 65 63 | 65 73 73 61 72 79 20 66 | are nec|essary f|
|00002080| 6f 72 20 72 65 73 70 6f | 6e 73 65 20 69 6e 20 6d |or respo|nse in m|
|00002090| 6f 73 74 20 70 61 74 69 | 65 6e 74 73 2e 20 20 57 |ost pati|ents. W|
|000020a0| 68 65 6e 20 54 34 20 6c | 65 76 65 6c 73 20 64 72 |hen T4 l|evels dr|
|000020b0| 6f 70 0d 0a 74 6f 20 74 | 68 65 20 6e 6f 72 6d 61 |op..to t|he norma|
|000020c0| 6c 20 72 61 6e 67 65 2c | 20 70 61 74 69 65 6e 74 |l range,| patient|
|000020d0| 73 20 74 65 6e 64 20 74 | 6f 20 72 65 6c 61 70 73 |s tend t|o relaps|
|000020e0| 65 2e 20 20 54 68 65 20 | 72 65 6d 6f 76 61 6c 20 |e. The |removal |
|000020f0| 6f 66 20 6c 65 76 6f 74 | 68 79 72 6f 78 69 6e 65 |of levot|hyroxine|
|00002100| 0d 0a 66 72 6f 6d 20 34 | 20 70 61 74 69 65 6e 74 |..from 4| patient|
|00002110| 73 20 69 6e 20 74 68 69 | 73 20 70 72 6f 6a 65 63 |s in thi|s projec|
|00002120| 74 20 61 6e 64 20 74 68 | 65 20 73 75 62 73 74 69 |t and th|e substi|
|00002130| 74 75 74 69 6f 6e 20 6f | 66 20 70 6c 61 63 65 62 |tution o|f placeb|
|00002140| 6f 20 72 65 73 75 6c 74 | 65 64 20 69 6e 0d 0a 72 |o result|ed in..r|
|00002150| 65 6c 61 70 73 65 20 69 | 6e 20 33 2e 20 20 49 6e |elapse i|n 3. In|
|00002160| 20 61 64 64 69 74 69 6f | 6e 20 74 6f 20 63 6f 6e | additio|n to con|
|00002170| 76 65 6e 74 69 6f 6e 61 | 6c 20 70 68 61 72 6d 61 |ventiona|l pharma|
|00002180| 63 6f 6c 6f 67 69 63 20 | 6d 61 6e 65 75 76 65 72 |cologic |maneuver|
|00002190| 73 2c 20 74 69 74 72 61 | 74 69 6f 6e 0d 0a 6f 66 |s, titra|tion..of|
|000021a0| 20 6c 65 76 6f 74 68 79 | 72 6f 78 69 6e 65 20 74 | levothy|roxine t|
|000021b0| 6f 20 74 68 65 20 70 6f | 69 6e 74 20 6f 66 20 6d |o the po|int of m|
|000021c0| 69 6c 64 20 63 68 65 6d | 69 63 61 6c 20 68 79 70 |ild chem|ical hyp|
|000021d0| 65 72 74 68 79 72 6f 69 | 64 69 73 6d 20 6d 61 79 |erthyroi|dism may|
|000021e0| 20 62 65 20 68 65 6c 70 | 66 75 6c 0d 0a 69 6e 20 | be help|ful..in |
|000021f0| 74 68 65 20 74 72 65 61 | 74 6d 65 6e 74 20 6f 66 |the trea|tment of|
|00002200| 20 72 61 70 69 64 20 63 | 79 63 6c 69 6e 67 20 62 | rapid c|ycling b|
|00002210| 69 70 6f 6c 61 72 20 61 | 66 66 65 63 74 69 76 65 |ipolar a|ffective|
|00002220| 20 64 69 73 6f 72 64 65 | 72 2e 0d 0a 20 20 20 20 | disorde|r... |
|00002230| 20 54 68 65 20 61 75 74 | 68 6f 72 73 2c 20 69 6e | The aut|hors, in|
|00002240| 20 61 20 63 6f 6d 70 61 | 6e 69 6f 6e 20 61 72 74 | a compa|nion art|
|00002250| 69 63 6c 65 2c 20 72 65 | 70 6f 72 74 20 74 68 61 |icle, re|port tha|
|00002260| 74 20 36 30 25 20 6f 66 | 20 74 68 65 69 72 20 70 |t 60% of| their p|
|00002270| 6f 70 75 6c 61 74 69 6f | 6e 0d 0a 6f 66 20 33 30 |opulatio|n..of 30|
|00002280| 20 72 61 70 69 64 20 63 | 79 63 6c 69 6e 67 20 62 | rapid c|ycling b|
|00002290| 69 70 6f 6c 61 72 20 61 | 66 66 65 63 74 69 76 65 |ipolar a|ffective|
|000022a0| 20 64 69 73 6f 72 64 65 | 72 20 70 61 74 69 65 6e | disorde|r patien|
|000022b0| 74 73 20 68 61 64 20 68 | 79 70 6f 74 68 79 72 6f |ts had h|ypothyro|
|000022c0| 69 64 69 73 6d 2e 0d 0a | 28 31 29 20 54 68 65 73 |idism...|(1) Thes|
|000022d0| 65 20 61 62 6e 6f 72 6d | 61 6c 69 74 69 65 73 20 |e abnorm|alities |
|000022e0| 63 6f 6e 73 69 73 74 65 | 64 20 6f 66 20 33 20 67 |consiste|d of 3 g|
|000022f0| 72 61 64 65 73 3a 20 20 | 47 72 61 64 65 20 31 2c |rades: |Grade 1,|
|00002300| 20 77 68 69 63 68 20 63 | 6f 6d 70 72 69 73 65 64 | which c|omprised|
|00002310| 20 32 33 25 0d 0a 6f 66 | 20 74 68 65 69 72 20 61 | 23%..of| their a|
|00002320| 62 6e 6f 72 6d 61 6c 20 | 70 6f 70 75 6c 61 74 69 |bnormal |populati|
|00002330| 6f 6e 2c 20 63 6f 6e 73 | 69 73 74 65 64 20 6f 66 |on, cons|isted of|
|00002340| 20 64 65 63 72 65 61 73 | 65 64 20 73 65 72 75 6d | decreas|ed serum|
|00002350| 20 54 34 20 6c 65 76 65 | 6c 73 20 6f 66 20 66 72 | T4 leve|ls of fr|
|00002360| 65 65 0d 0a 54 34 20 69 | 6e 64 65 78 2e 20 20 47 |ee..T4 i|ndex. G|
|00002370| 72 61 64 65 20 32 20 68 | 79 70 6f 74 68 79 72 6f |rade 2 h|ypothyro|
|00002380| 69 64 69 73 6d 20 77 61 | 73 20 63 68 61 72 61 63 |idism wa|s charac|
|00002390| 74 65 72 69 7a 65 64 20 | 62 79 20 61 6e 20 69 6e |terized |by an in|
|000023a0| 63 72 65 61 73 65 64 20 | 73 65 72 75 6d 0d 0a 74 |creased |serum..t|
|000023b0| 68 79 72 6f 74 72 6f 70 | 69 6e 20 6c 65 76 65 6c |hyrotrop|in level|
|000023c0| 20 77 69 74 68 20 61 20 | 6e 6f 72 6d 61 6c 20 66 | with a |normal f|
|000023d0| 72 65 65 20 54 34 20 69 | 6e 64 65 78 3b 20 74 68 |ree T4 i|ndex; th|
|000023e0| 69 73 20 63 6f 6d 70 72 | 69 73 65 64 20 32 37 25 |is compr|ised 27%|
|000023f0| 20 6f 66 20 74 68 65 69 | 72 0d 0a 70 6f 70 75 6c | of thei|r..popul|
|00002400| 61 74 69 6f 6e 2e 20 20 | 54 68 65 20 73 6d 61 6c |ation. |The smal|
|00002410| 6c 65 73 74 20 67 72 6f | 75 70 2c 20 63 6f 6e 73 |lest gro|up, cons|
|00002420| 69 73 74 69 6e 67 20 6f | 66 20 31 30 25 2c 20 68 |isting o|f 10%, h|
|00002430| 61 64 20 67 72 61 64 65 | 20 33 0d 0a 68 79 70 6f |ad grade| 3..hypo|
|00002440| 74 68 79 72 6f 69 64 69 | 73 6d 2c 20 69 2e 65 2e |thyroidi|sm, i.e.|
|00002450| 2c 20 74 68 65 20 70 72 | 65 73 65 6e 63 65 20 6f |, the pr|esence o|
|00002460| 66 20 69 73 6f 6c 61 74 | 65 64 20 65 78 61 67 67 |f isolat|ed exagg|
|00002470| 65 72 61 74 69 6f 6e 20 | 6f 66 20 74 68 65 20 74 |eration |of the t|
|00002480| 68 79 72 6f 74 72 6f 70 | 69 6e 0d 0a 72 65 73 70 |hyrotrop|in..resp|
|00002490| 6f 6e 73 65 20 74 6f 20 | 70 72 6f 74 69 72 65 6c |onse to |protirel|
|000024a0| 69 6e 20 69 6e 66 75 73 | 69 6f 6e 20 77 69 74 68 |in infus|ion with|
|000024b0| 20 6e 6f 72 6d 61 6c 20 | 62 61 73 61 6c 20 74 68 | normal |basal th|
|000024c0| 79 72 6f 74 72 6f 70 69 | 6e 20 6c 65 76 65 6c 73 |yrotropi|n levels|
|000024d0| 2e 0d 0a 20 20 20 20 20 | 54 68 69 73 20 63 6f 6d |... |This com|
|000024e0| 62 69 6e 65 64 20 66 72 | 65 71 75 65 6e 63 79 20 |bined fr|equency |
|000024f0| 6f 66 20 68 79 70 6f 74 | 68 79 72 6f 69 64 69 73 |of hypot|hyroidis|
|00002500| 6d 20 77 61 73 20 67 72 | 65 61 74 65 72 20 74 68 |m was gr|eater th|
|00002510| 61 6e 20 77 6f 75 6c 64 | 20 62 65 0d 0a 65 78 70 |an would| be..exp|
|00002520| 65 63 74 65 64 20 69 6e | 20 61 20 70 6f 70 75 6c |ected in| a popul|
|00002530| 61 74 69 6f 6e 20 63 68 | 72 6f 6e 69 63 61 6c 6c |ation ch|ronicall|
|00002540| 79 20 74 61 6b 69 6e 67 | 20 6c 69 74 68 69 75 6d |y taking| lithium|
|00002550| 2e 20 20 54 68 65 20 61 | 75 74 68 6f 72 73 20 62 |. The a|uthors b|
|00002560| 65 6c 69 65 76 65 64 0d | 0a 74 68 61 74 20 74 68 |elieved.|.that th|
|00002570| 65 69 72 20 66 69 6e 64 | 69 6e 67 73 20 63 6f 75 |eir find|ings cou|
|00002580| 6c 64 20 6e 6f 74 20 62 | 65 20 65 78 70 6c 61 69 |ld not b|e explai|
|00002590| 6e 65 64 20 65 69 74 68 | 65 72 20 62 79 20 74 68 |ned eith|er by th|
|000025a0| 65 20 61 64 6d 69 6e 69 | 73 74 72 61 74 69 6f 6e |e admini|stration|
|000025b0| 20 6f 66 0d 0a 6c 69 74 | 68 69 75 6d 20 6f 72 20 | of..lit|hium or |
|000025c0| 62 79 20 74 68 65 20 67 | 72 65 61 74 65 72 20 66 |by the g|reater f|
|000025d0| 72 65 71 75 65 6e 63 79 | 20 6f 66 20 68 79 70 6f |requency| of hypo|
|000025e0| 74 68 79 72 6f 69 64 69 | 73 6d 20 69 6e 20 66 65 |thyroidi|sm in fe|
|000025f0| 6d 61 6c 65 73 2c 20 77 | 68 69 63 68 20 6c 65 64 |males, w|hich led|
|00002600| 0d 0a 74 68 65 6d 20 74 | 6f 20 63 6f 6e 63 6c 75 |..them t|o conclu|
|00002610| 64 65 20 74 68 61 74 20 | 68 79 70 6f 74 68 79 72 |de that |hypothyr|
|00002620| 6f 69 64 69 73 6d 20 64 | 75 72 69 6e 67 20 62 69 |oidism d|uring bi|
|00002630| 70 6f 6c 61 72 20 69 6c | 6c 6e 65 73 73 20 69 73 |polar il|lness is|
|00002640| 20 61 20 72 69 73 6b 20 | 66 61 63 74 6f 72 0d 0a | a risk |factor..|
|00002650| 66 6f 72 20 74 68 65 20 | 64 65 76 65 6c 6f 70 6d |for the |developm|
|00002660| 65 6e 74 20 6f 66 20 72 | 61 70 69 64 20 63 79 63 |ent of r|apid cyc|
|00002670| 6c 69 6e 67 2e 2d 2d 44 | 2e 58 2e 20 46 72 65 65 |ling.--D|.X. Free|
|00002680| 64 6d 61 6e 2c 20 4d 2e | 44 2e 2c 20 61 6e 64 20 |dman, M.|D., and |
|00002690| 42 2e 48 2e 20 47 75 7a | 65 2c 0d 0a 4d 2e 44 2e |B.H. Guz|e,..M.D.|
|000026a0| 0d 0a 24 55 6e 69 71 75 | 65 5f 49 44 7b 59 52 42 |..$Uniqu|e_ID{YRB|
|000026b0| 30 33 34 30 32 7d 0d 0a | 24 54 69 74 6c 65 7b 53 |03402}..|$Title{S|
|000026c0| 70 65 63 74 72 75 6d 20 | 6f 66 20 45 66 66 69 63 |pectrum |of Effic|
|000026d0| 61 63 79 20 6f 66 20 56 | 61 6c 70 72 6f 61 74 65 |acy of V|alproate|
|000026e0| 20 69 6e 20 35 35 20 50 | 61 74 69 65 6e 74 73 20 | in 55 P|atients |
|000026f0| 57 69 74 68 20 52 61 70 | 69 64 2d 43 79 63 6c 69 |With Rap|id-Cycli|
|00002700| 6e 67 0d 0a 42 69 70 6f | 6c 61 72 20 44 69 73 6f |ng..Bipo|lar Diso|
|00002710| 72 64 65 72 7d 0d 0a 24 | 41 75 74 68 6f 72 7b 0d |rder}..$|Author{.|
|00002720| 0a 43 61 6c 61 62 72 65 | 73 65 2c 20 4a 52 0d 0a |.Calabre|se, JR..|
|00002730| 44 65 6c 75 63 63 68 69 | 2c 20 47 41 7d 0d 0a 24 |Delucchi|, GA}..$|
|00002740| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 43 61 73 65 |Affiliat|ion{Case|
|00002750| 20 57 65 73 74 65 72 6e | 20 52 65 73 65 72 76 65 | Western| Reserve|
|00002760| 20 55 6e 69 76 7d 0d 0a | 24 4a 6f 75 72 6e 61 6c | Univ}..|$Journal|
|00002770| 7b 41 6d 20 4a 20 50 73 | 79 63 68 69 61 74 72 79 |{Am J Ps|ychiatry|
|00002780| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 31 34 37 7d 0d |}..$Volu|me{147}.|
|00002790| 0a 24 50 61 67 65 7b 34 | 33 31 2d 34 33 34 7d 0d |.$Page{4|31-434}.|
|000027a0| 0a 24 44 61 74 65 7b 31 | 39 39 30 7d 0d 0a 24 59 |.$Date{1|990}..$Y|
|000027b0| 42 56 6f 6c 7b 31 39 39 | 31 20 59 65 61 72 20 42 |BVol{199|1 Year B|
|000027c0| 6f 6f 6b 20 6f 66 20 50 | 73 79 63 68 69 61 74 72 |ook of P|sychiatr|
|000027d0| 79 20 61 6e 64 20 41 70 | 70 6c 69 65 64 20 4d 65 |y and Ap|plied Me|
|000027e0| 6e 74 61 6c 20 48 65 61 | 6c 74 68 7d 0d 0a 24 43 |ntal Hea|lth}..$C|
|000027f0| 68 61 70 74 65 72 7b 37 | 2d 32 34 7d 0d 0a 24 59 |hapter{7|-24}..$Y|
|00002800| 42 45 64 69 74 6f 72 7b | 44 72 73 2e 20 54 61 6c |BEditor{|Drs. Tal|
|00002810| 62 6f 74 74 2c 20 46 72 | 61 6e 63 65 73 2c 20 46 |bott, Fr|ances, F|
|00002820| 72 65 65 64 6d 61 6e 2c | 20 4d 65 6c 74 7a 65 72 |reedman,| Meltzer|
|00002830| 2c 20 50 65 72 72 79 2c | 20 53 63 68 6f 77 61 6c |, Perry,| Schowal|
|00002840| 74 65 72 2c 20 61 6e 64 | 0d 0a 59 75 64 6f 66 73 |ter, and|..Yudofs|
|00002850| 6b 79 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |ky}..$Ta|ble{}..$|
|00002860| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 7d 0d 0a 0d |Commenta|tor{}...|
|00002870| 0a 43 6f 70 79 72 69 67 | 68 74 20 28 43 29 20 59 |.Copyrig|ht (C) Y|
|00002880| 65 61 72 20 42 6f 6f 6b | 20 4d 65 64 69 63 61 6c |ear Book| Medical|
|00002890| 20 50 75 62 6c 69 73 68 | 65 72 73 2c 20 49 6e 63 | Publish|ers, Inc|
|000028a0| 2e 20 31 39 39 31 0d 0a | 0d 0a 31 39 39 31 20 59 |. 1991..|..1991 Y|
