Efficacy in Subgroups
Besides severe agitation being a negative predictor of response to
lithium (in comparison to chlorpromazine) [13], depressive symptoms
during mania have been shown to predict a poorer response
to lithium (in comparison to valproate) [28]. When psychotic
symptoms are present in the context of mania, there is some evidence
indicating that lithium works equally well as antipsychotics
[15,29,30] and valproate [31]. However, a few earlier, small studies
indicated some additive effect of lithium and a typical antipsychotic
in combination in manic patients with psychotic symptoms
[32–34].