lithium therapy
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BJPsych Open ◽  
2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Adrian H. Heald ◽  
David Holland ◽  
Michael Stedman ◽  
Mark Davies ◽  
Chris J. Duff ◽  
...  

Background Lithium is viewed as the first-line long-term treatment for prevention of relapse in people with bipolar disorder. Aims This study examined factors associated with the likelihood of maintaining serum lithium levels within the recommended range and explored whether the monitoring interval could be extended in some cases. Method We included 46 555 lithium rest requests in 3371 individuals over 7 years from three UK centres. Using lithium results in four categories (<0.4 mmol/L; 0.40–0.79 mmol/L; 0.80–0.99 mmol/L; ≥1.0 mmol/L), we determined the proportion of instances where lithium results remained stable or switched category on subsequent testing, considering the effects of age, duration of lithium therapy and testing history. Results For tests within the recommended range (0.40–0.99 mmol/L categories), 84.5% of subsequent tests remained within this range. Overall, 3 monthly testing was associated with 90% of lithium results remaining within range, compared with 85% at 6 monthly intervals. In cases where the lithium level in the previous 12 months was on target (0.40–0.79 mmol/L; British National Formulary/National Institute for Health and Care Excellence criteria), 90% remained within the target range at 6 months. Neither age nor duration of lithium therapy had any significant effect on lithium level stability. Levels within the 0.80–0.99 mmol/L category were linked to a higher probability of moving to the ≥1.0 mmol/L category (10%) compared with those in the 0.4–0.79 mmol/L group (2%), irrespective of testing frequency. Conclusion We propose that for those who achieve 12 months of lithium tests within the 0.40–0.79 mmol/L range, the interval between tests could increase to 6 months, irrespective of age. Where lithium levels are 0.80–0.99 mmol/L, the test interval should remain at 3 months. This could reduce lithium test numbers by 15% and costs by ~$0.4 m p.a.


2021 ◽  
Vol 53 ◽  
pp. S498-S499
Author(s):  
K. Otani ◽  
A. Miura ◽  
H. Miyai ◽  
H. Fukushima ◽  
K. Matsuishi

2021 ◽  
Vol 40 (2) ◽  
pp. 7-13
Author(s):  
Carina Schifino Robles ◽  
Onofre Francisco de Quadros ◽  
Solange Bercht

The present work is a case study of 8 bipolar patients under lithium therapy, being all of them members of the lithium group of the Hospital de Clínicas de Porto Alegre. It describes the dental management of bipolar patients under lithium therapy, emphasizing dental caries and the clinical method of intervention. The work was divided into three phases, existing a ninety-day interval between each ofthem. In the first part ofthe research, dental examinations were carried out and the patients were interviewed with the special purpose of describing each one of them regarding his buccal health. They were also inquired about their experience in living with the bipolar disease, about the medication taken and its side effects. The patients received dental treatment according to the clinical method as they also attended health educational sessions destined to increase their autonomy up to the dental dismissal. In the second and third phases, the exams that had been carried out in the first phase were repeated in order to analyze the commitment of each bipolar patient to the proposed dental treatment. The questions about the relationship between the bipolar patient and the treatment of this disease were also repeated. It was concluded that the results of the dental exams were related to the degree of stabilization of the bipolar disease; the patients detaining the best results in the dental treatment were those who had the bipolar disease stabilized. It was concluded that, having in mind the occurrence frequency of bipolar disease, it would be plausible that a denfist who works in the Public Service sooner or later would attend bipolar patients; bipolar patients are a peculiar population group that need a specific dental program; the planning and scheduling of these specific odontological programs for bipolars should take into account the disruptions in the dental therapy, caused by the disease and it is also necessary to renegotiate with the bipolar, his responsibilities and his motivation for buccal self-care, which will result in more frequent dental visits.


2021 ◽  
pp. 171-205
Author(s):  
Anna V. Shurlygina ◽  
Lyubov N. Rachkovskaya ◽  
Margarita V. Robinson ◽  
Anastasia A. Kotlyarova ◽  
Maxim A. Korolev
Keyword(s):  

2021 ◽  
Vol 33 (S1) ◽  
pp. 63-64
Author(s):  
E. Herridge ◽  
L. Valentine ◽  
J. Cannon ◽  
R. Novac ◽  
S. Marmion ◽  
...  