|000028b0| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 50 73 79 63 |ear Book| of Psyc|
|000028c0| 68 69 61 74 72 79 20 61 | 6e 64 20 41 70 70 6c 69 |hiatry a|nd Appli|
|000028d0| 65 64 20 4d 65 6e 74 61 | 6c 20 48 65 61 6c 74 68 |ed Menta|l Health|
|000028e0| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 37 20 2d 2d |....Chap|ter 7 --|
|000028f0| 20 50 73 79 63 68 6f 70 | 68 61 72 6d 61 63 6f 6c | Psychop|harmacol|
|00002900| 6f 67 79 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ogy....-|--------|
|00002910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002930| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002940| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002950| 2d 2d 2d 2d 2d 0d 0a 53 | 70 65 63 74 72 75 6d 20 |-----..S|pectrum |
|00002960| 6f 66 20 45 66 66 69 63 | 61 63 79 20 6f 66 20 56 |of Effic|acy of V|
|00002970| 61 6c 70 72 6f 61 74 65 | 20 69 6e 20 35 35 20 50 |alproate| in 55 P|
|00002980| 61 74 69 65 6e 74 73 20 | 57 69 74 68 20 52 61 70 |atients |With Rap|
|00002990| 69 64 2d 43 79 63 6c 69 | 6e 67 20 42 69 70 6f 6c |id-Cycli|ng Bipol|
|000029a0| 61 72 0d 0a 44 69 73 6f | 72 64 65 72 0d 0a 0d 0a |ar..Diso|rder....|
|000029b0| 43 61 6c 61 62 72 65 73 | 65 20 4a 52 3b 20 44 65 |Calabres|e JR; De|
|000029c0| 6c 75 63 63 68 69 20 47 | 41 0d 0a 28 43 61 73 65 |lucchi G|A..(Case|
|000029d0| 20 57 65 73 74 65 72 6e | 20 52 65 73 65 72 76 65 | Western| Reserve|
|000029e0| 20 55 6e 69 76 29 0d 0a | 41 6d 20 4a 20 50 73 79 | Univ)..|Am J Psy|
|000029f0| 63 68 69 61 74 72 79 20 | 31 34 37 3a 34 33 31 2d |chiatry |147:431-|
|00002a00| 34 33 34 2c 20 31 39 39 | 30 0d 0a 2d 2d 2d 2d 2d |434, 199|0..-----|
|00002a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 0d 0a 41 62 73 |--------|-....Abs|
|00002a60| 74 72 61 63 74 0d 0a 0d | 0a 20 20 20 20 20 4d 61 |tract...|. Ma|
|00002a70| 6e 79 20 70 61 74 69 65 | 6e 74 73 20 77 69 74 68 |ny patie|nts with|
|00002a80| 20 62 69 70 6f 6c 61 72 | 20 61 66 66 65 63 74 69 | bipolar| affecti|
|00002a90| 76 65 20 64 69 73 6f 72 | 64 65 72 20 64 6f 20 6e |ve disor|der do n|
|00002aa0| 6f 74 20 74 6f 6c 65 72 | 61 74 65 20 6c 69 74 68 |ot toler|ate lith|
|00002ab0| 69 75 6d 20 6f 72 0d 0a | 66 61 69 6c 20 74 6f 20 |ium or..|fail to |
|00002ac0| 72 65 73 70 6f 6e 64 20 | 74 6f 20 69 74 2e 20 20 |respond |to it. |
|00002ad0| 54 68 65 20 6d 65 74 61 | 62 6f 6c 69 63 20 70 72 |The meta|bolic pr|
|00002ae0| 6f 62 6c 65 6d 73 20 65 | 6e 63 6f 75 6e 74 65 72 |oblems e|ncounter|
|00002af0| 65 64 20 77 69 74 68 20 | 63 61 72 62 61 6d 61 7a |ed with |carbamaz|
|00002b00| 65 70 69 6e 65 0d 0a 73 | 75 67 67 65 73 74 20 74 |epine..s|uggest t|
|00002b10| 68 65 20 75 73 65 20 6f | 66 20 76 61 6c 70 72 6f |he use o|f valpro|
|00002b20| 61 74 65 20 61 73 20 61 | 6e 20 61 6c 74 65 72 6e |ate as a|n altern|
|00002b30| 61 74 69 76 65 2e 20 20 | 54 6f 20 65 76 61 6c 75 |ative. |To evalu|
|00002b40| 61 74 65 20 74 68 65 20 | 65 66 66 69 63 61 63 79 |ate the |efficacy|
|00002b50| 20 6f 66 0d 0a 76 61 6c | 70 72 6f 61 74 65 20 69 | of..val|proate i|
|00002b60| 6e 20 72 61 70 69 64 2d | 63 79 63 6c 69 6e 67 20 |n rapid-|cycling |
|00002b70| 62 69 70 6f 6c 61 72 20 | 64 69 73 6f 72 64 65 72 |bipolar |disorder|
|00002b80| 2c 20 35 35 20 70 61 74 | 69 65 6e 74 73 20 6d 65 |, 55 pat|ients me|
|00002b90| 65 74 69 6e 67 20 44 53 | 4d 2d 49 49 49 2d 52 0d |eting DS|M-III-R.|
|00002ba0| 0a 63 72 69 74 65 72 69 | 61 20 66 6f 72 20 62 69 |.criteri|a for bi|
|00002bb0| 70 6f 6c 61 72 20 64 69 | 73 6f 72 64 65 72 20 70 |polar di|sorder p|
|00002bc0| 61 72 74 69 63 69 70 61 | 74 65 64 20 69 6e 20 61 |articipa|ted in a|
|00002bd0| 20 70 72 6f 73 70 65 63 | 74 69 76 65 2c 20 6f 70 | prospec|tive, op|
|00002be0| 65 6e 2c 20 37 2e 38 2d | 6d 6f 6e 74 68 0d 0a 74 |en, 7.8-|month..t|
|00002bf0| 72 69 61 6c 2e 20 20 41 | 6c 6c 20 6f 66 20 74 68 |rial. A|ll of th|
|00002c00| 65 20 70 61 74 69 65 6e | 74 73 20 77 65 72 65 20 |e patien|ts were |
|00002c10| 72 61 70 69 64 20 63 79 | 63 6c 65 72 73 3b 20 74 |rapid cy|clers; t|
|00002c20| 68 65 20 6d 65 61 6e 20 | 6e 75 6d 62 65 72 20 6f |he mean |number o|
|00002c30| 66 20 63 79 63 6c 65 73 | 20 65 61 63 68 0d 0a 79 |f cycles| each..y|
|00002c40| 65 61 72 20 77 61 73 20 | 39 2e 20 20 56 61 6c 70 |ear was |9. Valp|
|00002c50| 72 6f 61 74 65 20 74 68 | 65 72 61 70 79 20 77 61 |roate th|erapy wa|
|00002c60| 73 20 69 6e 69 74 69 61 | 74 65 64 20 69 6e 20 61 |s initia|ted in a|
|00002c70| 20 64 6f 73 65 20 6f 66 | 20 32 35 30 20 6d 67 20 | dose of| 250 mg |
|00002c80| 74 77 69 63 65 20 64 61 | 69 6c 79 2c 0d 0a 61 6e |twice da|ily,..an|
|00002c90| 64 20 69 6e 63 72 65 61 | 73 65 64 20 62 79 20 32 |d increa|sed by 2|
|00002ca0| 35 30 20 6d 67 20 65 76 | 65 72 79 20 35 2d 37 20 |50 mg ev|ery 5-7 |
|00002cb0| 64 61 79 73 20 61 73 20 | 74 6f 6c 65 72 61 74 65 |days as |tolerate|
|00002cc0| 64 2e 0d 0a 20 20 20 20 | 20 4e 65 61 72 6c 79 20 |d... | Nearly |
|00002cd0| 74 77 6f 20 74 68 69 72 | 64 73 20 6f 66 20 74 68 |two thir|ds of th|
|00002ce0| 65 20 70 61 74 69 65 6e | 74 73 20 77 65 72 65 20 |e patien|ts were |
|00002cf0| 72 65 73 69 73 74 61 6e | 74 20 74 6f 20 65 69 74 |resistan|t to eit|
|00002d00| 68 65 72 20 6c 69 74 68 | 69 75 6d 20 6f 72 0d 0a |her lith|ium or..|
|00002d10| 63 61 72 62 61 6d 61 7a | 65 70 69 6e 65 3b 20 32 |carbamaz|epine; 2|
|00002d20| 30 20 70 61 74 69 65 6e | 74 73 20 72 65 63 65 69 |0 patien|ts recei|
|00002d30| 76 65 64 20 76 61 6c 70 | 72 6f 61 74 65 20 61 6c |ved valp|roate al|
|00002d40| 6f 6e 65 20 61 6e 64 20 | 33 35 20 72 65 63 65 69 |one and |35 recei|
|00002d50| 76 65 64 20 69 74 20 69 | 6e 0d 0a 63 6f 6e 6a 75 |ved it i|n..conju|
|00002d60| 6e 63 74 69 6f 6e 20 77 | 69 74 68 20 6f 74 68 65 |nction w|ith othe|
|00002d70| 72 20 74 72 65 61 74 6d | 65 6e 74 2e 20 20 54 68 |r treatm|ent. Th|
|00002d80| 65 20 6d 65 61 6e 20 64 | 75 72 61 74 69 6f 6e 20 |e mean d|uration |
|00002d90| 6f 66 20 74 68 65 20 74 | 72 69 61 6c 20 77 61 73 |of the t|rial was|
|00002da0| 20 38 0d 0a 6d 6f 6e 74 | 68 73 2e 20 20 41 20 6d | 8..mont|hs. A m|
|00002db0| 6f 64 65 72 61 74 65 20 | 6f 72 20 6d 61 72 6b 65 |oderate |or marke|
|00002dc0| 64 20 61 63 75 74 65 20 | 61 6e 74 69 64 65 70 72 |d acute |antidepr|
|00002dd0| 65 73 73 61 6e 74 20 72 | 65 73 70 6f 6e 73 65 20 |essant r|esponse |
|00002de0| 6f 63 63 75 72 72 65 64 | 20 69 6e 20 34 37 25 20 |occurred| in 47% |
|00002df0| 6f 66 0d 0a 74 68 65 20 | 70 61 74 69 65 6e 74 73 |of..the |patients|
|00002e00| 20 61 6e 64 20 61 20 70 | 72 6f 70 68 79 6c 61 63 | and a p|rophylac|
|00002e10| 74 69 63 20 61 6e 74 69 | 64 65 70 72 65 73 73 61 |tic anti|depressa|
|00002e20| 6e 74 20 72 65 73 70 6f | 6e 73 65 20 69 6e 20 37 |nt respo|nse in 7|
|00002e30| 36 25 2e 20 20 41 6e 74 | 69 6d 61 6e 69 63 0d 0a |6%. Ant|imanic..|
|00002e40| 65 66 66 69 63 61 63 79 | 20 65 78 63 65 65 64 65 |efficacy| exceede|
|00002e50| 64 20 39 30 25 20 6f 6e | 20 62 6f 74 68 20 61 6e |d 90% on| both an|
|00002e60| 20 61 63 75 74 65 20 61 | 6e 64 20 70 72 6f 70 68 | acute a|nd proph|
|00002e70| 79 6c 61 63 74 69 63 20 | 62 61 73 69 73 2e 20 20 |ylactic |basis. |
|00002e80| 4f 66 20 70 61 74 69 65 | 6e 74 73 0d 0a 77 69 74 |Of patie|nts..wit|
|00002e90| 68 20 6d 69 78 65 64 20 | 73 74 61 74 65 73 2c 20 |h mixed |states, |
|00002ea0| 38 35 25 20 68 61 64 20 | 61 20 74 68 65 72 61 70 |85% had |a therap|
|00002eb0| 65 75 74 69 63 20 61 6e | 64 20 39 33 25 20 68 61 |eutic an|d 93% ha|
|00002ec0| 64 20 61 20 70 72 6f 70 | 68 79 6c 61 63 74 69 63 |d a prop|hylactic|
|00002ed0| 20 72 65 73 70 6f 6e 73 | 65 0d 0a 74 6f 20 76 61 | respons|e..to va|
|00002ee0| 6c 70 72 6f 61 74 65 2e | 20 20 41 62 6f 75 74 20 |lproate.| About |
|00002ef0| 68 61 6c 66 20 6f 66 20 | 74 68 65 20 70 61 74 69 |half of |the pati|
|00002f00| 65 6e 74 73 20 68 61 64 | 20 73 69 64 65 20 65 66 |ents had| side ef|
|00002f10| 66 65 63 74 73 2c 20 6d | 6f 73 74 20 6f 66 74 65 |fects, m|ost ofte|
|00002f20| 6e 0d 0a 69 6e 76 6f 6c | 76 69 6e 67 20 74 68 65 |n..invol|ving the|
|00002f30| 20 67 61 73 74 72 6f 69 | 6e 74 65 73 74 69 6e 61 | gastroi|ntestina|
|00002f40| 6c 20 74 72 61 63 74 2e | 20 20 54 72 65 61 74 6d |l tract.| Treatm|
|00002f50| 65 6e 74 20 77 61 73 20 | 73 74 6f 70 70 65 64 20 |ent was |stopped |
|00002f60| 69 6e 20 34 20 70 61 74 | 69 65 6e 74 73 0d 0a 62 |in 4 pat|ients..b|
|00002f70| 65 63 61 75 73 65 20 6f | 66 20 73 69 64 65 20 65 |ecause o|f side e|
|00002f80| 66 66 65 63 74 73 20 61 | 6e 64 20 69 6e 20 35 20 |ffects a|nd in 5 |
|00002f90| 62 65 63 61 75 73 65 20 | 6f 66 20 61 20 6c 61 63 |because |of a lac|
|00002fa0| 6b 20 6f 66 20 61 6e 74 | 69 64 65 70 72 65 73 73 |k of ant|idepress|
|00002fb0| 61 6e 74 20 65 66 66 69 | 63 61 63 79 2e 0d 0a 20 |ant effi|cacy... |
|00002fc0| 20 20 20 20 54 68 65 20 | 65 66 66 69 63 61 63 79 | The |efficacy|
|00002fd0| 20 6f 66 20 76 61 6c 70 | 72 6f 61 74 65 20 69 6e | of valp|roate in|
|00002fe0| 20 6d 61 6e 69 63 20 61 | 6e 64 20 6d 69 78 65 64 | manic a|nd mixed|
|00002ff0| 20 73 74 61 74 65 73 20 | 69 73 20 6d 6f 72 65 20 | states |is more |
|00003000| 69 6d 70 72 65 73 73 69 | 76 65 0d 0a 74 68 61 6e |impressi|ve..than|
|00003010| 20 69 74 73 20 61 6e 74 | 69 64 65 70 72 65 73 73 | its ant|idepress|
|00003020| 61 6e 74 20 70 72 6f 70 | 65 72 74 69 65 73 2e 20 |ant prop|erties. |
|00003030| 20 41 20 73 65 6c 66 2d | 61 64 6d 69 6e 69 73 74 | A self-|administ|
|00003040| 65 72 65 64 20 72 61 74 | 69 6e 67 20 73 63 61 6c |ered rat|ing scal|
|00003050| 65 20 77 6f 75 6c 64 0d | 0a 6d 61 6b 65 20 69 74 |e would.|.make it|
|00003060| 20 65 61 73 69 65 72 20 | 74 6f 20 61 73 73 65 73 | easier |to asses|
|00003070| 73 20 74 72 65 61 74 6d | 65 6e 74 20 65 66 66 65 |s treatm|ent effe|
|00003080| 63 74 73 20 69 6e 20 72 | 61 70 69 64 2d 63 79 63 |cts in r|apid-cyc|
|00003090| 6c 69 6e 67 20 70 61 74 | 69 65 6e 74 73 2e 0d 0a |ling pat|ients...|
|000030a0| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|000030b0| 0d 0a 20 20 20 20 20 53 | 6f 6d 65 20 65 66 66 69 |.. S|ome effi|
|000030c0| 63 61 63 79 20 6f 66 20 | 76 61 6c 70 72 6f 61 74 |cacy of |valproat|
|000030d0| 65 20 69 6e 20 74 68 65 | 20 74 72 65 61 74 6d 65 |e in the| treatme|
|000030e0| 6e 74 20 6f 66 20 74 68 | 65 20 61 63 74 69 76 65 |nt of th|e active|
|000030f0| 20 73 79 6d 70 74 6f 6d | 20 70 68 61 73 65 0d 0a | symptom| phase..|
|00003100| 6f 66 20 62 69 70 6f 6c | 61 72 20 69 6c 6c 6e 65 |of bipol|ar illne|
|00003110| 73 73 20 68 61 73 20 62 | 65 65 6e 20 64 6f 63 75 |ss has b|een docu|
|00003120| 6d 65 6e 74 65 64 2e 20 | 20 49 74 73 20 70 6f 74 |mented. | Its pot|
|00003130| 65 6e 74 69 61 6c 20 75 | 74 69 6c 69 74 79 20 69 |ential u|tility i|
|00003140| 73 20 62 65 69 6e 67 0d | 0a 65 78 70 61 6e 64 65 |s being.|.expande|
