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This chapter explores, for condensed matter formed by other elements, the novel physical and chemical properties that are dominated by full quantum effects. This includes elementary substances including relatively light elements (e.g., helium (He), lithium (Li), carbon (C), and boron (B)) as well as relatively heavy elements (e.g., oxygen (O) and silicon (Si)), and their compounds. The objects studied include liquid and solid helium, lithium bulk metal and clusters, bulk boron, borophene, boron nitride nanotubes, hexagonal boron nitride, magnesium diboride, diamond, graphene, carbon atoms in organic molecules, strontium titanate, barium ferrite, silicon semiconductors, etc. The related physical and chemical properties include superfluidity, supersolidity, elastic or plastic deformation, heat capacity, high-pressure phase diagram, bonding lengths, diffusion, crystal structure, electron–phonon coupling, bandgap renormalization, thermal expansion coefficient, thermal conductivity, phonon frequency distribution, superconducting temperature and light absorption, etc. Through a variety of fruitful aspects readers would overview the situations where full quantum effect is pronounced and even critical.
Lithium is the only true mood stabiliser as it is able to both treat and prevent mania and depression. In practice, its popularity has declined despite discovering it has anti-suicidal and neuroprotective properties. Here, we argue for recognition of its benefits and advocate for its clinical use more widely.
This chapter provides multiple-choice questions designed to reinforce and expand your knowledge of bipolar disorder, including symptom presentation and assessment, neurobiology, treatment mechanisms, clinical characteristics of treatments, treatment strategies, and considerations for special populations.
Edited by
Liz McDonald, East London NHS Foundation Trust,Roch Cantwell, Perinatal Mental Health Service and West of Scotland Mother & Baby Unit,Ian Jones, Cardiff University
Making decisions about prescribing medication for mental disorders in childbearing women is a task that may have profound and long-lasting implications for a mother and her family, and it is important that prescribers have access to up-to-date summaries and interpretations of research that examines how safe these medications are in pregnancy and lactation.
Because it is not possible to test a drug’s reproductive safety in randomised controlled trials, research has to rely on less rigorous study designs. The inherent difficulties and other methodological problems have meant that interpretation of the evidence has often been difficult. However, the volume and quality of research has dramatically increased in recent years. Current findings concerning antidepressant, antipsychotic and mood-stabilising medication during pregnancy and lactation are summarised in this chapter, and recommendations for clinical practice are made referring to published guidelines where they are available.
Early economic evaluations (EEE) can evaluate the economic potential of new innovative healthcare solutions. We present a methodological framework for EEE in bipolar disorder and use eLi12 as an illustrative case, a new method to estimate 12-h lithium blood levels when blood sampling deviates from the 12-h timing, enabling more flexibility for patients and better data on 12-h lithium levels.
Methods:
A decision-analytic model evaluated the costs and consequences of eLi12 for the treatment of bipolar disorder from a Danish national healthcare payer perspective, assessing the minimum efficacy threshold where eLi12 would be considered cost-effective compared with standard of care. The primary outcome was net monetary benefit (NMB), and we estimated quality-adjusted life-years (QALYs) assuming a willingness-to-pay threshold of €67,000/QALY gained. Costs associated with bipolar disorder and lithium treatment (e.g. hospitalisations, suicides, lost productivity, implementation costs) were estimated from literature, Danish registries, and expert opinion.
Results:
Assuming 28,000 patients with bipolar disorder whereof 10,000 are treated with lithium, a 2.5% reduction in number of hospitalisations and suicides are sufficient for eLi12 to be considered cost-effective within one year of implementation. When using a longer time horizon, allowing more savings to be included and thus considering a smaller improvement to be sufficient, less than 1% improvement by using eLi12 would be sufficient within a three-year time horizon.
Conclusion:
EEE can evaluate the health economic potential of new innovative methods, supporting early investment decisions and guiding research. eLi12 can have significant healthcare savings, emphasising the relevance of studying clinical implementation.
This chapter examines the development of the “mode of exchange” in Zimbabwe’s diamond sector. Before 2006, Zimbabwe’s small diamond production mostly went to Western Europe. During an extensive boom in diamond production from 2006 to 2010, many diamonds were smuggled out of the country amid foreign sanctions and a decline in the formal sector. Since 2010, the formal sector has bounced back, and many diamonds have been sold to the United Arab Emirates. Since 2016, Western Europe has once again become an export destination. However, in all periods, smuggling around the formal economy has persisted and had significant consequences for state capacity and institutions, which are examined in this chapter. This also traces the mode of exchange for other resources, particularly gold and lithium, which have been increasingly important. However, the drastic increase in diamond production that started in 2006 has uniquely impacted the Zimbabwean state. It provided an outlet to ZANU-PF during the economic collapse and increased political scrutiny, especially after the contested 2008 election, and contributed to the party being able to survive politically.
