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Cross-validation of clinical characteristics and treatment patterns associated with phenotypes for lithium response defined by the Alda scale

Lookup NU author(s): Emeritus Professor Jan Scott


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Background: It is increasingly recognised that reliable and valid assessments of lithium response are needed in order to target more efficiently the use of this medication in bipolar disorders (BD) and to identify genotypes, endophenotypes and biomarkers of response.Methods: In a large, multi-centre, clinically representative sample of 300 cases of BD, we assess external clinical validators of lithium response phenotypes as defined using three different recommended approaches to scoring the Alda lithium response scale. The scale comprises an A scale (rating lithium response) and a B scale (assessing confounders).Results: Analysis of the two continuous scoring methods (A scale score minus the B scale score, or A scale score in those with a low B scale score) demonstrated that 21-23% of the explained variance in lithium response was accounted for by a positive family history of BD I and the early introduction of lithium. Categorical definitions of response suggest poor response is also associated with a positive history of alcohol and/or substance use comorbidities. High B scale scores were significantly associated with longer duration of illness prior to receiving lithium and the presence of psychotic symptoms.Limitations: The original sample was not recruited specifically to study lithium response. The Alda scale is designed to assess response retrospectively.Conclusions: This cross-validation study identifies different clinical phenotypes of lithium response when defined by continuous or categorical measures. Future clinical, genetic and biomarker studies should report both the findings and the method employed to assess lithium response according to the Alda scale.

Publication metadata

Author(s): Scott J, Geoffroy PA, Sportiche S, Brichant-Petit-Jean C, Gard S, Kahn JP, Azorin JM, Henry C, Etain B, Bellivier F

Publication type: Article

Publication status: Published

Journal: Journal of Affective Disorders

Year: 2017

Volume: 208

Pages: 62-67

Print publication date: 15/01/2017

Online publication date: 11/10/2016

Acceptance date: 28/08/2016

ISSN (print): 0165-0327

ISSN (electronic): 1573-2517

Publisher: Elsevier Science BV.


DOI: 10.1016/j.jad.2016.08.069


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