Table Of ContentISBN 978-1-349-07288-0
9 781349 072880
The Psychopharmacology of Lithium
Thisbookisdedicatedto mygoodfriendandcolleague,
AthanasioKukopulos,whoseworkhas beenan inspira
tion to me, and whose warmth and generosity have
always beensofreelyexpressedtowardsme.
Included in this dedication are Daniela Reginaldi,
LeonardoTondo, and GianpaoloMinnai,allofwhomI
holdinthedeepestaffectionandesteem.
THE
PSYCH OPHARMACOLOGY
OF LITHIUM
F. Neil Johnson
Head ofthe Departmentof Psychology,
Universityof lancaster
M
MACMILLAN PRESS
LONDON
©F.NeilJohnson1984
Softcoverreprintofthehardcover1stedition 1984
Allrightsreserved.Nopartofthispublicationmaybereproduced
ortransmitted,inanyformorbyanymeans,withoutpermission
Firstpublished1984by
TheScientificandMedicalDivision
THE MACMILLANPRESS LTD
LondonandBasingstoke
Companiesandrepresentativesthroughouttheworld
FilmsettingbyVantagePhotosettingCoLtd
EastleighandLondon
PrintedinHongKong
BritishLibraryCataloguinginPublicationData
Johnson,F.Neil
ThePsychopharmacologyoflithium.
1.Lithium-Therapeuticuse
I.Title
616.89'18 RC483.5.L5
ISBN978-1-349-07288-0 ISBN978-1-349-07286-6(eBook)
DOI 10.1007/978-1-349-07286-6
Contents
Preface vii
1 Anoverviewoflithiumtherapy 1
2 Thepsychologicalapproachtodrugtreatmentinpsychiatry 6
3 Sensorysystems 12
4 Motorsystems 17
5 Perceptualprocesses 42
6 Intellectualfunctioning 53
7 Responseselectionandinitiation 69
8 Acquisitionandretentionprocesses 72
9 Feelings,moodsandemotionalstates 97
10 Verbalbehaviour 102
11 Sleep 106
12 Socialbehaviour 111
13 Miscellaneousunlearnedbehaviourpatterns 136
14 Circadianandotherperiodicitiesinbehaviour 144
vi CONrn~
15 Drug-inducedbehaviour 153
16 Problemsinvolvedininterpretinglithium-inducedbehaviour
change 171
17 Astimulusprocessingmodeloflithiumaction 188
18 Astimulusprocessingmodelofaffectivedisorders 211
19 Evidencefor astimulusprocessingmodelofaffective
disorders 226
20 Psychoanalyticviewsoflithiumaction 245
21 Acircadianrhythmmodelofaffectivedisorders 247
22 Psychologicalpredictionofresponsetolithiumtherapy 256
References 273
Subjectindex 321
Preface
It isalmost 35 years sinceCade rediscovered the therapeuticpropertiesof
lithium in the treatment of manic excitement, and lithium salts are now
firmly established in modern psychiatric treatment. It is, therefore, some
thingofacuriositythatrelativelylittlehasbeenwrittenaboutthepsycholog
ical mechanisms by which the lithium ion brings about its effects. Beinga
simpleionandsocloselyrelatedto sodiumandpotassium,lithiumnaturally
attracted the attention of biochemists and physiologists alike, but
psychologists have-for one reason or another-not been as drawn to
lithiumastheyhavebeento chlorpromazine,for example.
Thisbookrepresentsinpartan attempttocorrectthesituation,bypulling
togetherwhatstrandsofevidenceexistconcerningthepsychopharmacology
of lithium. Somewhere amongst the information which already
exists-disparate and formless as it often is-there lie the clues to a
psychological modeloflithium action, and I have done mybestto identify
them.WhetherIhavesucceeded,Idonotknow.