We hypothesized that semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA) and treatment currently U.S. Food and Drug Administration (FDA) approved to reduce worsening of kidney disease and kidney failure may protect against lithium-induced nephrotoxicity.
Methods
Renal adverse events (AEs) reported to the FDA Adverse Event Reporting System (FAERS) between December 2003 and December 2024 were analyzed using the validated OpenVigil 2.1 platform. Reporting odds ratios (RORs) were computed for the MedDRA terms renal impairment, renal failure, chronic kidney disease (CKD), end-stage renal disease (ESRD), and acute kidney injury (AKI) in association with lithium, semaglutide, and their co-reporting. A disproportionality signal was considered statistically significant when p < 0.05, and the lower bound of the information component (IC025) was greater than 0.
Results
Lithium was associated with significantly elevated reporting odds across all renal AEs, with each outcome exceeding statistical signal thresholds (p < 0.0001, IC025 > 0). In contrast, semaglutide demonstrated inverse associations for renal impairment, renal failure, CKD, and ESRD (RORs = 0.25–0.54), and a neutral association for AKI (ROR = 0.96); however, none met the criteria for a disproportionality signal (IC025 < 0). Co-reported use of lithium and semaglutide did not yield a significant signal for any renal outcome, including AKI (ROR = 5.81, p = 0.015, IC025 < 0).
Conclusions
This observation, provides impetus to conduct adequate, thorough, mechanistic, clinical, and observational studies to determine whether semaglutide (and/or other incretin receptor agonists) could possibly mitigate the risk for, and/or modify the trajectory of, lithium-induced nephrotoxicity.
We consider that the current National Institute for Health and Care Excellence (NICE) guideline CG185 on bipolar disorder does not provide sufficiently specific guidance for the safe monitoring of plasma lithium levels in older people. We feel this needs correction, and laboratories across the UK should lower the range recommended for monitoring older people’s lithium levels in line with guidelines from the International Society for Bipolar Disorder. This would provide a safety net in older people in order to prevent lithium toxicity without compromising efficacy.
This chapter describes material and immaterial labour in the context of the industrial production, resource extraction, and global circulation of the silvery-alkali metal known as lithium. It focuses on the different kinds of material labour involved in lithium’s extraction from local sites in and around the Atacama Desert in Latin America, as well as less visible forms of labour underpinning the mining industry, including the labour of social reproduction and colonial dispossession. In this context, it asks: how do narrative arts document the violence of lithium’s extraction as it materialises in damaged and dispossessed bodies and environments, as well as those less visible traces of lithium’s circulation around the world, and the different affective economies it inhabits? I suggest that a contradiction or tension between materiality and immateriality, between what is seen and unseen, defines every level of lithium’s transformation into a commodity, as registered within global networks of labour. These larger systems, I argue, are rendered invisible; just as lithium silently provides the charge for iPhone and Tesla, it is a vanishing mediator to what some thinkers have described as ‘new extractive imperialism’. This, however, becomes visible—precisely as a kind of ideological dissimulation—across a whole range of narrative forms.
The global energy transition carries significant geopolitical implications. This study examines how Chinese exports of critical electrical goods and geopolitical risk influence national energy transitions, focusing on lithium and rare earth production, pricing and oil markets. Using a Global Vector Autoregressive model across 12 major economies (2012–2019), with emphasis on Australia, China and the United States, the analysis shows that Chinese geopolitical risk affects the consumption of electrical goods, renewable energy deployment and critical mineral production. Empirical findings reveal that reliance on Chinese electrical goods creates strategic dependencies, making other countries vulnerable to shifts in China’s energy strategy. While oil prices are less relevant for most economies’ transitions, they remain central to the United States. The results highlight both the geopolitical risks and cooperative potential embedded in the global shift to clean energy.
Lithium treatment is associated with reduced mortality in bipolar disorder (BD), but the role of treatment continuity remains underexplored. This study investigated the association between patterns of lithium exposure and all-cause mortality in a population-based cohort.
Methods
We analyzed electronic health records from 15,384 individuals with BD in Catalonia, Spain (2010–2019). Patients were classified as having sustained, partial/intermittent, or no lithium exposure based on annual defined daily doses (DDDs). All-cause mortality was the primary outcome. Kaplan–Meier and Cox regression analyses (adjusted for sociodemographic, clinical, and treatment-related variables) estimated hazard ratios (HRs) for mortality risk. Interaction and sensitivity analyses were conducted to assess the role of comorbidity burden and dose effects.