|00003150| 64 20 74 6f 20 69 6e 63 | 6c 75 64 65 20 72 61 70 |d to inc|lude rap|
|00003160| 69 64 20 63 79 63 6c 69 | 6e 67 20 62 69 70 6f 6c |id cycli|ng bipol|
|00003170| 61 72 20 64 69 73 6f 72 | 64 65 72 2e 20 20 48 6f |ar disor|der. Ho|
|00003180| 77 65 76 65 72 2c 20 73 | 74 69 6c 6c 20 6c 61 63 |wever, s|till lac|
|00003190| 6b 69 6e 67 0d 0a 61 72 | 65 20 74 72 69 61 6c 73 |king..ar|e trials|
|000031a0| 20 74 6f 20 66 75 6c 6c | 79 20 64 65 6c 69 6e 65 | to full|y deline|
|000031b0| 61 74 65 20 74 68 65 20 | 72 6f 6c 65 20 6f 66 20 |ate the |role of |
|000031c0| 76 61 6c 70 72 6f 61 74 | 65 20 69 6e 20 6d 61 69 |valproat|e in mai|
|000031d0| 6e 74 65 6e 61 6e 63 65 | 20 73 74 75 64 69 65 73 |ntenance| studies|
|000031e0| 2e 0d 0a 54 68 65 20 6c | 69 6d 69 74 65 64 20 64 |...The l|imited d|
|000031f0| 61 74 61 20 74 6f 20 64 | 61 74 65 20 73 75 67 67 |ata to d|ate sugg|
|00003200| 65 73 74 20 74 68 61 74 | 20 69 74 73 20 76 61 6c |est that| its val|
|00003210| 75 65 20 69 6e 20 74 68 | 69 73 20 72 65 67 61 72 |ue in th|is regar|
|00003220| 64 20 6d 61 79 20 62 65 | 0d 0a 6c 69 6d 69 74 65 |d may be|..limite|
|00003230| 64 2e 2d 2d 44 2e 58 2e | 20 46 72 65 65 64 6d 61 |d.--D.X.| Freedma|
|00003240| 6e 2c 20 4d 2e 44 2e 2c | 20 61 6e 64 20 42 2e 48 |n, M.D.,| and B.H|
|00003250| 2e 20 47 75 7a 65 2c 20 | 4d 2e 44 2e 0d 0a 24 55 |. Guze, |M.D...$U|
|00003260| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 33 34 30 |nique_ID|{YRB0340|
|00003270| 33 7d 0d 0a 24 54 69 74 | 6c 65 7b 41 20 43 6f 6d |3}..$Tit|le{A Com|
|00003280| 70 61 72 69 73 6f 6e 20 | 6f 66 20 54 77 6f 20 41 |parison |of Two A|
|00003290| 64 6a 75 6e 63 74 69 76 | 65 20 54 72 65 61 74 6d |djunctiv|e Treatm|
|000032a0| 65 6e 74 20 53 74 72 61 | 74 65 67 69 65 73 20 69 |ent Stra|tegies i|
|000032b0| 6e 20 41 63 75 74 65 20 | 4d 61 6e 69 61 7d 0d 0a |n Acute |Mania}..|
|000032c0| 24 41 75 74 68 6f 72 7b | 0d 0a 42 75 73 63 68 2c |$Author{|..Busch,|
|000032d0| 20 46 4e 0d 0a 4d 69 6c | 6c 65 72 2c 20 46 54 0d | FN..Mil|ler, FT.|
|000032e0| 0a 57 65 69 64 65 6e 2c | 20 50 4a 7d 0d 0a 24 41 |.Weiden,| PJ}..$A|
|000032f0| 66 66 69 6c 69 61 74 69 | 6f 6e 7b 43 6f 72 6e 65 |ffiliati|on{Corne|
|00003300| 6c 6c 20 55 6e 69 76 3b | 20 50 61 79 6e 65 20 57 |ll Univ;| Payne W|
|00003310| 68 69 74 6e 65 79 20 43 | 6c 69 6e 69 63 2c 20 4e |hitney C|linic, N|
|00003320| 65 77 20 59 6f 72 6b 20 | 48 6f 73 70 7d 0d 0a 24 |ew York |Hosp}..$|
|00003330| 4a 6f 75 72 6e 61 6c 7b | 4a 20 43 6c 69 6e 20 50 |Journal{|J Clin P|
|00003340| 73 79 63 68 69 61 74 72 | 79 7d 0d 0a 24 56 6f 6c |sychiatr|y}..$Vol|
|00003350| 75 6d 65 7b 35 30 7d 0d | 0a 24 50 61 67 65 7b 34 |ume{50}.|.$Page{4|
|00003360| 35 33 2d 34 35 35 7d 0d | 0a 24 44 61 74 65 7b 31 |53-455}.|.$Date{1|
|00003370| 39 38 39 7d 0d 0a 24 59 | 42 56 6f 6c 7b 31 39 39 |989}..$Y|BVol{199|
|00003380| 31 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 50 |1 Year B|ook of P|
|00003390| 73 79 63 68 69 61 74 72 | 79 20 61 6e 64 20 41 70 |sychiatr|y and Ap|
|000033a0| 70 6c 69 65 64 20 4d 65 | 6e 74 61 6c 20 48 65 61 |plied Me|ntal Hea|
|000033b0| 6c 74 68 7d 0d 0a 24 43 | 68 61 70 74 65 72 7b 37 |lth}..$C|hapter{7|
|000033c0| 2d 32 35 7d 0d 0a 24 59 | 42 45 64 69 74 6f 72 7b |-25}..$Y|BEditor{|
|000033d0| 44 72 73 2e 20 54 61 6c | 62 6f 74 74 2c 20 46 72 |Drs. Tal|bott, Fr|
|000033e0| 61 6e 63 65 73 2c 20 46 | 72 65 65 64 6d 61 6e 2c |ances, F|reedman,|
|000033f0| 20 4d 65 6c 74 7a 65 72 | 2c 20 50 65 72 72 79 2c | Meltzer|, Perry,|
|00003400| 20 53 63 68 6f 77 61 6c | 74 65 72 2c 20 61 6e 64 | Schowal|ter, and|
|00003410| 0d 0a 59 75 64 6f 66 73 | 6b 79 7d 0d 0a 24 54 61 |..Yudofs|ky}..$Ta|
|00003420| 62 6c 65 7b 7d 0d 0a 24 | 43 6f 6d 6d 65 6e 74 61 |ble{}..$|Commenta|
|00003430| 74 6f 72 7b 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |tor{}...|.Copyrig|
|00003440| 68 74 20 28 43 29 20 59 | 65 61 72 20 42 6f 6f 6b |ht (C) Y|ear Book|
|00003450| 20 4d 65 64 69 63 61 6c | 20 50 75 62 6c 69 73 68 | Medical| Publish|
|00003460| 65 72 73 2c 20 49 6e 63 | 2e 20 31 39 39 31 0d 0a |ers, Inc|. 1991..|
|00003470| 0d 0a 31 39 39 31 20 59 | 65 61 72 20 42 6f 6f 6b |..1991 Y|ear Book|
|00003480| 20 6f 66 20 50 73 79 63 | 68 69 61 74 72 79 20 61 | of Psyc|hiatry a|
|00003490| 6e 64 20 41 70 70 6c 69 | 65 64 20 4d 65 6e 74 61 |nd Appli|ed Menta|
|000034a0| 6c 20 48 65 61 6c 74 68 | 0d 0a 0d 0a 43 68 61 70 |l Health|....Chap|
|000034b0| 74 65 72 20 37 20 2d 2d | 20 50 73 79 63 68 6f 70 |ter 7 --| Psychop|
|000034c0| 68 61 72 6d 61 63 6f 6c | 6f 67 79 0d 0a 0d 0a 2d |harmacol|ogy....-|
|000034d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000034e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000034f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003500| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003510| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 41 |--------|-----..A|
|00003520| 20 43 6f 6d 70 61 72 69 | 73 6f 6e 20 6f 66 20 54 | Compari|son of T|
|00003530| 77 6f 20 41 64 6a 75 6e | 63 74 69 76 65 20 54 72 |wo Adjun|ctive Tr|
|00003540| 65 61 74 6d 65 6e 74 20 | 53 74 72 61 74 65 67 69 |eatment |Strategi|
|00003550| 65 73 20 69 6e 20 41 63 | 75 74 65 20 4d 61 6e 69 |es in Ac|ute Mani|
|00003560| 61 0d 0a 0d 0a 42 75 73 | 63 68 20 46 4e 3b 20 4d |a....Bus|ch FN; M|
|00003570| 69 6c 6c 65 72 20 46 54 | 3b 20 57 65 69 64 65 6e |iller FT|; Weiden|
|00003580| 20 50 4a 0d 0a 28 43 6f | 72 6e 65 6c 6c 20 55 6e | PJ..(Co|rnell Un|
|00003590| 69 76 3b 20 50 61 79 6e | 65 20 57 68 69 74 6e 65 |iv; Payn|e Whitne|
|000035a0| 79 20 43 6c 69 6e 69 63 | 2c 20 4e 65 77 20 59 6f |y Clinic|, New Yo|
|000035b0| 72 6b 20 48 6f 73 70 29 | 0d 0a 4a 20 43 6c 69 6e |rk Hosp)|..J Clin|
|000035c0| 20 50 73 79 63 68 69 61 | 74 72 79 20 35 30 3a 34 | Psychia|try 50:4|
|000035d0| 35 33 2d 34 35 35 2c 20 | 31 39 38 39 0d 0a 2d 2d |53-455, |1989..--|
|000035e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000035f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00003630| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00003640| 20 4e 65 75 72 6f 6c 65 | 70 74 69 63 20 64 72 75 | Neurole|ptic dru|
|00003650| 67 73 20 61 72 65 20 61 | 64 6d 69 6e 69 73 74 65 |gs are a|dministe|
|00003660| 72 65 64 20 72 6f 75 74 | 69 6e 65 6c 79 20 74 6f |red rout|inely to|
|00003670| 20 6e 65 77 6c 79 20 61 | 64 6d 69 74 74 65 64 20 | newly a|dmitted |
|00003680| 62 69 70 6f 6c 61 72 0d | 0a 6d 61 6e 69 63 20 70 |bipolar.|.manic p|
|00003690| 61 74 69 65 6e 74 73 2c | 20 62 75 74 20 74 68 65 |atients,| but the|
|000036a0| 69 72 20 75 73 65 20 63 | 61 6e 20 72 65 73 75 6c |ir use c|an resul|
|000036b0| 74 20 69 6e 20 73 65 76 | 65 72 65 20 73 69 64 65 |t in sev|ere side|
|000036c0| 20 65 66 66 65 63 74 73 | 2e 20 20 4c 6f 77 20 74 | effects|. Low t|
|000036d0| 6f 0d 0a 6d 6f 64 65 72 | 61 74 65 20 64 6f 73 65 |o..moder|ate dose|
|000036e0| 73 20 6f 66 20 6e 65 75 | 72 6f 6c 65 70 74 69 63 |s of neu|roleptic|
|000036f0| 73 20 6d 61 79 20 62 65 | 20 65 71 75 61 6c 20 6f |s may be| equal o|
|00003700| 72 20 65 76 65 6e 20 73 | 75 70 65 72 69 6f 72 20 |r even s|uperior |
|00003710| 74 6f 20 68 69 67 68 20 | 64 6f 73 65 73 2e 0d 0a |to high |doses...|
|00003720| 54 68 65 20 72 65 73 75 | 6c 74 73 20 6f 66 20 75 |The resu|lts of u|
|00003730| 73 69 6e 67 20 73 69 67 | 6e 69 66 69 63 61 6e 74 |sing sig|nificant|
|00003740| 6c 79 20 64 65 63 72 65 | 61 73 65 64 20 6e 65 75 |ly decre|ased neu|
|00003750| 72 6f 6c 65 70 74 69 63 | 20 64 6f 73 65 73 20 63 |roleptic| doses c|
|00003760| 6f 6d 62 69 6e 65 64 20 | 77 69 74 68 0d 0a 62 65 |ombined |with..be|
|00003770| 6e 7a 6f 64 69 61 7a 65 | 70 69 6e 65 73 20 77 65 |nzodiaze|pines we|
|00003780| 72 65 20 65 76 61 6c 75 | 61 74 65 64 20 69 6e 20 |re evalu|ated in |
|00003790| 33 30 20 6e 65 77 6c 79 | 20 61 64 6d 69 74 74 65 |30 newly| admitte|
|000037a0| 64 20 6d 61 6e 69 63 20 | 70 61 74 69 65 6e 74 73 |d manic |patients|
|000037b0| 20 77 68 6f 20 77 65 72 | 65 0d 0a 67 69 76 65 6e | who wer|e..given|
|000037c0| 20 6c 6f 77 2d 64 6f 73 | 65 20 6e 65 75 72 6f 6c | low-dos|e neurol|
|000037d0| 65 70 74 69 63 73 2d 2d | 63 68 6c 6f 72 70 72 6f |eptics--|chlorpro|
|000037e0| 6d 61 7a 69 6e 65 20 65 | 71 75 69 76 61 6c 65 6e |mazine e|quivalen|
|000037f0| 74 73 20 28 33 31 30 20 | 6d 67 2f 64 61 79 29 2d |ts (310 |mg/day)-|
|00003800| 2d 61 6e 64 0d 0a 62 65 | 6e 7a 6f 64 69 61 7a 65 |-and..be|nzodiaze|
|00003810| 70 69 6e 65 73 2d 2d 6c | 6f 72 61 7a 65 70 61 6d |pines--l|orazepam|
|00003820| 20 65 71 75 69 76 61 6c | 65 6e 74 73 20 28 31 2e | equival|ents (1.|
|00003830| 36 20 6d 67 2f 64 61 79 | 29 2e 20 20 41 20 72 65 |6 mg/day|). A re|
|00003840| 74 72 6f 73 70 65 63 74 | 69 76 65 0d 0a 63 6f 6d |trospect|ive..com|
|00003850| 70 61 72 69 73 6f 6e 20 | 77 61 73 20 6d 61 64 65 |parison |was made|
|00003860| 20 77 69 74 68 20 72 65 | 73 75 6c 74 73 20 69 6e | with re|sults in|
|00003870| 20 33 30 20 73 69 6d 69 | 6c 61 72 20 70 61 74 69 | 30 simi|lar pati|
|00003880| 65 6e 74 73 20 67 69 76 | 65 6e 20 73 74 61 6e 64 |ents giv|en stand|
|00003890| 61 72 64 20 64 6f 73 65 | 73 0d 0a 6f 66 20 6e 65 |ard dose|s..of ne|
|000038a0| 75 72 6f 6c 65 70 74 69 | 63 2d 2d 63 68 6c 6f 72 |urolepti|c--chlor|
|000038b0| 70 72 6f 6d 61 7a 69 6e | 65 20 65 71 75 69 76 61 |promazin|e equiva|
|000038c0| 6c 65 6e 74 73 2c 20 35 | 39 30 20 6d 67 2f 64 61 |lents, 5|90 mg/da|
|000038d0| 79 2c 20 6f 72 20 6c 6f | 72 61 7a 65 70 61 6d 0d |y, or lo|razepam.|
|000038e0| 0a 65 71 75 69 76 61 6c | 65 6e 74 73 2c 20 2e 30 |.equival|ents, .0|
|000038f0| 39 20 6d 67 2f 64 61 79 | 2e 0d 0a 20 20 20 20 20 |9 mg/day|... |
|00003900| 54 68 65 20 70 61 74 69 | 65 6e 74 73 20 74 72 65 |The pati|ents tre|
|00003910| 61 74 65 64 20 77 69 74 | 68 20 74 68 65 20 62 65 |ated wit|h the be|
|00003920| 6e 7a 6f 64 69 61 7a 65 | 70 69 6e 65 2d 6e 65 75 |nzodiaze|pine-neu|
|00003930| 72 6f 6c 65 70 74 69 63 | 20 63 6f 6d 62 69 6e 61 |roleptic| combina|
|00003940| 74 69 6f 6e 20 68 61 64 | 0d 0a 73 69 67 6e 69 66 |tion had|..signif|
|00003950| 69 63 61 6e 74 6c 79 20 | 66 65 77 65 72 20 73 65 |icantly |fewer se|
|00003960| 63 6c 75 73 69 6f 6e 20 | 61 6e 64 20 72 65 73 74 |clusion |and rest|
|00003970| 72 61 69 6e 74 20 65 70 | 69 73 6f 64 65 73 20 74 |raint ep|isodes t|
|00003980| 68 61 6e 20 74 68 6f 73 | 65 20 74 72 65 61 74 65 |han thos|e treate|
|00003990| 64 20 77 69 74 68 0d 0a | 73 74 61 6e 64 61 72 64 |d with..|standard|
|000039a0| 20 64 6f 73 65 73 20 6f | 66 20 6e 65 75 72 6f 6c | doses o|f neurol|
|000039b0| 65 70 74 69 63 73 2e 20 | 20 54 68 65 20 32 20 67 |eptics. | The 2 g|
|000039c0| 72 6f 75 70 73 20 77 65 | 72 65 20 63 6f 6d 70 61 |roups we|re compa|
