Current p SYCHIATRY

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USING LITHIUM IN Practical Clinical Reviews HYPOCHONDRIASIS PREVALENCE “Tips for Using Lithium in Bipolar Current Suzanne Feinstein, PhD, and Brian p SYCHIATRY Disorder” by West B. Magnon, MD, A Dowden Publication ■ Vol. 2, No. 9 / September 2003 Fallon, MD, MPH, note that “In psy-

Reducing risk (Pearls, CURRENT , in psychiatric disorders chiatric or medical clinics, women Ross J. Baldessarini, MD

Don’t be fooled by hypochondria September 2003, p. 52) had some “do Checklist helps avoid treatment errors (have) hypochondriasis three to four 5 keys to improve counseling not try this at home” aspects to it. for dual-diagnosis patients times more often than men1” CASES THAT TEST YOUR SKILLS PRIMARY CARE UPDATE Two African-American men display Domestic violence: How to detect, prevent abuse in psychiatric patients For example, when Dr. Magnon apparent delusional behavior. (CURRENT PSYCHIATRY, September ■ You decide: Are they psychotic PEARLS IS IT ADOLESCENT ? CONSIDER THESE 6 ISSUES

or victims of racial misunderstanding? ■ TIPS FOR USING LITHIUM said “Lithium, 900 mg/d, works fine,” IN BIPOLAR DISORDER 2003, p. 28-39). Current Psychiatry U.S. POSTAGE PAID 110 Summit Avenue MAILED FROM Montvale, NJ 07645 ZIP CODE 40150 PERMIT NO. 141 I believe he was referring to 900 mg/d PRESORTED STANDARD DSM-IV-TR,2 however, reports of lithium carbonate, because 900 mg www.currentpsychiatry.com equal incidence of hypochondriasis in of lithium is equivalent to 4,791 mg of men and women, as do Tasman, Kay lithium carbonate, a generally toxic dose. Also, to & Lieberman.3 suggest that one dosage fits all flies in the face of Researchers have distinguished between the decades of research. incidence and prevalence of hypochondriasis in More important, to say that “Gauging lithi- the general and medical populations. DSM-IV- um blood levels is a waste of time, assuming you TR places hypochondriasis prevalence at 1 to 5% have checked for kidney ” is a dangerous in the general population and 2 to 7% in the med- statement. Numerous examples exist of lithium ical population. Martin & Yutzy’s4 estimate of 3 to toxicity induced by drug interactions or dehydra- 13% prevalence in the medical population jibes tion in patients without kidney disease. with Dr. Feinstein’s and Dr. Fallon’s article. James W. Jefferson, MD To my knowledge, however, data on Distinguished senior scientist, Madison Institute of Medicine hypochondriasis prevalence among psychiatric Clinical professor of psychiatry, University of Wisconsin Medical School outpatients are lacking. Extrapolating this infor- mation from the general medical population and implying a similar prevalence among psychiatric Dr. Magnon responds outpatients may not be correct. Dr. Jefferson’s comments reflect the standard Jessica Bright, MD thinking about use of lithium carbonate. Child psychiatry fellow Department of psychiatry and human behavior My points are: Thomas Jefferson University, Philadelphia, PA • I have not seen these so-called extensive studies about lithium toxicity • When given in reasonable, effective References 1. Diagnostic and statistical manual of mental disorders (4th ed-text revision). dosages, the patient responds without Washington, DC: American Psychiatric Association, 2000. toxic effects. 2. Barsky AJ, Wyshak G, Klerman GL, Latham KS. The prevalence of Lithium does have some unpleasant side hypochondriasis in medical outpatients. Soc Psychiatry Psychiatr Epidemiol 1990;25(2):89-94. effects, such as tremor, and weight gain is common 3. Tasman A, Kay J, Lieberman, JA (eds). Psychiatry, Vol. 2 (1st ed). in some patients, especially women. Continuous Philadelphia: WB Saunders, 1997. lab testing is just not necessary, however. 4. Martin RL,Yutzy SH. Somatoform disorders. In: Tasman A, Kay J, Lieberman JA (eds). Psychiatry (1st ed). Philadelphia: WB Saunders, West B. Magnon, MD 1997:1144-8. Bradenton, FL

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