Results
Over the study period, 715 deaths were recorded. In fully adjusted models, sustained lithium exposure was associated with a significantly lower mortality risk compared to no exposure (HR = 0.69, 95% confidence interval [CI]: 0.51–0.93, p = 0.016). In the lithium-exposed subgroup, sustained use was also protective compared to partial/intermittent exposure (HR = 0.70, 95% CI: 0.51–0.97, p = 0.03). No significant interaction was observed between sustained lithium use and comorbidity burden. Sensitivity analyses confirmed this effect at lower dose thresholds but not at higher ones.
Conclusions
Sustained lithium use is associated with improved survival in BD. Discontinuous exposure does not confer the same benefit. Ensuring treatment continuity may maximize lithium’s protective effect and improve long-term outcomes.
Since the 1980s, state capacity has been a major explanation for countries leaving the middle-income trap. However, this literature is unable to explain the failed experiences of countries with relatively high state capacity. This was the case of Chile after the unsuccessful enaction of a series of policies in the mid-2010s to upgrade the country’s position in the lithium value chain. To understand this failure, we combine the literature on developmental states and the literature on business power. We use the concept of institutional business power to understand how business actions erode state capacities leading to countries’ persistent inability to leave the middle-income trap. In the case of Chile, despite the relatively high levels of state capacity, previous processes of deregulation and privatization in the country configured a situation favorable to business’ monopolization of information and technical knowledge about lithium production and innovation processes that directly affected the capacity of the state to regulate the sector, let alone implement policies designed to upgrade the industry. The article highlights the need to investigate further the role of not just the state, but of the private sector in either facilitating or blocking value chain upgrading in countries caught in the middle-income trap.
The scramble to extract critical energy transition minerals creates risk of widespread negative human rights impacts. A just transition in the extraction of critical minerals must involve deep examination of the mine-community interface to gain a better understanding of the drivers of successful engagement between mining companies and communities. Drawing on fieldwork in South America’s lithium triangle, this paper finds that the nature of the corporate-community relationship is increasingly key to enabling a just transition whereby communities participate in the benefits of extraction with negative impacts mitigated. It establishes that key success factors are related to empowerment of Indigenous communities and have the potential to maximise positive outcomes for communities in the context of lithium extraction. Governments and companies must embed a more bottom-up process with an end goal of communities themselves defining the parameters of what a just transition means in the critical minerals context.
Humankind came to substances early. Poppy pods have been found with Neanderthal burials and spiritual and other group practices, still seen today but with millennia behind them, bear witness to the role of induced experiential change in human social evolution. Despite generations of history, the knowledge to unlock what mind-altering substances might do and the substrates through which they do it has only started to reveal itself within living memory through development of innovative investigative methods and an expanding cast of centrally acting compounds with clinical and laboratory potential.
A widening, if somewhat artificial, distinction has emerged where those who seek to modify brain systems with patients are considered psychopharmacologists, while those seeking to unravel mechanisms are considered neuropharmacologists. Expertise may differ, but the quest of clinician and basic scientist is the same, each benefitting from knowledge of the other.
This was a happy and productive time. Increase in writing and work productivity. Explored theories for my illness, and did lots of music, reading, and socialising, with generally elevated mood. Diagnosis was revised again to bipolar disorder, well controlled on lithium. Further ECT continued as an out-patient; unilateral treatment has less affect on memory.
Increasing pressure to return to work coupled with increasing feelings of inadequacy. Reached rock bottom, and was persuaded to start lithium, and after all this time, started to slowly improve.
Started work as a core psychiatric trainee in the Scottish Borders, with very supportive staff, although still had to work full-time. It was still a difficult switch from being patient to psychiatrist; Passed MRCGP exam, then became pregnant again. I then became pregnant again.
Aggression is often defined with reference to the intended consequences of an act exhibited by a person, or as any behaviour exhibited by a person where they intentionally acted to cause harm to another. Behaviours which cause harm but without associated intent tend not to be defined as aggression. Some people with intellectual disability may engage in behaviours with intent to cause harm to another, while for others, especially those with severe to profound intellectual disability, an absence of intent may exist. Aggressive behaviour exhibited by people with intellectual disability can take the form of verbal threats, physical aggression directed towards others including punching, kicking, slapping and biting, amongst other behaviours, as well as property damage and destruction. Aggressive behaviour can cause serious harm to others which may be life-threatening and result in social exclusion and a reduced quality of life. This chapter provides an overview of severe aggression and self-injurious behaviour relevant to people with disorders of intellectual development, and focuses on the evidence base for the various challenging behaviours and whether there is benefit from medication or alternative approaches.