|000039d0| 72 61 62 6c 65 20 6f 6e | 20 6f 74 68 65 72 0d 0a |rable on| other..|
|000039e0| 70 61 72 61 6d 65 74 65 | 72 73 2e 0d 0a 20 20 20 |paramete|rs... |
|000039f0| 20 20 43 6c 69 6e 69 63 | 69 61 6e 73 20 63 61 6e | Clinic|ians can|
|00003a00| 20 61 6e 64 20 73 68 6f | 75 6c 64 20 75 73 65 20 | and sho|uld use |
|00003a10| 6c 6f 77 65 72 20 64 6f | 73 65 73 20 6f 66 20 6e |lower do|ses of n|
|00003a20| 65 75 72 6f 6c 65 70 74 | 69 63 73 20 77 68 65 6e |eurolept|ics when|
|00003a30| 20 74 72 65 61 74 69 6e | 67 0d 0a 61 63 75 74 65 | treatin|g..acute|
|00003a40| 20 70 73 79 63 68 6f 73 | 69 73 2e 20 20 42 65 6e | psychos|is. Ben|
|00003a50| 7a 6f 64 69 61 7a 65 70 | 69 6e 65 73 2c 20 6e 6f |zodiazep|ines, no|
|00003a60| 74 20 68 69 67 68 65 72 | 20 64 6f 73 65 73 20 6f |t higher| doses o|
|00003a70| 66 20 6e 65 75 72 6f 6c | 65 70 74 69 63 73 2c 20 |f neurol|eptics, |
|00003a80| 73 68 6f 75 6c 64 20 62 | 65 0d 0a 75 73 65 64 20 |should b|e..used |
|00003a90| 74 6f 20 74 72 65 61 74 | 20 63 6f 6e 63 6f 6d 69 |to treat| concomi|
|00003aa0| 74 61 6e 74 20 73 79 6d | 70 74 6f 6d 73 20 61 6e |tant sym|ptoms an|
|00003ab0| 64 20 73 69 67 6e 73 20 | 6f 66 20 61 67 69 74 61 |d signs |of agita|
|00003ac0| 74 69 6f 6e 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |tion....|.Post-Co|
|00003ad0| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 53 65 |mment...|. Se|
|00003ae0| 76 65 72 61 6c 20 70 68 | 61 72 6d 61 63 6f 6c 6f |veral ph|armacolo|
|00003af0| 67 69 63 20 6f 70 74 69 | 6f 6e 73 20 61 72 65 20 |gic opti|ons are |
|00003b00| 61 76 61 69 6c 61 62 6c | 65 20 74 6f 20 74 68 65 |availabl|e to the|
|00003b10| 20 63 6c 69 6e 69 63 69 | 61 6e 20 66 6f 72 20 74 | clinici|an for t|
|00003b20| 68 65 0d 0a 74 72 65 61 | 74 6d 65 6e 74 20 6f 66 |he..trea|tment of|
|00003b30| 20 61 63 75 74 65 20 6d | 61 6e 69 61 2e 20 20 54 | acute m|ania. T|
|00003b40| 68 65 20 63 6f 6d 62 69 | 6e 61 74 69 6f 6e 20 6f |he combi|nation o|
|00003b50| 66 20 61 20 68 69 67 68 | 20 70 6f 74 65 6e 63 79 |f a high| potency|
|00003b60| 20 62 65 6e 7a 6f 64 69 | 61 7a 65 70 69 6e 65 0d | benzodi|azepine.|
|00003b70| 0a 77 69 74 68 20 61 20 | 6e 65 75 72 6f 6c 65 70 |.with a |neurolep|
|00003b80| 74 69 63 20 69 73 20 61 | 6e 20 65 78 74 72 65 6d |tic is a|n extrem|
|00003b90| 65 6c 79 20 65 66 66 65 | 63 74 69 76 65 20 61 70 |ely effe|ctive ap|
|00003ba0| 70 72 6f 61 63 68 20 66 | 6f 72 20 74 68 65 20 74 |proach f|or the t|
|00003bb0| 72 65 61 74 6d 65 6e 74 | 20 6f 66 0d 0a 61 63 75 |reatment| of..acu|
|00003bc0| 74 65 20 6d 61 6e 69 61 | 20 77 68 65 6e 20 61 67 |te mania| when ag|
|00003bd0| 69 74 61 74 69 6f 6e 20 | 69 73 20 61 6e 20 69 6d |itation |is an im|
|00003be0| 70 6f 72 74 61 6e 74 20 | 63 6c 69 6e 69 63 61 6c |portant |clinical|
|00003bf0| 20 69 73 73 75 65 2e 20 | 20 54 68 69 73 20 61 70 | issue. | This ap|
|00003c00| 70 72 6f 61 63 68 0d 0a | 61 70 70 65 61 72 73 20 |proach..|appears |
|00003c10| 74 6f 20 62 65 20 73 61 | 66 65 20 61 6e 64 20 65 |to be sa|fe and e|
|00003c20| 66 66 65 63 74 69 76 65 | 20 69 6e 20 6d 6f 73 74 |ffective| in most|
|00003c30| 20 70 61 74 69 65 6e 74 | 73 20 61 6e 64 20 72 61 | patient|s and ra|
|00003c40| 70 69 64 6c 79 20 63 6f | 6e 74 72 6f 6c 73 20 74 |pidly co|ntrols t|
|00003c50| 61 72 67 65 74 0d 0a 73 | 79 6d 70 74 6f 6d 73 2e |arget..s|ymptoms.|
|00003c60| 20 20 49 6e 64 65 65 64 | 2c 20 69 74 20 68 61 73 | Indeed|, it has|
|00003c70| 20 62 65 65 6e 20 73 75 | 67 67 65 73 74 65 64 20 | been su|ggested |
|00003c80| 74 68 61 74 20 67 61 6d | 6d 61 2d 61 6d 69 6e 6f |that gam|ma-amino|
|00003c90| 62 75 74 79 72 69 63 20 | 61 63 69 64 20 6d 61 79 |butyric |acid may|
|00003ca0| 0d 0a 70 6c 61 79 20 61 | 20 72 6f 6c 65 20 69 6e |..play a| role in|
|00003cb0| 20 74 68 65 20 70 61 74 | 68 6f 70 68 79 73 69 6f | the pat|hophysio|
|00003cc0| 6c 6f 67 79 20 6f 66 20 | 6d 6f 6f 64 20 64 69 73 |logy of |mood dis|
|00003cd0| 6f 72 64 65 72 73 2e 20 | 28 31 29 2d 2d 44 2e 58 |orders. |(1)--D.X|
|00003ce0| 2e 20 46 72 65 65 64 6d | 61 6e 2c 0d 0a 4d 2e 44 |. Freedm|an,..M.D|
|00003cf0| 2e 2c 20 61 6e 64 20 42 | 2e 48 2e 20 47 75 7a 65 |., and B|.H. Guze|
|00003d00| 2c 20 4d 2e 44 2e 0d 0a | 24 55 6e 69 71 75 65 5f |, M.D...|$Unique_|
|00003d10| 49 44 7b 59 52 42 30 33 | 34 30 34 7d 0d 0a 24 54 |ID{YRB03|404}..$T|
|00003d20| 69 74 6c 65 7b 54 68 65 | 20 41 64 64 69 74 69 6f |itle{The| Additio|
|00003d30| 6e 20 6f 66 20 4c 69 74 | 68 69 75 6d 20 74 6f 20 |n of Lit|hium to |
|00003d40| 43 61 72 62 61 6d 61 7a | 65 70 69 6e 65 3a 20 20 |Carbamaz|epine: |
|00003d50| 41 6e 74 69 64 65 70 72 | 65 73 73 61 6e 74 20 45 |Antidepr|essant E|
|00003d60| 66 66 69 63 61 63 79 20 | 69 6e 0d 0a 54 72 65 61 |fficacy |in..Trea|
|00003d70| 74 6d 65 6e 74 2d 52 65 | 73 69 73 74 61 6e 74 20 |tment-Re|sistant |
|00003d80| 44 65 70 72 65 73 73 69 | 6f 6e 7d 0d 0a 24 41 75 |Depressi|on}..$Au|
|00003d90| 74 68 6f 72 7b 0d 0a 4b | 72 61 6d 6c 69 6e 67 65 |thor{..K|ramlinge|
|00003da0| 72 2c 20 4b 47 0d 0a 50 | 6f 73 74 2c 20 52 4d 7d |r, KG..P|ost, RM}|
|00003db0| 0d 0a 24 41 66 66 69 6c | 69 61 74 69 6f 6e 7b 4e |..$Affil|iation{N|
|00003dc0| 61 74 6c 20 49 6e 73 74 | 20 6f 66 20 4d 65 6e 74 |atl Inst| of Ment|
|00003dd0| 61 6c 20 48 65 61 6c 74 | 68 2c 20 42 65 74 68 65 |al Healt|h, Bethe|
|00003de0| 73 64 61 2c 20 4d 64 7d | 0d 0a 24 4a 6f 75 72 6e |sda, Md}|..$Journ|
|00003df0| 61 6c 7b 41 72 63 68 20 | 47 65 6e 20 50 73 79 63 |al{Arch |Gen Psyc|
|00003e00| 68 69 61 74 72 79 7d 0d | 0a 24 56 6f 6c 75 6d 65 |hiatry}.|.$Volume|
|00003e10| 7b 34 36 7d 0d 0a 24 50 | 61 67 65 7b 37 39 34 2d |{46}..$P|age{794-|
|00003e20| 38 30 30 7d 0d 0a 24 44 | 61 74 65 7b 31 39 38 39 |800}..$D|ate{1989|
|00003e30| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 39 31 20 59 |}..$YBVo|l{1991 Y|
|00003e40| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 50 73 79 63 |ear Book| of Psyc|
|00003e50| 68 69 61 74 72 79 20 61 | 6e 64 20 41 70 70 6c 69 |hiatry a|nd Appli|
|00003e60| 65 64 20 4d 65 6e 74 61 | 6c 20 48 65 61 6c 74 68 |ed Menta|l Health|
|00003e70| 7d 0d 0a 24 43 68 61 70 | 74 65 72 7b 37 2d 32 36 |}..$Chap|ter{7-26|
|00003e80| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|00003e90| 2e 20 54 61 6c 62 6f 74 | 74 2c 20 46 72 61 6e 63 |. Talbot|t, Franc|
|00003ea0| 65 73 2c 20 46 72 65 65 | 64 6d 61 6e 2c 20 4d 65 |es, Free|dman, Me|
|00003eb0| 6c 74 7a 65 72 2c 20 50 | 65 72 72 79 2c 20 53 63 |ltzer, P|erry, Sc|
|00003ec0| 68 6f 77 61 6c 74 65 72 | 2c 20 61 6e 64 0d 0a 59 |howalter|, and..Y|
|00003ed0| 75 64 6f 66 73 6b 79 7d | 0d 0a 24 54 61 62 6c 65 |udofsky}|..$Table|
|00003ee0| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|00003ef0| 7b 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |{}....Co|pyright |
|00003f00| 28 43 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(C) Year| Book Me|
|00003f10| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|00003f20| 2c 20 49 6e 63 2e 20 31 | 39 39 31 0d 0a 0d 0a 31 |, Inc. 1|991....1|
|00003f30| 39 39 31 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |991 Year| Book of|
|00003f40| 20 50 73 79 63 68 69 61 | 74 72 79 20 61 6e 64 20 | Psychia|try and |
|00003f50| 41 70 70 6c 69 65 64 20 | 4d 65 6e 74 61 6c 20 48 |Applied |Mental H|
|00003f60| 65 61 6c 74 68 0d 0a 0d | 0a 43 68 61 70 74 65 72 |ealth...|.Chapter|
|00003f70| 20 37 20 2d 2d 20 50 73 | 79 63 68 6f 70 68 61 72 | 7 -- Ps|ychophar|
|00003f80| 6d 61 63 6f 6c 6f 67 79 | 0d 0a 0d 0a 2d 2d 2d 2d |macology|....----|
|00003f90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003fa0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003fb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003fc0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003fd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 54 68 65 20 |--------|--..The |
|00003fe0| 41 64 64 69 74 69 6f 6e | 20 6f 66 20 4c 69 74 68 |Addition| of Lith|
|00003ff0| 69 75 6d 20 74 6f 20 43 | 61 72 62 61 6d 61 7a 65 |ium to C|arbamaze|
|00004000| 70 69 6e 65 3a 20 20 41 | 6e 74 69 64 65 70 72 65 |pine: A|ntidepre|
|00004010| 73 73 61 6e 74 20 45 66 | 66 69 63 61 63 79 20 69 |ssant Ef|ficacy i|
|00004020| 6e 0d 0a 54 72 65 61 74 | 6d 65 6e 74 2d 52 65 73 |n..Treat|ment-Res|
|00004030| 69 73 74 61 6e 74 20 44 | 65 70 72 65 73 73 69 6f |istant D|epressio|
|00004040| 6e 0d 0a 0d 0a 4b 72 61 | 6d 6c 69 6e 67 65 72 20 |n....Kra|mlinger |
|00004050| 4b 47 3b 20 50 6f 73 74 | 20 52 4d 0d 0a 28 4e 61 |KG; Post| RM..(Na|
|00004060| 74 6c 20 49 6e 73 74 20 | 6f 66 20 4d 65 6e 74 61 |tl Inst |of Menta|
|00004070| 6c 20 48 65 61 6c 74 68 | 2c 20 42 65 74 68 65 73 |l Health|, Bethes|
|00004080| 64 61 2c 20 4d 64 29 0d | 0a 41 72 63 68 20 47 65 |da, Md).|.Arch Ge|
|00004090| 6e 20 50 73 79 63 68 69 | 61 74 72 79 20 34 36 3a |n Psychi|atry 46:|
|000040a0| 37 39 34 2d 38 30 30 2c | 20 31 39 38 39 0d 0a 2d |794-800,| 1989..-|
|000040b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00004100| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00004110| 20 20 41 20 70 6f 74 65 | 6e 74 69 61 6c 20 73 79 | A pote|ntial sy|
|00004120| 6e 65 72 67 69 73 6d 20 | 62 65 74 77 65 65 6e 20 |nergism |between |
|00004130| 63 61 72 62 61 6d 61 7a | 65 70 69 6e 65 20 61 6e |carbamaz|epine an|
|00004140| 64 20 6c 69 74 68 69 75 | 6d 20 68 61 73 20 62 65 |d lithiu|m has be|
|00004150| 65 6e 20 72 65 70 6f 72 | 74 65 64 0d 0a 69 6e 20 |en repor|ted..in |
|00004160| 74 68 65 20 61 63 75 74 | 65 20 61 6e 64 20 70 72 |the acut|e and pr|
|00004170| 6f 70 68 79 6c 61 63 74 | 69 63 20 74 72 65 61 74 |ophylact|ic treat|
|00004180| 6d 65 6e 74 20 6f 66 20 | 6d 61 6e 69 63 20 70 61 |ment of |manic pa|
|00004190| 74 69 65 6e 74 73 20 77 | 68 6f 20 61 72 65 20 72 |tients w|ho are r|
|000041a0| 65 66 72 61 63 74 6f 72 | 79 0d 0a 74 6f 20 65 61 |efractor|y..to ea|
|000041b0| 63 68 20 61 67 65 6e 74 | 20 61 6c 6f 6e 65 2e 20 |ch agent| alone. |
|000041c0| 20 53 79 6e 65 72 67 69 | 73 6d 20 62 65 74 77 65 | Synergi|sm betwe|
|000041d0| 65 6e 20 6c 69 74 68 69 | 75 6d 20 61 6e 64 20 63 |en lithi|um and c|
|000041e0| 61 72 62 61 6d 61 7a 65 | 70 69 6e 65 20 61 6c 73 |arbamaze|pine als|
|000041f0| 6f 20 6d 61 79 0d 0a 6f | 63 63 75 72 20 69 6e 20 |o may..o|ccur in |
|00004200| 74 72 65 61 74 6d 65 6e | 74 2d 72 65 73 69 73 74 |treatmen|t-resist|
|00004210| 61 6e 74 20 64 65 70 72 | 65 73 73 69 6f 6e 2e 0d |ant depr|ession..|
|00004220| 0a 20 20 20 20 20 54 68 | 65 20 65 66 66 69 63 61 |. Th|e effica|
|00004230| 63 79 20 6f 66 20 6c 69 | 74 68 69 75 6d 20 73 75 |cy of li|thium su|
|00004240| 70 70 6c 65 6d 65 6e 74 | 61 74 69 6f 6e 20 77 61 |pplement|ation wa|
|00004250| 73 20 73 74 75 64 69 65 | 64 20 69 6e 20 31 35 20 |s studie|d in 15 |
|00004260| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 0d 0a 64 |patients| with..d|
