An open label pilot trial of low-dose lithium for young people at ultra-high risk for psychosis

Simon M Rice; Barnaby Nelson; G Paul Amminger; Shona M Francey; Lisa J Phillips; Magenta B Simmons; Margaret Ross; Hok Pan Yuen; Alison R Yung; Kieran O'Gorman; Patrick D McGorry; Stephen J Wood; Gregor E Berger

doi:10.1111/eip.13526

An open label pilot trial of low-dose lithium for young people at ultra-high risk for psychosis

Early Interv Psychiatry. 2024 Apr 10. doi: 10.1111/eip.13526. Online ahead of print.

Authors

Simon M Rice^{1

2}, Barnaby Nelson^{1

2}, G Paul Amminger^{1

2}, Shona M Francey^{1

2}, Lisa J Phillips³, Magenta B Simmons^{1

2}, Margaret Ross^{1

2}, Hok Pan Yuen^{1

2}, Alison R Yung^{1

2

4

5}, Kieran O'Gorman^{1

2}, Patrick D McGorry^{1

2}, Stephen J Wood^{1

2

6}, Gregor E Berger^{1

2

7}

Affiliations

¹ Orygen, Melbourne, Victoria, Australia.
² Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
³ Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Victoria, Australia.
⁵ Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.
⁶ Institute for Mental Health, University of Birmingham, Birmingham, UK.
⁷ Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland.

PMID: 38600049
DOI: 10.1111/eip.13526

Abstract

Aim: Lithium, even at low doses, appears to offer neuroprotection against a wide variety of insults. In this controlled pilot, we examined the safety (i.e., side-effect profile) of lithium in a sample of young people identified at ultra-high risk (UHR) for psychosis. The secondary aim was to explore whether lithium provided a signal of clinical efficacy in reducing transition to psychosis compared with treatment as usual (TAU).

Methods: Young people attending the PACE clinic at Orygen, Melbourne, were prescribed a fixed dose (450 mg) of lithium (n = 25) or received TAU (n = 78). The primary outcome examined side-effects, with transition to psychosis, functioning and measures of psychopathology assessed as secondary outcomes.

Results: Participants in both groups were functionally compromised (lithium group GAF = 56.6; monitoring group GAF = 56.9). Side-effect assessment indicated that lithium was well-tolerated. 64% (n = 16) of participants in the lithium group were lithium-adherent to week 12. Few cases transitioned to psychosis across the study period; lithium group 4% (n = 1); monitoring group 7.7% (n = 6). There was no difference in time to transition to psychosis between the groups. No group differences were observed in other functioning and symptom domains, although all outcomes improved over time.

Conclusions: With a side-effect profile either comparable to, or better than UHR antipsychotic trials, lithium might be explored for further research with UHR young people. A definitive larger trial is needed to determine the efficacy of lithium in this cohort.

Keywords: UHR; lithium; psychosis; ultra‐high‐risk; young people.

Abstract

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