Thyroid dysfunction and lithium maintenance therapy in Bahraini out-patients

The definition, prevalence, etiology and clinical significance of lithium-associated subclinical hypothyroidism are uncertain. To determine the prevalence and risk factors for subclinical hypothyroidism among Bahraini patients on long-term lithium therapy. A retrospective study was conducted in all patients attending the out-patient clinic at the Bahrain Psychiatric Hospital who were diagnosed according to ICD-10 criteria as bipolar affective disorder, schizoaffective disorder or resistant depression, and were receiving maintenance lithium therapy for one year or longer. The age, gender, dosage of lithium, duration of lithium therapy, and duration of therapy until the development of thyroid dysfunction if it occurred, was the variables analyzed. Thyroid stimulating hormone [TSH; reference range 0.25 - 4.5 mU/L] and free thyroxine [T[4]; reference range 6.0 - 24.5 pmol/L] in serum were measured. In a sample of 32 patients 12 were female and 20 were male with a mean [ +/- SD] age 40.41 +/- 9.13 years. The age at onset of illness was 22.78 +/- 7.4 years, and lithium therapy was initiated at the age of 30.53 +/- 8.85 years. The dosage of lithium [mean +/- SD] was 812.5 +/- 282.6 mgs/day administered for a duration of 10.72 +/- 7.02 years. The level of TSH and thyroxine [mean +/- SD] were 3.45 +/- 3.1 mU/L and 15.5 +/- 3.14 pmol/L, respectively. Seven patients [21.9%] were considered to have had a subclinical hypothyroidism judged by a TSH level of >/= 4.5 mU/L; of these four were females. None of the patients had overt hypothyroidism or hyperthyroidism. Subclinical hypothyroidism is a relatively common adverse effect associated with lithium maintenance therapy. The duration of lithium therapy and female gender are important predictive factors. It is important to screen patients on lithium therapy for thyroid dysfunction for early detection and management

Mental health services in Bahrain: current structure and future directions

A review of the current psychiatric services in the state of Bahrain is made with an attempt at projecting the necessary increase in the number of psychiatrists, psychiatric nurses and inpatient beds as well as the necessary services to meet the increased population by the year 2000 using the guidelines of the Royal College of Psychiatrists White Paper [1977] coupled with WHO projections [1979]. It was recommended that the number of psychiatrists doubled; while an 80% increase in the number of psychiatric nurses was deemed necessary, the number of beds has to increase by 200. In addition, psychiatric training of family physicians and exp and ing psychiatric services at the primary care level was needed. Development of Bahraini nursing staff and other allied health care staff level as social workers was planned. The plan for meeting such dem and s and an alternate route for future developments was discussed

Depression following mania: a retrospective study in Bahrain

In a retrospective study conducted on 40 inpatients admitted to the Psychiatric Hospital, Bahrain, for treatment of hypomania during the years 1986-1990, we observed that depressive symptoms occurred in 40% of cases during the first three months after euthymia. The data analysis included age, sex, past history of mania and depression, family history of psychiatric illness, neuroleptic and lithium therapy. A past history of depression had a significant association with the occurrence of depression following mania