|00004270| 65 70 72 65 73 73 69 6f | 6e 20 61 73 20 64 69 61 |epressio|n as dia|
|00004280| 67 6e 6f 73 65 64 20 62 | 79 20 44 53 4d 2d 49 49 |gnosed b|y DSM-II|
|00004290| 49 20 63 72 69 74 65 72 | 69 61 2e 20 20 54 68 65 |I criter|ia. The|
|000042a0| 79 20 68 61 64 20 6e 6f | 74 20 72 65 73 70 6f 6e |y had no|t respon|
|000042b0| 64 65 64 20 74 6f 0d 0a | 64 6f 75 62 6c 65 2d 62 |ded to..|double-b|
|000042c0| 6c 69 6e 64 20 74 72 65 | 61 74 6d 65 6e 74 20 77 |lind tre|atment w|
|000042d0| 69 74 68 20 63 61 72 62 | 61 6d 61 7a 65 70 69 6e |ith carb|amazepin|
|000042e0| 65 2e 20 20 49 6e 20 74 | 68 65 20 63 6f 75 72 73 |e. In t|he cours|
|000042f0| 65 20 6f 66 20 74 72 65 | 61 74 6d 65 6e 74 2c 0d |e of tre|atment,.|
|00004300| 0a 6c 69 74 68 69 75 6d | 20 77 61 73 20 61 64 64 |.lithium| was add|
|00004310| 65 64 20 74 6f 20 63 61 | 72 62 61 6d 61 7a 65 70 |ed to ca|rbamazep|
|00004320| 69 6e 65 20 62 6c 69 6e | 64 6c 79 2e 20 20 45 69 |ine blin|dly. Ei|
|00004330| 67 68 74 20 70 61 74 69 | 65 6e 74 73 2c 20 6f 72 |ght pati|ents, or|
|00004340| 20 35 33 25 2c 20 68 61 | 64 20 61 0d 0a 6d 6f 64 | 53%, ha|d a..mod|
|00004350| 65 72 61 74 65 20 74 6f | 20 6d 61 72 6b 65 64 20 |erate to| marked |
|00004360| 69 6d 70 72 6f 76 65 6d | 65 6e 74 2e 20 20 54 68 |improvem|ent. Th|
|00004370| 65 20 6d 65 61 6e 20 74 | 69 6d 65 20 74 6f 20 6f |e mean t|ime to o|
|00004380| 6e 73 65 74 20 6f 66 20 | 73 75 62 73 74 61 6e 74 |nset of |substant|
|00004390| 69 61 6c 0d 0a 63 6c 69 | 6e 69 63 61 6c 20 69 6d |ial..cli|nical im|
|000043a0| 70 72 6f 76 65 6d 65 6e | 74 20 77 61 73 20 6f 6e |provemen|t was on|
|000043b0| 6c 79 20 34 2e 31 20 64 | 61 79 73 20 77 69 74 68 |ly 4.1 d|ays with|
|000043c0| 20 6c 69 74 68 69 75 6d | 20 70 6f 74 65 6e 74 69 | lithium| potenti|
|000043d0| 61 74 69 6f 6e 20 63 6f | 6d 70 61 72 65 64 20 74 |ation co|mpared t|
|000043e0| 6f 0d 0a 39 2e 37 20 64 | 61 79 73 20 69 6e 20 61 |o..9.7 d|ays in a|
|000043f0| 20 73 65 70 61 72 61 74 | 65 20 67 72 6f 75 70 20 | separat|e group |
|00004400| 6f 66 20 64 65 70 72 65 | 73 73 65 64 20 70 61 74 |of depre|ssed pat|
|00004410| 69 65 6e 74 73 20 77 68 | 6f 20 72 65 73 70 6f 6e |ients wh|o respon|
|00004420| 64 65 64 20 74 6f 20 6c | 69 74 68 69 75 6d 0d 0a |ded to l|ithium..|
|00004430| 61 6c 6f 6e 65 2e 20 20 | 54 68 65 20 63 61 72 62 |alone. |The carb|
|00004440| 61 6d 61 7a 65 70 69 6e | 65 2d 6c 69 74 68 69 75 |amazepin|e-lithiu|
|00004450| 6d 20 63 6f 6d 62 69 6e | 61 74 69 6f 6e 20 74 72 |m combin|ation tr|
|00004460| 65 61 74 6d 65 6e 74 20 | 70 72 6f 64 75 63 65 64 |eatment |produced|
|00004470| 20 6d 69 6e 69 6d 61 6c | 20 73 69 64 65 0d 0a 65 | minimal| side..e|
|00004480| 66 66 65 63 74 73 2e 0d | 0a 20 20 20 20 20 41 64 |ffects..|. Ad|
|00004490| 64 69 6e 67 20 6c 69 74 | 68 69 75 6d 20 74 6f 20 |ding lit|hium to |
|000044a0| 63 61 72 62 61 6d 61 7a | 65 70 69 6e 65 20 69 6e |carbamaz|epine in|
|000044b0| 20 74 72 65 61 74 6d 65 | 6e 74 2d 72 65 73 69 73 | treatme|nt-resis|
|000044c0| 74 61 6e 74 20 64 65 70 | 72 65 73 73 69 6f 6e 20 |tant dep|ression |
|000044d0| 61 70 70 65 61 72 73 0d | 0a 74 6f 20 62 65 20 61 |appears.|.to be a|
|000044e0| 20 73 61 66 65 2c 20 77 | 65 6c 6c 20 74 6f 6c 65 | safe, w|ell tole|
|000044f0| 72 61 74 65 64 2c 20 61 | 6e 64 20 65 66 66 65 63 |rated, a|nd effec|
|00004500| 74 69 76 65 20 74 72 65 | 61 74 6d 65 6e 74 2e 20 |tive tre|atment. |
|00004510| 20 49 74 20 65 66 66 65 | 63 74 65 64 20 61 20 72 | It effe|cted a r|
|00004520| 61 70 69 64 2c 0d 0a 73 | 75 62 73 74 61 6e 74 69 |apid,..s|ubstanti|
|00004530| 61 6c 20 64 65 67 72 65 | 65 20 6f 66 20 61 6e 74 |al degre|e of ant|
|00004540| 69 64 65 70 72 65 73 73 | 61 6e 74 20 72 65 73 70 |idepress|ant resp|
|00004550| 6f 6e 73 65 20 69 6e 20 | 61 20 73 69 67 6e 69 66 |onse in |a signif|
|00004560| 69 63 61 6e 74 20 70 72 | 6f 70 6f 72 74 69 6f 6e |icant pr|oportion|
|00004570| 20 6f 66 0d 0a 70 61 74 | 69 65 6e 74 73 2e 0d 0a | of..pat|ients...|
|00004580| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|00004590| 0d 0a 20 20 20 20 20 54 | 68 65 20 61 64 64 69 74 |.. T|he addit|
|000045a0| 69 6f 6e 20 6f 66 20 6c | 69 74 68 69 75 6d 20 74 |ion of l|ithium t|
|000045b0| 6f 20 63 61 72 62 61 6d | 61 7a 65 70 69 6e 65 20 |o carbam|azepine |
|000045c0| 6d 61 79 20 62 65 20 71 | 75 69 74 65 20 65 66 66 |may be q|uite eff|
|000045d0| 65 63 74 69 76 65 20 69 | 6e 0d 0a 74 72 65 61 74 |ective i|n..treat|
|000045e0| 69 6e 67 20 64 65 70 72 | 65 73 73 69 6f 6e 2e 20 |ing depr|ession. |
|000045f0| 20 41 73 20 73 75 63 68 | 20 69 74 20 72 65 70 72 | As such| it repr|
|00004600| 65 73 65 6e 74 73 20 61 | 20 66 75 72 74 68 65 72 |esents a| further|
|00004610| 20 72 65 66 69 6e 65 6d | 65 6e 74 20 6f 66 20 74 | refinem|ent of t|
|00004620| 68 65 20 75 73 65 20 6f | 66 0d 0a 63 61 72 62 61 |he use o|f..carba|
|00004630| 6d 61 7a 65 70 69 6e 65 | 20 69 6e 20 6d 6f 6f 64 |mazepine| in mood|
|00004640| 20 64 69 73 6f 72 64 65 | 72 73 2e 20 20 49 6e 20 | disorde|rs. In |
|00004650| 74 68 69 73 20 61 70 70 | 72 6f 61 63 68 2c 20 6c |this app|roach, l|
|00004660| 69 74 68 69 75 6d 20 68 | 61 73 20 62 65 65 6e 20 |ithium h|as been |
|00004670| 75 73 65 64 20 74 6f 0d | 0a 61 75 67 6d 65 6e 74 |used to.|.augment|
|00004680| 20 63 61 72 62 61 6d 61 | 7a 65 70 69 6e 65 20 28 | carbama|zepine (|
|00004690| 61 20 74 72 69 63 79 63 | 6c 69 63 20 61 73 20 77 |a tricyc|lic as w|
|000046a0| 65 6c 6c 20 61 73 20 61 | 6e 20 61 6e 74 69 65 70 |ell as a|n antiep|
|000046b0| 69 6c 65 70 74 69 63 20 | 69 6e 20 65 66 66 65 63 |ileptic |in effec|
|000046c0| 74 29 2e 0d 0a 46 75 72 | 74 68 65 72 6d 6f 72 65 |t)...Fur|thermore|
|000046d0| 2c 20 74 68 65 72 65 20 | 77 61 73 20 61 20 6d 6f |, there |was a mo|
|000046e0| 6f 64 20 69 6d 70 72 6f | 76 65 6d 65 6e 74 20 69 |od impro|vement i|
|000046f0| 6e 20 61 70 70 72 6f 78 | 69 6d 61 74 65 6c 79 20 |n approx|imately |
|00004700| 34 20 64 61 79 73 2d 2d | 61 20 72 65 73 70 6f 6e |4 days--|a respon|
|00004710| 73 65 0d 0a 63 6f 6e 73 | 69 73 74 65 6e 74 20 77 |se..cons|istent w|
|00004720| 69 74 68 20 6c 69 74 68 | 69 75 6d 20 61 75 67 6d |ith lith|ium augm|
|00004730| 65 6e 74 61 74 69 6f 6e | 2e 2d 2d 44 2e 58 2e 20 |entation|.--D.X. |
|00004740| 46 72 65 65 64 6d 61 6e | 2c 20 4d 2e 44 2e 2c 20 |Freedman|, M.D., |
|00004750| 61 6e 64 20 42 2e 48 2e | 20 47 75 7a 65 2c 0d 0a |and B.H.| Guze,..|
|00004760| 4d 2e 44 2e 0d 0a 24 55 | 6e 69 71 75 65 5f 49 44 |M.D...$U|nique_ID|
|00004770| 7b 59 52 42 30 33 34 30 | 35 7d 0d 0a 24 54 69 74 |{YRB0340|5}..$Tit|
|00004780| 6c 65 7b 41 64 64 69 74 | 69 6f 6e 20 6f 66 20 4c |le{Addit|ion of L|
|00004790| 69 74 68 69 75 6d 20 43 | 61 72 62 6f 6e 61 74 65 |ithium C|arbonate|
|000047a0| 20 74 6f 20 43 61 72 62 | 61 6d 61 7a 65 70 69 6e | to Carb|amazepin|
|000047b0| 65 3a 20 20 48 65 6d 61 | 74 6f 6c 6f 67 69 63 61 |e: Hema|tologica|
|000047c0| 6c 20 61 6e 64 0d 0a 54 | 68 79 72 6f 69 64 20 45 |l and..T|hyroid E|
|000047d0| 66 66 65 63 74 73 7d 0d | 0a 24 41 75 74 68 6f 72 |ffects}.|.$Author|
|000047e0| 7b 0d 0a 4b 72 61 6d 6c | 69 6e 67 65 72 2c 20 4b |{..Kraml|inger, K|
|000047f0| 47 0d 0a 50 6f 73 74 2c | 20 52 4d 7d 0d 0a 24 41 |G..Post,| RM}..$A|
|00004800| 66 66 69 6c 69 61 74 69 | 6f 6e 7b 4e 61 74 6c 20 |ffiliati|on{Natl |
|00004810| 49 6e 73 74 20 6f 66 20 | 4d 65 6e 74 61 6c 20 48 |Inst of |Mental H|
|00004820| 65 61 6c 74 68 2c 20 42 | 65 74 68 65 73 64 61 2c |ealth, B|ethesda,|
|00004830| 20 4d 64 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 41 | Md}..$J|ournal{A|
|00004840| 6d 20 4a 20 50 73 79 63 | 68 69 61 74 72 79 7d 0d |m J Psyc|hiatry}.|
|00004850| 0a 24 56 6f 6c 75 6d 65 | 7b 31 34 37 7d 0d 0a 24 |.$Volume|{147}..$|
|00004860| 50 61 67 65 7b 36 31 35 | 2d 36 32 30 7d 0d 0a 24 |Page{615|-620}..$|
|00004870| 44 61 74 65 7b 31 39 39 | 30 7d 0d 0a 24 59 42 56 |Date{199|0}..$YBV|
|00004880| 6f 6c 7b 31 39 39 31 20 | 59 65 61 72 20 42 6f 6f |ol{1991 |Year Boo|
|00004890| 6b 20 6f 66 20 50 73 79 | 63 68 69 61 74 72 79 20 |k of Psy|chiatry |
|000048a0| 61 6e 64 20 41 70 70 6c | 69 65 64 20 4d 65 6e 74 |and Appl|ied Ment|
|000048b0| 61 6c 20 48 65 61 6c 74 | 68 7d 0d 0a 24 43 68 61 |al Healt|h}..$Cha|
|000048c0| 70 74 65 72 7b 37 2d 32 | 37 7d 0d 0a 24 59 42 45 |pter{7-2|7}..$YBE|
|000048d0| 64 69 74 6f 72 7b 44 72 | 73 2e 20 54 61 6c 62 6f |ditor{Dr|s. Talbo|
|000048e0| 74 74 2c 20 46 72 61 6e | 63 65 73 2c 20 46 72 65 |tt, Fran|ces, Fre|
|000048f0| 65 64 6d 61 6e 2c 20 4d | 65 6c 74 7a 65 72 2c 20 |edman, M|eltzer, |
|00004900| 50 65 72 72 79 2c 20 53 | 63 68 6f 77 61 6c 74 65 |Perry, S|chowalte|
|00004910| 72 2c 20 61 6e 64 0d 0a | 59 75 64 6f 66 73 6b 79 |r, and..|Yudofsky|
|00004920| 7d 0d 0a 24 54 61 62 6c | 65 7b 7d 0d 0a 24 43 6f |}..$Tabl|e{}..$Co|
|00004930| 6d 6d 65 6e 74 61 74 6f | 72 7b 7d 0d 0a 0d 0a 43 |mmentato|r{}....C|
|00004940| 6f 70 79 72 69 67 68 74 | 20 28 43 29 20 59 65 61 |opyright| (C) Yea|
|00004950| 72 20 42 6f 6f 6b 20 4d | 65 64 69 63 61 6c 20 50 |r Book M|edical P|
|00004960| 75 62 6c 69 73 68 65 72 | 73 2c 20 49 6e 63 2e 20 |ublisher|s, Inc. |
|00004970| 31 39 39 31 0d 0a 0d 0a | 31 39 39 31 20 59 65 61 |1991....|1991 Yea|
|00004980| 72 20 42 6f 6f 6b 20 6f | 66 20 50 73 79 63 68 69 |r Book o|f Psychi|
|00004990| 61 74 72 79 20 61 6e 64 | 20 41 70 70 6c 69 65 64 |atry and| Applied|
|000049a0| 20 4d 65 6e 74 61 6c 20 | 48 65 61 6c 74 68 0d 0a | Mental |Health..|
|000049b0| 0d 0a 43 68 61 70 74 65 | 72 20 37 20 2d 2d 20 50 |..Chapte|r 7 -- P|
|000049c0| 73 79 63 68 6f 70 68 61 | 72 6d 61 63 6f 6c 6f 67 |sychopha|rmacolog|
|000049d0| 79 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |y....---|--------|
|000049e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000049f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a20| 2d 2d 2d 0d 0a 41 64 64 | 69 74 69 6f 6e 20 6f 66 |---..Add|ition of|
|00004a30| 20 4c 69 74 68 69 75 6d | 20 43 61 72 62 6f 6e 61 | Lithium| Carbona|
|00004a40| 74 65 20 74 6f 20 43 61 | 72 62 61 6d 61 7a 65 70 |te to Ca|rbamazep|
|00004a50| 69 6e 65 3a 20 20 48 65 | 6d 61 74 6f 6c 6f 67 69 |ine: He|matologi|
|00004a60| 63 61 6c 20 61 6e 64 20 | 54 68 79 72 6f 69 64 0d |cal and |Thyroid.|
|00004a70| 0a 45 66 66 65 63 74 73 | 0d 0a 0d 0a 4b 72 61 6d |.Effects|....Kram|
|00004a80| 6c 69 6e 67 65 72 20 4b | 47 3b 20 50 6f 73 74 20 |linger K|G; Post |
|00004a90| 52 4d 0d 0a 28 4e 61 74 | 6c 20 49 6e 73 74 20 6f |RM..(Nat|l Inst o|
|00004aa0| 66 20 4d 65 6e 74 61 6c | 20 48 65 61 6c 74 68 2c |f Mental| Health,|
|00004ab0| 20 42 65 74 68 65 73 64 | 61 2c 20 4d 64 29 0d 0a | Bethesd|a, Md)..|
|00004ac0| 41 6d 20 4a 20 50 73 79 | 63 68 69 61 74 72 79 20 |Am J Psy|chiatry |
|00004ad0| 31 34 37 3a 36 31 35 2d | 36 32 30 2c 20 31 39 39 |147:615-|620, 199|
