Lithium carbonate has been used with caution and control at the New York State Psychiatric Institute for the past six years. Nineteen patients, 15 of whom had at least two well-documented prior manic attacks, were given 25 trials of lithium after therapeutic refractoriness on phenothiazines. Eleven of the 25 manic episodes had good responses to lithium treatment; the individual manic attack was definitely shortened as compared with the patient's past attacks. The authors suggest that lithium may be the treatment of choice for phenothiazine-refractory or phenothiazine-allergic manic patients treated in a research setting.Abstract Teaser