IV. CLINICAL ANALYSIS AND EVALUATION OF THE EFFECT OF LITHIUM THERAPY

Summary A sample comprising 123 manic‐depressive patients, who had experienced at least one manic phase, was studied with respect to age of onset of symptoms, mode of onset, the character of the first and second episodes, and the effect of lithium treatment. The age of onset of all patients irrespective of the nature of the first phase was on average 33 years, median = 30 years. In 63 per cent of cases, the first episode of illness was depressive, in other cases manic. Regardless of whether the first episode was mania or depression the chances that the second episode would be manic or depressive were approximately equal. The clinical details of five manic patients who failed to improve after more than 9 days lithium treatment are presented. These patients had a symptom profile in common, characterized by severe manic symptoms, aggression, and marked flight of ideas with a confusional component in the clinical picture. Eighty‐five manic‐depressive patients received prophylactic lithium treatment for a varying time in an open investigation. The number and duration of manic and depressive episodes were calculated for a period which extended from and included the onset phase to thestart of the control period, for a control period without lithium treatment, and for a lithium treatment period immediately following the control period. A significant reduction in the number of both manic and depressive episodes per year was recorded in both sexes during the lithium period as compared with the control period. During the latter, the number of manic episodes in general was similar for men and women, while the number of depressive episodes was greater in the female patients. During the lithium period, the number of manic and depressive episodes for both men and women was reduced to the same level. During both the control and the lithium period higher rates were found for depression than for mania in both sexes. During the control period, the manic and depressive episodes lasted on average somewhat longer in male as compared with female patients. In comparison with the control period, a reduction in the length of the phases was observed during the lithium period. The proportion of time during which the patients were ill with mania or depression or both was reduced significantly, and to the same level, in both men and women during the lithium period as compared with the control period. During the latter period, the total duration of manic phases in male patients was slightly yet consistently longer than in females, while the sexes did not differ in respect of depression. During both periods, in both sexes, the depressive phases lasted overall for nearly twice as long as the manic phases. In the present investigation a definite prophylactic effect of lithium was demonstrated, by individual calculation in both male and female patients, for both the manic and depressive phases of manic‐depressive disease.