|00004ae0| 30 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |0..-----|--------|
|00004af0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004b00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004b10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004b20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004b30| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|00004b40| 0a 20 20 20 20 20 54 68 | 65 20 63 6f 6d 62 69 6e |. Th|e combin|
|00004b50| 61 74 69 6f 6e 20 6f 66 | 20 6c 69 74 68 69 75 6d |ation of| lithium|
|00004b60| 20 61 6e 64 20 63 61 72 | 62 61 6d 61 7a 65 70 69 | and car|bamazepi|
|00004b70| 6e 65 20 69 73 20 62 65 | 69 6e 67 20 69 6e 63 72 |ne is be|ing incr|
|00004b80| 65 61 73 69 6e 67 6c 79 | 20 75 73 65 64 0d 0a 66 |easingly| used..f|
|00004b90| 6f 72 20 74 72 65 61 74 | 6d 65 6e 74 2d 72 65 73 |or treat|ment-res|
|00004ba0| 69 73 74 61 6e 74 20 70 | 61 74 69 65 6e 74 73 2e |istant p|atients.|
|00004bb0| 20 20 54 68 65 20 65 66 | 66 65 63 74 73 20 6f 66 | The ef|fects of|
|00004bc0| 20 61 64 64 69 6e 67 20 | 6c 69 74 68 69 75 6d 20 | adding |lithium |
|00004bd0| 63 61 72 62 6f 6e 61 74 | 65 20 74 6f 0d 0a 63 61 |carbonat|e to..ca|
|00004be0| 72 62 61 6d 61 7a 65 70 | 69 6e 65 20 6f 6e 20 68 |rbamazep|ine on h|
|00004bf0| 65 6d 61 74 6f 6c 6f 67 | 69 63 20 6d 65 61 73 75 |ematolog|ic measu|
|00004c00| 72 65 73 20 61 6e 64 20 | 74 68 79 72 6f 69 64 20 |res and |thyroid |
|00004c10| 69 6e 64 69 63 65 73 20 | 77 65 72 65 20 69 6e 76 |indices |were inv|
|00004c20| 65 73 74 69 67 61 74 65 | 64 20 69 6e 0d 0a 32 33 |estigate|d in..23|
|00004c30| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 61 | patient|s with a|
|00004c40| 66 66 65 63 74 69 76 65 | 20 64 69 73 6f 72 64 65 |ffective| disorde|
|00004c50| 72 73 2e 0d 0a 20 20 20 | 20 20 4c 69 74 68 69 75 |rs... | Lithiu|
|00004c60| 6d 20 70 72 6f 64 75 63 | 65 64 20 61 20 72 6f 62 |m produc|ed a rob|
|00004c70| 75 73 74 20 72 65 76 65 | 72 73 61 6c 20 6f 66 20 |ust reve|rsal of |
|00004c80| 63 61 72 62 61 6d 61 7a | 65 70 69 6e 65 2d 69 6e |carbamaz|epine-in|
|00004c90| 64 75 63 65 64 20 6c 65 | 75 6b 6f 70 65 6e 69 61 |duced le|ukopenia|
|00004ca0| 2c 0d 0a 69 6e 63 72 65 | 61 73 69 6e 67 20 77 68 |,..incre|asing wh|
|00004cb0| 69 74 65 20 62 6c 6f 6f | 64 20 63 65 6c 6c 73 2c |ite bloo|d cells,|
|00004cc0| 20 6d 6f 73 74 6c 79 20 | 6e 65 75 74 72 6f 70 68 | mostly |neutroph|
|00004cd0| 69 6c 73 2c 20 74 6f 20 | 63 6f 6e 63 65 6e 74 72 |ils, to |concentr|
|00004ce0| 61 74 69 6f 6e 73 0d 0a | 73 69 67 6e 69 66 69 63 |ations..|signific|
|00004cf0| 61 6e 74 6c 79 20 61 62 | 6f 76 65 20 62 61 73 65 |antly ab|ove base|
|00004d00| 6c 69 6e 65 20 76 61 6c | 75 65 73 2e 20 20 43 6f |line val|ues. Co|
|00004d10| 6d 62 69 6e 65 64 20 6c | 69 74 68 69 75 6d 20 61 |mbined l|ithium a|
|00004d20| 6e 64 20 63 61 72 62 61 | 6d 61 7a 65 70 69 6e 65 |nd carba|mazepine|
|00004d30| 20 61 6c 73 6f 0d 0a 70 | 72 6f 64 75 63 65 64 20 | also..p|roduced |
|00004d40| 61 64 64 69 74 69 76 65 | 20 61 6e 74 69 74 68 79 |additive| antithy|
|00004d50| 72 6f 69 64 61 6c 20 65 | 66 66 65 63 74 73 2c 20 |roidal e|ffects, |
|00004d60| 74 68 61 74 20 72 65 73 | 75 6c 74 65 64 20 69 6e |that res|ulted in|
|00004d70| 20 67 72 65 61 74 65 72 | 20 72 65 64 75 63 74 69 | greater| reducti|
|00004d80| 6f 6e 73 0d 0a 69 6e 20 | 74 68 79 72 6f 78 69 6e |ons..in |thyroxin|
|00004d90| 65 20 61 6e 64 20 66 72 | 65 65 20 74 68 79 72 6f |e and fr|ee thyro|
|00004da0| 78 69 6e 65 20 74 68 61 | 6e 20 74 68 6f 73 65 20 |xine tha|n those |
|00004db0| 6f 62 73 65 72 76 65 64 | 20 77 69 74 68 20 63 61 |observed| with ca|
|00004dc0| 72 62 61 6d 61 7a 65 70 | 69 6e 65 20 61 6c 6f 6e |rbamazep|ine alon|
|00004dd0| 65 2e 0d 0a 54 68 65 20 | 61 64 64 69 74 69 6f 6e |e...The |addition|
|00004de0| 20 6f 66 20 6c 69 74 68 | 69 75 6d 20 77 61 73 20 | of lith|ium was |
|00004df0| 61 73 73 6f 63 69 61 74 | 65 64 20 77 69 74 68 20 |associat|ed with |
|00004e00| 61 20 73 6c 69 67 68 74 | 6c 79 20 68 69 67 68 65 |a slight|ly highe|
|00004e10| 72 0d 0a 74 68 79 72 6f | 69 64 2d 73 74 69 6d 75 |r..thyro|id-stimu|
|00004e20| 6c 61 74 69 6e 67 20 68 | 6f 72 6d 6f 6e 65 20 6c |lating h|ormone l|
|00004e30| 65 76 65 6c 2e 0d 0a 20 | 20 20 20 20 54 68 65 20 |evel... | The |
|00004e40| 61 64 64 69 74 69 6f 6e | 20 6f 66 20 6c 69 74 68 |addition| of lith|
|00004e50| 69 75 6d 20 63 61 72 62 | 6f 6e 61 74 65 20 74 6f |ium carb|onate to|
|00004e60| 20 61 20 73 74 61 62 6c | 65 20 63 61 72 62 61 6d | a stabl|e carbam|
|00004e70| 61 7a 65 70 69 6e 65 20 | 72 65 67 69 6d 65 6e 0d |azepine |regimen.|
|00004e80| 0a 70 72 6f 64 75 63 65 | 73 20 73 65 76 65 72 61 |.produce|s severa|
|00004e90| 6c 20 73 69 67 6e 69 66 | 69 63 61 6e 74 20 63 6c |l signif|icant cl|
|00004ea0| 69 6e 69 63 61 6c 20 6c | 61 62 6f 72 61 74 6f 72 |inical l|aborator|
|00004eb0| 79 20 65 66 66 65 63 74 | 73 20 69 6e 76 6f 6c 76 |y effect|s involv|
|00004ec0| 69 6e 67 20 68 65 6d 61 | 74 6f 6c 6f 67 69 63 0d |ing hema|tologic.|
|00004ed0| 0a 61 6e 64 20 74 68 79 | 72 6f 69 64 20 69 6e 64 |.and thy|roid ind|
|00004ee0| 69 63 65 73 2e 20 20 4b | 6e 6f 77 6c 65 64 67 65 |ices. K|nowledge|
|00004ef0| 20 6f 66 20 74 68 65 73 | 65 20 63 68 61 6e 67 65 | of thes|e change|
|00004f00| 73 20 69 73 20 65 73 73 | 65 6e 74 69 61 6c 20 66 |s is ess|ential f|
|00004f10| 6f 72 20 6f 70 74 69 6d | 61 6c 0d 0a 70 61 74 69 |or optim|al..pati|
|00004f20| 65 6e 74 20 6d 61 6e 61 | 67 65 6d 65 6e 74 2e 0d |ent mana|gement..|
|00004f30| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00004f40| 0a 0d 0a 20 20 20 20 20 | 41 62 73 74 72 61 63 74 |... |Abstract|
|00004f50| 20 37 2d 32 36 20 64 65 | 74 61 69 6c 73 20 74 68 | 7-26 de|tails th|
|00004f60| 65 20 63 6c 69 6e 69 63 | 61 6c 20 65 66 66 69 63 |e clinic|al effic|
|00004f70| 61 63 79 20 6f 66 20 74 | 68 65 20 61 64 64 69 74 |acy of t|he addit|
|00004f80| 69 6f 6e 20 6f 66 20 6c | 69 74 68 69 75 6d 20 74 |ion of l|ithium t|
|00004f90| 6f 0d 0a 63 61 72 62 61 | 6d 61 7a 65 70 69 6e 65 |o..carba|mazepine|
|00004fa0| 2e 20 20 54 68 69 73 20 | 61 62 73 74 72 61 63 74 |. This |abstract|
|00004fb0| 20 72 65 76 69 65 77 73 | 20 62 6f 74 68 20 74 68 | reviews| both th|
|00004fc0| 65 20 68 65 6d 61 74 6f | 6c 6f 67 69 63 20 63 6f |e hemato|logic co|
|00004fd0| 6e 73 65 71 75 65 6e 63 | 65 73 20 61 6e 64 0d 0a |nsequenc|es and..|
|00004fe0| 74 68 65 20 74 68 79 72 | 6f 69 64 20 65 66 66 65 |the thyr|oid effe|
|00004ff0| 63 74 73 20 6f 66 20 73 | 75 63 68 20 61 20 63 6f |cts of s|uch a co|
|00005000| 6d 62 69 6e 61 74 69 6f | 6e 2e 20 20 4c 69 74 68 |mbinatio|n. Lith|
|00005010| 69 75 6d 20 72 65 64 75 | 63 65 73 0d 0a 63 61 72 |ium redu|ces..car|
|00005020| 62 61 6d 61 7a 65 70 69 | 6e 65 2d 69 6e 64 75 63 |bamazepi|ne-induc|
|00005030| 65 64 20 6c 65 75 6b 6f | 70 65 6e 69 61 20 62 75 |ed leuko|penia bu|
|00005040| 74 2c 20 75 6e 66 6f 72 | 74 75 6e 61 74 65 6c 79 |t, unfor|tunately|
|00005050| 2c 20 74 68 65 20 63 6f | 6d 62 69 6e 61 74 69 6f |, the co|mbinatio|
|00005060| 6e 20 70 72 6f 64 75 63 | 65 73 0d 0a 61 64 64 69 |n produc|es..addi|
|00005070| 74 69 76 65 20 61 6e 74 | 69 74 68 79 72 6f 69 64 |tive ant|ithyroid|
|00005080| 61 6c 20 65 66 66 65 63 | 74 73 2e 20 20 54 68 69 |al effec|ts. Thi|
|00005090| 73 20 73 74 75 64 79 20 | 61 6c 65 72 74 73 20 75 |s study |alerts u|
|000050a0| 73 20 74 6f 20 69 6d 70 | 6f 72 74 61 6e 74 20 66 |s to imp|ortant f|
|000050b0| 61 63 74 6f 72 73 20 74 | 6f 0d 0a 6d 6f 6e 69 74 |actors t|o..monit|
|000050c0| 6f 72 20 77 68 65 6e 20 | 74 68 69 73 20 63 6f 6d |or when |this com|
|000050d0| 62 69 6e 61 74 69 6f 6e | 20 69 73 20 75 73 65 64 |bination| is used|
|000050e0| 2e 20 20 41 6e 20 69 6d | 70 6f 72 74 61 6e 74 20 |. An im|portant |
|000050f0| 6f 62 73 65 72 76 61 74 | 69 6f 6e 20 69 73 20 74 |observat|ion is t|
|00005100| 68 61 74 20 77 68 65 6e | 0d 0a 6c 69 74 68 69 75 |hat when|..lithiu|
|00005110| 6d 20 69 73 20 63 6f 6d | 62 69 6e 65 64 20 77 69 |m is com|bined wi|
|00005120| 74 68 20 63 61 72 62 61 | 6d 61 7a 65 70 69 6e 65 |th carba|mazepine|
|00005130| 20 69 6e 20 70 61 74 69 | 65 6e 74 73 20 77 68 6f | in pati|ents who|
|00005140| 20 68 61 76 65 20 6c 65 | 75 6b 6f 70 65 6e 69 61 | have le|ukopenia|
|00005150| 2c 0d 0a 6c 69 74 68 69 | 75 6d 20 6d 61 79 20 72 |,..lithi|um may r|
|00005160| 65 76 65 72 73 65 20 74 | 68 65 20 64 72 75 67 27 |everse t|he drug'|
|00005170| 73 20 68 65 6d 61 74 6f | 6c 6f 67 69 63 20 73 69 |s hemato|logic si|
|00005180| 64 65 20 65 66 66 65 63 | 74 73 2e 2d 2d 44 2e 58 |de effec|ts.--D.X|
|00005190| 2e 20 46 72 65 65 64 6d | 61 6e 2c 20 4d 2e 44 2e |. Freedm|an, M.D.|
|000051a0| 2c 0d 0a 61 6e 64 20 42 | 2e 48 2e 20 47 75 7a 65 |,..and B|.H. Guze|
|000051b0| 2c 20 4d 2e 44 2e 0d 0a | 24 55 6e 69 71 75 65 5f |, M.D...|$Unique_|
|000051c0| 49 44 7b 59 52 42 30 33 | 34 30 36 7d 0d 0a 24 54 |ID{YRB03|406}..$T|
|000051d0| 69 74 6c 65 7b 41 20 43 | 61 73 65 2d 43 6f 6e 74 |itle{A C|ase-Cont|
|000051e0| 72 6f 6c 20 53 74 75 64 | 79 20 6f 6e 20 74 68 65 |rol Stud|y on the|
|000051f0| 20 41 73 73 6f 63 69 61 | 74 69 6f 6e 20 42 65 74 | Associa|tion Bet|
|00005200| 77 65 65 6e 20 46 69 72 | 73 74 20 54 72 69 6d 65 |ween Fir|st Trime|
|00005210| 73 74 65 72 0d 0a 45 78 | 70 6f 73 75 72 65 20 74 |ster..Ex|posure t|
|00005220| 6f 20 4c 69 74 68 69 75 | 6d 20 61 6e 64 20 45 62 |o Lithiu|m and Eb|
|00005230| 73 74 65 69 6e 27 73 20 | 41 6e 6f 6d 61 6c 79 7d |stein's |Anomaly}|
|00005240| 0d 0a 24 41 75 74 68 6f | 72 7b 0d 0a 5a 61 6c 7a |..$Autho|r{..Zalz|
|00005250| 73 74 65 69 6e 2c 20 45 | 0d 0a 4b 6f 72 65 6e 2c |stein, E|..Koren,|
|00005260| 20 47 0d 0a 45 69 6e 61 | 72 73 6f 6e 2c 20 54 0d | G..Eina|rson, T.|
|00005270| 0a 46 72 65 65 64 6f 6d | 2c 20 52 4d 7d 0d 0a 24 |.Freedom|, RM}..$|
|00005280| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 48 6f 73 70 |Affiliat|ion{Hosp|
|00005290| 20 66 6f 72 20 53 69 63 | 6b 20 43 68 69 6c 64 72 | for Sic|k Childr|
|000052a0| 65 6e 2c 20 54 6f 72 6f | 6e 74 6f 3b 20 55 6e 69 |en, Toro|nto; Uni|
|000052b0| 76 20 6f 66 20 54 6f 72 | 6f 6e 74 6f 7d 0d 0a 24 |v of Tor|onto}..$|
|000052c0| 4a 6f 75 72 6e 61 6c 7b | 41 6d 20 4a 20 43 61 72 |Journal{|Am J Car|
|000052d0| 64 69 6f 6c 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 36 |diol}..$|Volume{6|
|000052e0| 35 7d 0d 0a 24 50 61 67 | 65 7b 38 31 37 2d 38 31 |5}..$Pag|e{817-81|
|000052f0| 38 7d 0d 0a 24 44 61 74 | 65 7b 31 39 39 30 7d 0d |8}..$Dat|e{1990}.|
|00005300| 0a 24 59 42 56 6f 6c 7b | 31 39 39 31 20 59 65 61 |.$YBVol{|1991 Yea|
|00005310| 72 20 42 6f 6f 6b 20 6f | 66 20 50 73 79 63 68 69 |r Book o|f Psychi|
|00005320| 61 74 72 79 20 61 6e 64 | 20 41 70 70 6c 69 65 64 |atry and| Applied|
