Patient experiences with brain 1H proton and 7Lithium magnetic resonance imaging before and during lithium treatment for bipolar affective disorder: a qualitative analysis

BACKGROUND: This study aimed to explore and understand the experiences of patients with bipolar disorder type I who underwent magnetic resonance imaging (MRI) brain scans as part of lithium treatment assessment in the European R-LiNK study.

METHODS: All participants underwent brain imaging at baseline and three months after starting lithium treatment. 1 H-MRI scans (structural, diffusion-weighted, and single voxel proton spectroscopy) were conducted on both occasions, with 7Li-MRI at the second visit, all at 3T. The study used a qualitative, inductive approach to explore patients' subjective experiences.

PARTICIPANTS: Eight participants were included, four males and four females, aged 22 to 52 years. This group was selected from the R-LiNK study based on s having completed the imaging component before and after lithium treatment initiation.

RESULTS: Seven themes were identified: Motivations for Participation, Experiences with MRI Scans, Psychological Impact of MRI Scans, Patient Reflections on Lithium Use, Integration of Technology in Treatment, Evaluating Combined Treatment Strategies, and Implications for Future Research. Participants commonly described lithium as contributing to mood stabilisation, while the MRI scans provided several individuals with a tangible sense of the biological underpinnings of their illness. Conversely, some participants reported anxiety and discomfort with the MRI procedure and particularly in relation to lithium's side effects, emphasizing the importance of supportive and empathetic communication throughout the treatment process to encourage trust and understanding.

CONCLUSIONS: This qualitative study revealed that adding 7Li-MRI scans to the early stages of lithium treatment subjectively validated the diagnosis, increased participants' confidence in the treatment process, and highlighted the importance of integrating patient experiences when incorporating advanced technology to monitor treatment response.