I have presented at some length my own proposed model of lithium
action,basedontheideaofstimulusprocessing,andhavethendevelopeda
modelofmanicdepressionusingthesameconcepts,notbecauseIamfirmly
convinced that this is the only, or indeed the best, approach to lithium
psychopharmacology,butsimplyto illustratethegeneralmannerinwhichI
wouldliketo seethepsychologicalapproachto lithiumdevelopingoverthe
nextfew years.
I am convinced thatifwe can establish a viable psychologicalmodel (or
models)of actionofagentswhichareeffectiveagainstmaniaanddepression
weshallhavethekey to thepsychologicalprocessesunderlyingtheaffective
disorders;Iam furtherconvincedthatinthisendeavourthestudyoflithium
offers us the best chance of a breakthrough in the initial model-building
process.
I hope that The Psychopharmacology ofLithium will serve a numberof
different, butcomplementary, purposes. It isareferencetext,andassuchI
viii PREFACE
havetriedtomakeitascompleteaspossible.Ihavebeengreatlyaidedinthis
by the fact that the British Lithium Index, housed at the University of
Lancaster, contains copies of practically all that has been published on
lithiumfromabiologicalpointofview: IamgreatlyindebtedtomyEditorial
Assistant,MrsJulieWest,whomaintainstheIndexwithgreatefficiencyand
without whose help and knowledge it would not have been possible to
complete this book. Delandale LaboratoriesLtd, of Canterbury,Kent,the
manufacturersof Priadel, have for a numberofyearsprovidedthefunding
necessaryto maintaintheBritishLithiumIndexandtheeditorialassistance
neededto runit, anditismypleasureto acknowledgeMrJ. M. Olivant,the
Managing Director of Delandale, for his generosity and encouragement.
The pharmaceutical industry frequently comes under attack from many
directions: societyseemstohavealove-haterelationshipwiththemanufac
turers of its medicines, but in so manyareasof basicmedicalresearchthe
drug companies make possible workwhichcouldnototherwisebe carried
out. Delandale Laboratories, in particular, takeveryseriouslytheirrolein
encouragingresearch.
In addition to the book's purely reference function, I hope that the
theoretical discussions which it contains will prompt others to undertake
similar exercises or at least to test some of the propositions which I have
advanced. If I can, in somesmallway, give a little impetusto psychophar
macologicalresearchonlithiumIshallbewellsatisfied.
Forthosewhoarenotwell acquaintedwiththepsychologicalapproachto
the study of drug action, this bookmayserve as an introduction. Tothose
who wish to relate their physiological or biochemical studies to the be
havioural andcognitive aspectsof drugeffects,itmayhelpto pointto ways
inwhichsuchasynthesismaybe achieved.
Ihaveaimedthebookatallthosewhostudy,employortakeaninterestin
lithiumtherapyinparticularandinpsychoactiveagentsingeneral.
The greater part of the manuscript for this book was prepared in the
course of a period of sabbatical leave spent at the Centre de Recherche
Delalande, at Rueil-Malmaison near Paris, and I wish to express my
warmestthanksto allthosewhomademystaytheresopleasantandfruitful.
The manuscript, in the most appalling handwriting, was turned into a
legible typescript by Sylvia Boyle. How she did it-and so quickly and
accurately, too-I shall never understand; but she did, and I am very
grateful.
Mythanksaredueto allthosefriendsandcolleagueswho offeredadvice,
clarified points, or generally encouraged me. As always, the greatest
stimulustoperseverewithwhat,attimes,seemedanendlessdrudgery,came
from my wife, Susan, and I thankher andmychildren,ReubenandJenny,
for the understandingwhichtheyshowed, particularlyat thosetimeswhen
papers littered our home and my conversation consisted of irritable
monosyllables.
The Psychopharmacology ofLithiumis the latest in a seriesof bookson
PREFACE ix
lithiumwithwhichIhavebeeninvolved.It maynotbethebest,andIdonot
doubtthatit will notbethelast,butithascertainlybeenthemosttaxingto
write and, in the end, maybethe onewithwhichI have most reasonto be
pleased-that depends on what it achieves, and I have no way of even
guessingwhatthatmaybe.
Lancaster,1983 F.N.J.