|00005330| 20 4d 65 6e 74 61 6c 20 | 48 65 61 6c 74 68 7d 0d | Mental |Health}.|
|00005340| 0a 24 43 68 61 70 74 65 | 72 7b 37 2d 32 38 7d 0d |.$Chapte|r{7-28}.|
|00005350| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|00005360| 54 61 6c 62 6f 74 74 2c | 20 46 72 61 6e 63 65 73 |Talbott,| Frances|
|00005370| 2c 20 46 72 65 65 64 6d | 61 6e 2c 20 4d 65 6c 74 |, Freedm|an, Melt|
|00005380| 7a 65 72 2c 20 50 65 72 | 72 79 2c 20 53 63 68 6f |zer, Per|ry, Scho|
|00005390| 77 61 6c 74 65 72 2c 20 | 61 6e 64 0d 0a 59 75 64 |walter, |and..Yud|
|000053a0| 6f 66 73 6b 79 7d 0d 0a | 24 54 61 62 6c 65 7b 7d |ofsky}..|$Table{}|
|000053b0| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 7d |..$Comme|ntator{}|
|000053c0| 0d 0a 0d 0a 43 6f 70 79 | 72 69 67 68 74 20 28 43 |....Copy|right (C|
|000053d0| 29 20 59 65 61 72 20 42 | 6f 6f 6b 20 4d 65 64 69 |) Year B|ook Medi|
|000053e0| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|000053f0| 49 6e 63 2e 20 31 39 39 | 31 0d 0a 0d 0a 31 39 39 |Inc. 199|1....199|
|00005400| 31 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 50 |1 Year B|ook of P|
|00005410| 73 79 63 68 69 61 74 72 | 79 20 61 6e 64 20 41 70 |sychiatr|y and Ap|
|00005420| 70 6c 69 65 64 20 4d 65 | 6e 74 61 6c 20 48 65 61 |plied Me|ntal Hea|
|00005430| 6c 74 68 0d 0a 0d 0a 43 | 68 61 70 74 65 72 20 37 |lth....C|hapter 7|
|00005440| 20 2d 2d 20 50 73 79 63 | 68 6f 70 68 61 72 6d 61 | -- Psyc|hopharma|
|00005450| 63 6f 6c 6f 67 79 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |cology..|..------|
|00005460| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005470| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005480| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005490| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000054a0| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 41 20 43 61 73 65 |--------|..A Case|
|000054b0| 2d 43 6f 6e 74 72 6f 6c | 20 53 74 75 64 79 20 6f |-Control| Study o|
|000054c0| 6e 20 74 68 65 20 41 73 | 73 6f 63 69 61 74 69 6f |n the As|sociatio|
|000054d0| 6e 20 42 65 74 77 65 65 | 6e 20 46 69 72 73 74 20 |n Betwee|n First |
|000054e0| 54 72 69 6d 65 73 74 65 | 72 20 45 78 70 6f 73 75 |Trimeste|r Exposu|
|000054f0| 72 65 20 74 6f 0d 0a 4c | 69 74 68 69 75 6d 20 61 |re to..L|ithium a|
|00005500| 6e 64 20 45 62 73 74 65 | 69 6e 27 73 20 41 6e 6f |nd Ebste|in's Ano|
|00005510| 6d 61 6c 79 0d 0a 0d 0a | 5a 61 6c 7a 73 74 65 69 |maly....|Zalzstei|
|00005520| 6e 20 45 3b 20 4b 6f 72 | 65 6e 20 47 3b 20 45 69 |n E; Kor|en G; Ei|
|00005530| 6e 61 72 73 6f 6e 20 54 | 3b 20 46 72 65 65 64 6f |narson T|; Freedo|
|00005540| 6d 20 52 4d 0d 0a 28 48 | 6f 73 70 20 66 6f 72 20 |m RM..(H|osp for |
|00005550| 53 69 63 6b 20 43 68 69 | 6c 64 72 65 6e 2c 20 54 |Sick Chi|ldren, T|
|00005560| 6f 72 6f 6e 74 6f 3b 20 | 55 6e 69 76 20 6f 66 20 |oronto; |Univ of |
|00005570| 54 6f 72 6f 6e 74 6f 29 | 0d 0a 41 6d 20 4a 20 43 |Toronto)|..Am J C|
|00005580| 61 72 64 69 6f 6c 20 36 | 35 3a 38 31 37 2d 38 31 |ardiol 6|5:817-81|
|00005590| 38 2c 20 31 39 39 30 0d | 0a 2d 2d 2d 2d 2d 2d 2d |8, 1990.|.-------|
|000055a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055e0| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|000055f0| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 41 6e 20 65 |act.... | An e|
|00005600| 73 74 69 6d 61 74 65 64 | 20 2e 31 25 20 6f 66 20 |stimated| .1% of |
|00005610| 70 72 65 67 6e 61 6e 74 | 20 77 6f 6d 65 6e 20 75 |pregnant| women u|
|00005620| 73 65 20 6c 69 74 68 69 | 75 6d 20 63 61 72 62 6f |se lithi|um carbo|
|00005630| 6e 61 74 65 20 61 73 20 | 74 72 65 61 74 6d 65 6e |nate as |treatmen|
|00005640| 74 20 66 6f 72 0d 0a 6d | 61 6e 69 63 2d 64 65 70 |t for..m|anic-dep|
|00005650| 72 65 73 73 69 76 65 20 | 69 6c 6c 6e 65 73 73 2e |ressive |illness.|
|00005660| 20 20 54 68 65 72 65 20 | 69 73 20 69 6e 63 72 65 | There |is incre|
|00005670| 61 73 69 6e 67 20 65 76 | 69 64 65 6e 63 65 20 74 |asing ev|idence t|
|00005680| 68 61 74 20 6c 69 74 68 | 69 75 6d 20 6d 61 79 20 |hat lith|ium may |
|00005690| 62 65 0d 0a 74 65 72 61 | 74 6f 67 65 6e 69 63 20 |be..tera|togenic |
|000056a0| 69 6e 20 68 75 6d 61 6e | 20 62 65 69 6e 67 73 2c |in human| beings,|
|000056b0| 20 61 6e 64 20 61 20 44 | 61 6e 69 73 68 20 72 65 | and a D|anish re|
|000056c0| 67 69 73 74 72 79 20 68 | 61 73 20 72 65 70 6f 72 |gistry h|as repor|
|000056d0| 74 65 64 20 38 20 70 61 | 74 69 65 6e 74 73 0d 0a |ted 8 pa|tients..|
|000056e0| 77 69 74 68 20 45 62 73 | 74 65 69 6e 27 73 20 61 |with Ebs|tein's a|
|000056f0| 6e 6f 6d 61 6c 79 2c 20 | 72 65 66 6c 65 63 74 69 |nomaly, |reflecti|
|00005700| 6e 67 20 61 20 72 65 6c | 61 74 69 76 65 20 72 69 |ng a rel|ative ri|
|00005710| 73 6b 20 35 30 30 2d 66 | 6f 6c 64 20 67 72 65 61 |sk 500-f|old grea|
|00005720| 74 65 72 20 74 68 61 6e | 20 69 6e 0d 0a 74 68 65 |ter than| in..the|
|00005730| 20 67 65 6e 65 72 61 6c | 20 70 6f 70 75 6c 61 74 | general| populat|
|00005740| 69 6f 6e 2e 20 20 44 61 | 74 61 20 6f 6e 20 35 39 |ion. Da|ta on 59|
|00005750| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 45 | patient|s with E|
|00005760| 62 73 74 65 69 6e 27 73 | 20 61 6e 6f 6d 61 6c 79 |bstein's| anomaly|
|00005770| 20 64 69 61 67 6e 6f 73 | 65 64 0d 0a 69 6e 20 31 | diagnos|ed..in 1|
|00005780| 39 37 31 2d 31 39 38 38 | 20 77 65 72 65 20 72 65 |971-1988| were re|
|00005790| 76 69 65 77 65 64 2e 20 | 20 50 61 74 69 65 6e 74 |viewed. | Patient|
|000057a0| 73 20 77 69 74 68 20 6e | 65 75 72 6f 62 6c 61 73 |s with n|euroblas|
|000057b0| 74 6f 6d 61 20 64 69 61 | 67 6e 6f 73 65 64 20 69 |toma dia|gnosed i|
|000057c0| 6e 0d 0a 31 39 37 31 2d | 31 39 38 36 20 73 65 72 |n..1971-|1986 ser|
|000057d0| 76 65 64 20 61 73 20 61 | 20 63 6f 6e 74 72 6f 6c |ved as a| control|
|000057e0| 20 67 72 6f 75 70 2e 0d | 0a 20 20 20 20 20 4d 6f | group..|. Mo|
|000057f0| 73 74 20 6f 66 20 74 68 | 65 20 73 74 75 64 79 20 |st of th|e study |
|00005800| 63 68 69 6c 64 72 65 6e | 20 68 61 64 20 6f 74 68 |children| had oth|
|00005810| 65 72 20 63 61 72 64 69 | 61 63 20 6d 61 6c 66 6f |er cardi|ac malfo|
|00005820| 72 6d 61 74 69 6f 6e 73 | 2c 20 61 6e 64 20 73 6f |rmations|, and so|
|00005830| 6d 65 20 68 61 64 0d 0a | 6e 6f 6e 63 61 72 64 69 |me had..|noncardi|
|00005840| 61 63 20 61 6e 6f 6d 61 | 6c 69 65 73 2e 20 20 54 |ac anoma|lies. T|
|00005850| 68 65 20 6d 65 61 6e 20 | 6d 61 74 65 72 6e 61 6c |he mean |maternal|
|00005860| 20 61 67 65 20 61 74 20 | 62 69 72 74 68 20 77 61 | age at |birth wa|
|00005870| 73 20 32 36 20 79 65 61 | 72 73 2e 20 20 4e 6f 6e |s 26 yea|rs. Non|
|00005880| 65 20 6f 66 0d 0a 74 68 | 65 20 6d 6f 74 68 65 72 |e of..th|e mother|
|00005890| 73 20 68 61 64 20 6d 61 | 6e 69 63 2d 64 65 70 72 |s had ma|nic-depr|
|000058a0| 65 73 73 69 76 65 20 70 | 73 79 63 68 6f 73 69 73 |essive p|sychosis|
|000058b0| 20 6f 72 20 68 61 64 20 | 72 65 63 65 69 76 65 64 | or had |received|
|000058c0| 20 6c 69 74 68 69 75 6d | 20 62 65 66 6f 72 65 20 | lithium| before |
|000058d0| 6f 72 0d 0a 64 75 72 69 | 6e 67 20 70 72 65 67 6e |or..duri|ng pregn|
|000058e0| 61 6e 63 79 2e 20 20 4f | 6e 65 20 6f 66 20 74 68 |ancy. O|ne of th|
|000058f0| 65 20 77 6f 6d 65 6e 20 | 68 65 72 73 65 6c 66 20 |e women |herself |
|00005900| 68 61 64 20 45 62 73 74 | 65 69 6e 27 73 20 61 6e |had Ebst|ein's an|
|00005910| 6f 6d 61 6c 79 2e 20 20 | 54 77 6f 20 6f 66 20 31 |omaly. |Two of 1|
|00005920| 36 38 0d 0a 6d 6f 74 68 | 65 72 73 20 69 6e 20 74 |68..moth|ers in t|
|00005930| 68 65 20 63 6f 6e 74 72 | 6f 6c 20 67 72 6f 75 70 |he contr|ol group|
|00005940| 20 68 61 64 20 64 65 70 | 72 65 73 73 69 76 65 20 | had dep|ressive |
|00005950| 64 69 73 65 61 73 65 2e | 20 20 52 61 74 65 73 20 |disease.| Rates |
|00005960| 6f 66 20 6c 69 74 68 69 | 75 6d 0d 0a 65 78 70 6f |of lithi|um..expo|
|00005970| 73 75 72 65 20 64 69 64 | 20 6e 6f 74 20 64 69 66 |sure did| not dif|
|00005980| 66 65 72 20 69 6e 20 74 | 68 65 20 73 74 75 64 79 |fer in t|he study|
|00005990| 20 61 6e 64 20 63 6f 6e | 74 72 6f 6c 20 67 72 6f | and con|trol gro|
|000059a0| 75 70 73 2e 0d 0a 20 20 | 20 20 20 41 6c 74 68 6f |ups... | Altho|
|000059b0| 75 67 68 20 61 6e 20 61 | 73 73 6f 63 69 61 74 69 |ugh an a|ssociati|
|000059c0| 6f 6e 20 62 65 74 77 65 | 65 6e 20 6c 69 74 68 69 |on betwe|en lithi|
|000059d0| 75 6d 20 65 78 70 6f 73 | 75 72 65 20 61 6e 64 20 |um expos|ure and |
|000059e0| 45 62 73 74 65 69 6e 27 | 73 20 61 6e 6f 6d 61 6c |Ebstein'|s anomal|
|000059f0| 79 0d 0a 68 61 73 20 6e | 6f 74 20 62 65 65 6e 20 |y..has n|ot been |
|00005a00| 72 75 6c 65 64 20 6f 75 | 74 2c 20 74 68 65 20 70 |ruled ou|t, the p|
|00005a10| 6f 74 65 6e 74 69 61 6c | 20 72 69 73 6b 20 69 73 |otential| risk is|
|00005a20| 20 6d 75 63 68 20 6c 6f | 77 65 72 20 74 68 61 6e | much lo|wer than|
|00005a30| 20 73 75 67 67 65 73 74 | 65 64 20 62 79 0d 0a 64 | suggest|ed by..d|
|00005a40| 61 74 61 20 66 72 6f 6d | 20 74 68 65 20 75 6e 63 |ata from| the unc|
|00005a50| 6f 6e 74 72 6f 6c 6c 65 | 64 20 44 61 6e 69 73 68 |ontrolle|d Danish|
|00005a60| 20 72 65 67 69 73 74 72 | 79 2e 0d 0a 0d 0a 50 6f | registr|y.....Po|
|00005a70| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt.... |
|00005a80| 20 20 20 54 68 65 20 63 | 6f 6e 63 65 72 6e 73 20 | The c|oncerns |
|00005a90| 61 62 6f 75 74 20 6c 69 | 74 68 69 75 6d 27 73 20 |about li|thium's |
|00005aa0| 65 66 66 65 63 74 73 20 | 6f 6e 20 63 61 72 64 69 |effects |on cardi|
|00005ab0| 61 63 20 64 65 76 65 6c | 6f 70 6d 65 6e 74 20 61 |ac devel|opment a|
|00005ac0| 72 65 20 6c 6f 6e 67 0d | 0a 73 74 61 6e 64 69 6e |re long.|.standin|
|00005ad0| 67 2e 20 20 54 68 65 73 | 65 20 68 61 76 65 20 62 |g. Thes|e have b|
|00005ae0| 65 65 6e 20 62 61 73 65 | 64 20 6d 6f 73 74 6c 79 |een base|d mostly|
|00005af0| 20 6f 6e 20 74 68 65 20 | 6c 69 74 68 69 75 6d 20 | on the |lithium |
|00005b00| 69 6e 66 61 6e 74 20 72 | 65 67 69 73 74 72 79 0d |infant r|egistry.|
|00005b10| 0a 6d 61 69 6e 74 61 69 | 6e 65 64 20 69 6e 20 53 |.maintai|ned in S|
|00005b20| 63 61 6e 64 69 6e 61 76 | 69 61 2e 20 20 4f 62 76 |candinav|ia. Obv|
|00005b30| 69 6f 75 73 6c 79 2c 20 | 74 68 65 72 65 20 61 72 |iously, |there ar|
|00005b40| 65 20 64 69 66 66 69 63 | 75 6c 74 69 65 73 20 62 |e diffic|ulties b|
|00005b50| 65 63 61 75 73 65 20 73 | 75 63 68 20 61 0d 0a 72 |ecause s|uch a..r|
|00005b60| 65 67 69 73 74 72 79 20 | 69 73 20 6d 6f 72 65 20 |egistry |is more |
|00005b70| 6c 69 6b 65 6c 79 20 74 | 6f 20 72 65 63 65 69 76 |likely t|o receiv|
|00005b80| 65 20 72 65 70 6f 72 74 | 73 20 6f 66 20 61 62 6e |e report|s of abn|
|00005b90| 6f 72 6d 61 6c 69 74 69 | 65 73 2e 20 20 54 68 69 |ormaliti|es. Thi|
|00005ba0| 73 20 72 65 70 6f 72 74 | 0d 0a 73 75 67 67 65 73 |s report|..sugges|
