A common mistake is overlooking that a patient's constant mild mania (hyperthymic or cyclothymic) is part of their personality and overall condition. Their baseline isn't normal; it's a little manic and should be considered. #mentalhealth #bipolar

Unlike other medical specialties that rely on research and scientific studies to define conditions, psychiatry heavily depends on the DSM. It's time for psychiatry to base diagnostic definitions on current scientific knowledge. #psychiatry #DSM

Mood temperaments, while not always illnesses themselves, are biologically and genetically linked to conditions like manic depression. They can be risk factors for future mood episodes and may be incorrectly pathologized in psychiatry. #MoodTemperaments #MentalHealth

The DSM's focus on reliability over validity has led to stagnation, with subsequent editions making minimal changes, hindering scientific progress and treating diagnostic criteria as unchangeable truths. #DSM #psychology

In recurrent, severe depression, mania often precedes the depression. Treat the cause (mania) with mood stabilizers to prevent future depressive episodes. #mentalhealth #depression

Is low-dose lithium safe? The data suggests at one-third to one-half the usual dose, kidney risks are very low—perhaps 1-5% after 30-40 years. Thyroid effects might occur but are reversible. Benefits often outweigh harms. #lithium #mentalhealth

Is lithium the safest psychiatric drug? Studies suggest low doses (0.4-0.6) are effective for many, with minimal long-term kidney, thyroid, or cognitive side effects. #MentalHealth #Lithium

Why aren't we using low-dose lithium more? It works for anxiety, depression, mania, prevents suicide & dementia, and has minimal side effects. We've been overdosing it for 50 years based on weak evidence. #MentalHealth #Lithium

Does lithium harm kidneys? A study found that in 60% of people treated with lithium for 15+ years, there was no effect on their kidneys at all. Multiple daily dosing is the real culprit. #Lithium #KidneyHealth

Lithium prevents dementia & suicide, even at very low doses. Studies show tiny amounts (1mg elemental lithium, ~5mg lithium carbonate) cut suicide rates by 50%. No minimum effective dose exists. Every bit helps! #MentalHealth #Lithium

Studies show lithium in drinking water, at levels FAR below pharmacological doses, is associated with reduced rates of suicide, homicide, rape, and drug arrests. A Texas study showed up to 56% reduction in homicide. #MentalHealth #Lithium

Lithium & kidney health: Risk is 1-5% after 20 years, based on large Scandinavian databases. Risk factors include multiple daily doses. 60% have no kidney effects, while others might experience reversible issues. #Lithium #KidneyHealth

Lithium isn't just a mood stabilizer; it's also proven to reduce mortality in those with mood disorders and dementia. It may even extend lifespan by a decade, protecting against cardiovascular disease. #MentalHealth #Lithium

Lithium's safety is misunderstood. The idea it's unsafe with a narrow therapeutic index is false. At lower doses, side effects are minimal, and it could cut suicide rates while reducing dementia. #MentalHealth #Lithium

Low-dose lithium shows great promise as a primary treatment, especially in suicide prevention, based on clinical experience. It's an effective option compared to other medications. #Lithium #MentalHealth

We have begun a series of podcast episodes on psychiatrists you should know, older historical figures like Emil Kraepelin and more recent leaders like my mentor Frederick Goodwin. The links below take you to those episodes: youtube.com/watch?v=57c3xR… youtube.com/watch?v=y0xiiH…

Psychiatric diagnosis owes a lot to Kraepelin, who combined French clinical insights with Wundt's psychology. This led to key distinctions we still use: mood illnesses, psychotic conditions, personality disorders, and addictions. #Psychiatry #MentalHealth

Fred spanned the pre- and post-DSM eras. He didn't oppose DSM-III at first, but always sought to improve it, especially bipolar definitions. He supported a broader bipolar spectrum definition. #Psychiatry #DSM

Kraepelin's insights on schizophrenia and mood disorders still hold weight today. His view? Course of illness is key to diagnosis, symptoms less so. It's a perspective that could sharpen modern psychiatry. #Psychiatry #MentalHealth

Recurrence, not polarity, matters most in bipolar disorder. It's an illness of repeated mood episodes—depressive, manic, or mixed. Focus on the pattern, not just the type. #BipolarDisorder #MentalHealth