|00005bb0| 74 73 20 74 68 61 74 20 | 69 6e 20 75 74 65 72 6f |ts that |in utero|
|00005bc0| 20 6c 69 74 68 69 75 6d | 20 65 78 70 6f 73 75 72 | lithium| exposur|
|00005bd0| 65 20 6d 61 79 20 62 65 | 20 61 73 73 6f 63 69 61 |e may be| associa|
|00005be0| 74 65 64 20 77 69 74 68 | 20 45 62 73 74 65 69 6e |ted with| Ebstein|
|00005bf0| 27 73 0d 0a 61 6e 6f 6d | 61 6c 79 2c 20 62 75 74 |'s..anom|aly, but|
|00005c00| 20 74 68 61 74 20 74 68 | 65 20 70 6f 74 65 6e 74 | that th|e potent|
|00005c10| 69 61 6c 20 72 69 73 6b | 20 69 73 20 6d 75 63 68 |ial risk| is much|
|00005c20| 20 6c 6f 77 65 72 20 74 | 68 61 6e 20 68 61 73 20 | lower t|han has |
|00005c30| 62 65 65 6e 20 73 75 67 | 67 65 73 74 65 64 0d 0a |been sug|gested..|
|00005c40| 66 72 6f 6d 20 74 68 65 | 20 75 6e 63 6f 6e 74 72 |from the| uncontr|
|00005c50| 6f 6c 6c 65 64 20 44 61 | 6e 69 73 68 20 72 65 67 |olled Da|nish reg|
|00005c60| 69 73 74 72 79 20 73 74 | 75 64 79 2e 20 20 54 68 |istry st|udy. Th|
|00005c70| 69 73 20 73 68 6f 75 6c | 64 20 62 65 20 72 65 61 |is shoul|d be rea|
|00005c80| 73 73 75 72 69 6e 67 20 | 74 6f 0d 0a 74 68 6f 73 |ssuring |to..thos|
|00005c90| 65 20 63 6c 69 6e 69 63 | 69 61 6e 73 20 77 68 6f |e clinic|ians who|
|00005ca0| 20 6e 65 65 64 20 74 6f | 20 74 72 65 61 74 20 73 | need to| treat s|
|00005cb0| 79 6d 70 74 6f 6d 61 74 | 69 63 20 70 72 65 67 6e |ymptomat|ic pregn|
|00005cc0| 61 6e 74 20 70 61 74 69 | 65 6e 74 73 20 61 6e 64 |ant pati|ents and|
|00005cd0| 20 74 68 6f 73 65 0d 0a | 70 72 65 67 6e 61 6e 74 | those..|pregnant|
|00005ce0| 20 70 61 74 69 65 6e 74 | 73 20 69 6e 20 77 68 6f | patient|s in who|
|00005cf0| 6d 20 74 68 65 20 72 69 | 73 6b 20 6f 66 20 72 65 |m the ri|sk of re|
|00005d00| 6c 61 70 73 65 20 64 75 | 72 69 6e 67 20 61 20 6d |lapse du|ring a m|
|00005d10| 61 69 6e 74 65 6e 61 6e | 63 65 20 70 68 61 73 65 |aintenan|ce phase|
|00005d20| 0d 0a 77 69 74 68 6f 75 | 74 20 6d 65 64 69 63 61 |..withou|t medica|
|00005d30| 74 69 6f 6e 20 77 6f 75 | 6c 64 20 62 65 20 65 78 |tion wou|ld be ex|
|00005d40| 74 72 65 6d 65 2e 20 20 | 53 75 63 68 20 71 75 61 |treme. |Such qua|
|00005d50| 6e 74 69 66 69 61 62 6c | 65 20 64 61 74 61 20 61 |ntifiabl|e data a|
|00005d60| 72 65 20 74 68 65 20 6d | 6f 73 74 0d 0a 65 66 66 |re the m|ost..eff|
|00005d70| 65 63 74 69 76 65 20 74 | 6f 6f 6c 73 20 69 6e 20 |ective t|ools in |
|00005d80| 64 69 73 63 75 73 73 69 | 6f 6e 73 20 62 65 74 77 |discussi|ons betw|
|00005d90| 65 65 6e 20 63 6c 69 6e | 69 63 69 61 6e 73 20 61 |een clin|icians a|
|00005da0| 6e 64 20 70 61 74 69 65 | 6e 74 73 20 61 73 20 70 |nd patie|nts as p|
|00005db0| 61 72 74 20 6f 66 20 61 | 0d 0a 63 6f 6c 6c 61 62 |art of a|..collab|
|00005dc0| 6f 72 61 74 69 76 65 20 | 64 65 63 69 73 69 6f 6e |orative |decision|
|00005dd0| 20 6d 61 6b 69 6e 67 20 | 70 72 6f 63 65 73 73 2e | making |process.|
|00005de0| 2d 2d 44 2e 58 2e 20 46 | 72 65 65 64 6d 61 6e 2c |--D.X. F|reedman,|
|00005df0| 20 4d 2e 44 2e 2c 20 61 | 6e 64 20 42 2e 48 2e 20 | M.D., a|nd B.H. |
|00005e00| 47 75 7a 65 2c 0d 0a 4d | 2e 44 2e 0d 0a 24 55 6e |Guze,..M|.D...$Un|
|00005e10| 69 71 75 65 5f 49 44 7b | 59 52 42 30 33 34 30 37 |ique_ID{|YRB03407|
|00005e20| 7d 0d 0a 24 54 69 74 6c | 65 7b 43 6f 6d 70 61 72 |}..$Titl|e{Compar|
|00005e30| 69 73 6f 6e 20 6f 66 20 | 53 74 61 6e 64 61 72 64 |ison of |Standard|
|00005e40| 20 61 6e 64 20 4c 6f 77 | 20 53 65 72 75 6d 20 4c | and Low| Serum L|
|00005e50| 65 76 65 6c 73 20 6f 66 | 20 4c 69 74 68 69 75 6d |evels of| Lithium|
|00005e60| 20 66 6f 72 20 4d 61 69 | 6e 74 65 6e 61 6e 63 65 | for Mai|ntenance|
|00005e70| 0d 0a 54 72 65 61 74 6d | 65 6e 74 20 6f 66 20 42 |..Treatm|ent of B|
|00005e80| 69 70 6f 6c 61 72 20 44 | 69 73 6f 72 64 65 72 7d |ipolar D|isorder}|
|00005e90| 0d 0a 24 41 75 74 68 6f | 72 7b 0d 0a 47 65 6c 65 |..$Autho|r{..Gele|
|00005ea0| 6e 62 65 72 67 2c 20 41 | 4a 0d 0a 4b 61 6e 65 2c |nberg, A|J..Kane,|
|00005eb0| 20 4a 4d 0d 0a 4b 65 6c | 6c 65 72 2c 20 4d 42 0d | JM..Kel|ler, MB.|
|00005ec0| 0a 4c 61 76 6f 72 69 2c | 20 50 0d 0a 52 6f 73 65 |.Lavori,| P..Rose|
|00005ed0| 6e 62 61 75 6d 2c 20 4a | 46 0d 0a 43 6f 6c 65 2c |nbaum, J|F..Cole,|
|00005ee0| 20 4b 0d 0a 4c 61 76 65 | 6c 6c 65 2c 20 4a 7d 0d | K..Lave|lle, J}.|
|00005ef0| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 48 61 |.$Affili|ation{Ha|
|00005f00| 72 76 61 72 64 20 4d 65 | 64 20 53 63 68 6f 6f 6c |rvard Me|d School|
|00005f10| 3b 20 48 69 6c 6c 73 69 | 64 65 20 48 6f 73 70 20 |; Hillsi|de Hosp |
|00005f20| 6f 66 20 4c 6f 6e 67 20 | 49 73 6c 61 6e 64 20 4a |of Long |Island J|
|00005f30| 65 77 69 73 68 20 4d 65 | 64 20 43 74 72 2c 0d 0a |ewish Me|d Ctr,..|
|00005f40| 47 6c 65 6e 20 4f 61 6b | 73 2c 20 4e 59 7d 0d 0a |Glen Oak|s, NY}..|
|00005f50| 24 4a 6f 75 72 6e 61 6c | 7b 4e 20 45 6e 67 6c 20 |$Journal|{N Engl |
|00005f60| 4a 20 4d 65 64 7d 0d 0a | 24 56 6f 6c 75 6d 65 7b |J Med}..|$Volume{|
|00005f70| 33 32 31 7d 0d 0a 24 50 | 61 67 65 7b 31 34 38 39 |321}..$P|age{1489|
|00005f80| 2d 31 34 39 33 7d 0d 0a | 24 44 61 74 65 7b 31 39 |-1493}..|$Date{19|
|00005f90| 38 39 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 31 |89}..$YB|Vol{1991|
|00005fa0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 50 73 | Year Bo|ok of Ps|
|00005fb0| 79 63 68 69 61 74 72 79 | 20 61 6e 64 20 41 70 70 |ychiatry| and App|
|00005fc0| 6c 69 65 64 20 4d 65 6e | 74 61 6c 20 48 65 61 6c |lied Men|tal Heal|
|00005fd0| 74 68 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 37 2d |th}..$Ch|apter{7-|
|00005fe0| 32 39 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |29}..$YB|Editor{D|
|00005ff0| 72 73 2e 20 54 61 6c 62 | 6f 74 74 2c 20 46 72 61 |rs. Talb|ott, Fra|
|00006000| 6e 63 65 73 2c 20 46 72 | 65 65 64 6d 61 6e 2c 20 |nces, Fr|eedman, |
|00006010| 4d 65 6c 74 7a 65 72 2c | 20 50 65 72 72 79 2c 20 |Meltzer,| Perry, |
|00006020| 53 63 68 6f 77 61 6c 74 | 65 72 2c 20 61 6e 64 0d |Schowalt|er, and.|
|00006030| 0a 59 75 64 6f 66 73 6b | 79 7d 0d 0a 24 54 61 62 |.Yudofsk|y}..$Tab|
|00006040| 6c 65 7b 7d 0d 0a 24 43 | 6f 6d 6d 65 6e 74 61 74 |le{}..$C|ommentat|
|00006050| 6f 72 7b 7d 0d 0a 0d 0a | 43 6f 70 79 72 69 67 68 |or{}....|Copyrigh|
|00006060| 74 20 28 43 29 20 59 65 | 61 72 20 42 6f 6f 6b 20 |t (C) Ye|ar Book |
|00006070| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00006080| 72 73 2c 20 49 6e 63 2e | 20 31 39 39 31 0d 0a 0d |rs, Inc.| 1991...|
|00006090| 0a 31 39 39 31 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1991 Ye|ar Book |
|000060a0| 6f 66 20 50 73 79 63 68 | 69 61 74 72 79 20 61 6e |of Psych|iatry an|
|000060b0| 64 20 41 70 70 6c 69 65 | 64 20 4d 65 6e 74 61 6c |d Applie|d Mental|
|000060c0| 20 48 65 61 6c 74 68 0d | 0a 0d 0a 43 68 61 70 74 | Health.|...Chapt|
|000060d0| 65 72 20 37 20 2d 2d 20 | 50 73 79 63 68 6f 70 68 |er 7 -- |Psychoph|
|000060e0| 61 72 6d 61 63 6f 6c 6f | 67 79 0d 0a 0d 0a 2d 2d |armacolo|gy....--|
|000060f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006100| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006110| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006120| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006130| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 43 6f |--------|----..Co|
|00006140| 6d 70 61 72 69 73 6f 6e | 20 6f 66 20 53 74 61 6e |mparison| of Stan|
|00006150| 64 61 72 64 20 61 6e 64 | 20 4c 6f 77 20 53 65 72 |dard and| Low Ser|
|00006160| 75 6d 20 4c 65 76 65 6c | 73 20 6f 66 20 4c 69 74 |um Level|s of Lit|
|00006170| 68 69 75 6d 20 66 6f 72 | 20 4d 61 69 6e 74 65 6e |hium for| Mainten|
|00006180| 61 6e 63 65 0d 0a 54 72 | 65 61 74 6d 65 6e 74 20 |ance..Tr|eatment |
|00006190| 6f 66 20 42 69 70 6f 6c | 61 72 20 44 69 73 6f 72 |of Bipol|ar Disor|
|000061a0| 64 65 72 0d 0a 0d 0a 47 | 65 6c 65 6e 62 65 72 67 |der....G|elenberg|
|000061b0| 20 41 4a 3b 20 4b 61 6e | 65 20 4a 4d 3b 20 4b 65 | AJ; Kan|e JM; Ke|
|000061c0| 6c 6c 65 72 20 4d 42 3b | 20 4c 61 76 6f 72 69 20 |ller MB;| Lavori |
|000061d0| 50 3b 20 52 6f 73 65 6e | 62 61 75 6d 20 4a 46 3b |P; Rosen|baum JF;|
|000061e0| 20 43 6f 6c 65 20 4b 3b | 20 4c 61 76 65 6c 6c 65 | Cole K;| Lavelle|
|000061f0| 20 4a 0d 0a 28 48 61 72 | 76 61 72 64 20 4d 65 64 | J..(Har|vard Med|
|00006200| 20 53 63 68 6f 6f 6c 3b | 20 48 69 6c 6c 73 69 64 | School;| Hillsid|
|00006210| 65 20 48 6f 73 70 20 6f | 66 20 4c 6f 6e 67 20 49 |e Hosp o|f Long I|
|00006220| 73 6c 61 6e 64 20 4a 65 | 77 69 73 68 20 4d 65 64 |sland Je|wish Med|
|00006230| 20 43 74 72 2c 20 47 6c | 65 6e 20 4f 61 6b 73 2c | Ctr, Gl|en Oaks,|
|00006240| 0d 0a 4e 59 29 20 4e 20 | 45 6e 67 6c 20 4a 20 4d |..NY) N |Engl J M|
|00006250| 65 64 20 33 32 31 3a 31 | 34 38 39 2d 31 34 39 33 |ed 321:1|489-1493|
|00006260| 2c 20 31 39 38 39 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |, 1989..|--------|
|00006270| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006280| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006290| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000062a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000062b0| 2d 2d 2d 2d 2d 2d 0d 0a | 0d 0a 41 62 73 74 72 61 |------..|..Abstra|
|000062c0| 63 74 0d 0a 0d 0a 20 20 | 20 20 20 44 6f 65 73 20 |ct.... | Does |
|000062d0| 61 20 6c 6f 77 65 72 20 | 73 65 72 75 6d 20 6c 69 |a lower |serum li|
|000062e0| 74 68 69 75 6d 20 6c 65 | 76 65 6c 20 63 6f 6d 70 |thium le|vel comp|
|000062f0| 72 6f 6d 69 73 65 20 74 | 68 65 72 61 70 65 75 74 |romise t|herapeut|
|00006300| 69 63 20 65 66 66 69 63 | 61 63 79 20 69 6e 0d 0a |ic effic|acy in..|
|00006310| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 62 69 |patients| with bi|
|00006320| 70 6f 6c 61 72 20 64 65 | 70 72 65 73 73 69 76 65 |polar de|pressive|
|00006330| 20 64 69 73 6f 72 64 65 | 72 3f 20 20 4e 69 6e 65 | disorde|r? Nine|
|00006340| 74 79 2d 66 6f 75 72 20 | 70 61 74 69 65 6e 74 73 |ty-four |patients|
|00006350| 20 77 65 72 65 20 65 6e | 74 65 72 65 64 0d 0a 69 | were en|tered..i|
|00006360| 6e 74 6f 20 61 20 64 6f | 75 62 6c 65 2d 62 6c 69 |nto a do|uble-bli|
|00006370| 6e 64 20 74 72 69 61 6c | 20 6f 66 20 32 20 6d 61 |nd trial| of 2 ma|
|00006380| 69 6e 74 65 6e 61 6e 63 | 65 20 64 6f 73 65 73 20 |intenanc|e doses |
|00006390| 6f 66 20 6c 69 74 68 69 | 75 6d 2e 20 20 54 68 65 |of lithi|um. The|
|000063a0| 20 22 73 74 61 6e 64 61 | 72 64 22 0d 0a 64 6f 73 | "standa|rd"..dos|
|000063b0| 65 20 77 61 73 20 61 64 | 6a 75 73 74 65 64 20 74 |e was ad|justed t|
|000063c0| 6f 20 70 72 6f 64 75 63 | 65 20 61 20 73 65 72 75 |o produc|e a seru|
|000063d0| 6d 20 6c 69 74 68 69 75 | 6d 20 6c 65 76 65 6c 20 |m lithiu|m level |
|000063e0| 6f 66 20 2e 38 2d 31 2e | 30 20 6d 4d 2f 4c 2c 20 |of .8-1.|0 mM/L, |
|000063f0| 61 6e 64 20 74 68 65 0d | 0a 22 6c 6f 77 22 20 64 |and the.|."low" d|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.