INTRODUCTION:Lithium has a narrow therapeutic index with a risk of toxicity and potential to increase morbidity and mortality, particularly in the elderly with co-morbid illness and polypharmacy. Lithium therapy and monitoring of lithium levels require precision and several guidelines have been issued including recommendations for strict control of lithium levels in the elderly population.RESEARCH OBJECTIVE:We evaluated the effect of implementation of a multifaceted management programme on the compliance with international practice standards for lithium monitoring in patients under the care of Psychiatry of Old Age (POA), Sligo Leitrim Mental Health Services in the North West of Ireland.METHODS:Results from a prior audit performed in February 2020 involving a cohort of 18 patients prescribed lithium under the care of POA were analysed and compared to accepted standards. The guideline used as the benchmark for compliance was the National Institute for Clinical Excellence (NICE) guidelines on the use and monitoring of lithium therapy, as published in 2014. Several deficits were found and therefore a designated Lithium Management Programme was established. A subsequent audit, performed using a simplified audit tool incorporating the NICE guidelines, delivered results which were directly compared to the initial findings and analysed to evaluate the effect of the implemented management programme.PRELIMINARY RESULTS OF THE ONGOING STUDY:In comparison with findings from 2020, there had been a significant improvement in most facets of lithium management and compliance to practice standards. Of particular note was the improvement of biochemical monitoring, side effect screening, polypharmacy surveillance, patient education and interdisciplinary communication.CONCLUSION:The launch of a dedicated Lithium Management Programme with specific features aimed at identifying and addressing poor compliance with monitoring guidelines has led to improved adherence to accepted international practice standards. Our model provides a dynamic, multi-layered system which paves the way for better patient outcomes, timely access to care and furthering education for patients and staff members.


Author(s):  
Shweta Vohra ◽  
Akshyaya Pradhan ◽  
Rishi Sethi ◽  
Monika Bhandari

AbstractLithium is considered a gold standard drug for the management of bipolar disorder and is a widely used mood-stabilizing drug in psychiatry practice. However, its side effects are of important concern. The narrow therapeutic index of lithium predispose it to toxicity/side effects, but various case reports in literature have shown that adverse drug reactions can occur even in the therapeutic range. We present the case of a 56-year-old woman with no history of cardiac illness presenting with tachycardia-bradycardia syndrome along with moderate pulmonary hypertension. Patient reverted to sinus rhythm after withholding lithium therapy for 1 week while her mean pulmonary artery pressure remained the same at day 10 of drug withdrawal.


Author(s):  
M. Kâzım Yazıcı ◽  
Elçin Özçelik Eroğlu ◽  
Aygün Ertuğrul ◽  
A. Elif Anıl Yağcıoğlu ◽  
Esen Ağaoğlu ◽  
...  

Author(s):  
Rajesh Kumar Gupta ◽  
Mithileshwer Raut ◽  
Aseem Bhattarai ◽  
Eans Tara Tuladhar ◽  
Vijay Kumar Sharma ◽  
...  

Background: Lithium has been used for decades as mood-stabilizing agents in the management of bipolar disorder and other condition with a manic component. However, some studies have also reported varying degrees of thyroid abnormalities associated with lithium therapy and effect of such therapy on thyroid function is unclear in this part of world. Therefore, we aimed to determine the effect of long term use of lithium on thyroidfunctionin the individual with bipolar disorder receiving lithium therapy. Methods: A total of 75 bipolar disorder patients (24 males, 51 females) who are under lithium therapy and equal number of control were recruited for this study. Diagnosis of bipolar disorder was made by psychiatrist according to ICD-10-DCR guidelines and DSM-IV criteria. Serum fT3, fT4 and TSH were measured by enhanced chemiluminescence immunoassay. Statistical analysis was performed using SPSS 20.0 version. Results: The prevalence of primary hypothyroidism and subclinical hypothyroidism were found significantly increased in lithium treated group (12% and 17%, respectively) which was further increased with duration of treatment. The mean fT3 and fT4 concentration is low in lithium treated group compared to control group.Butmean TSH level was found significantlyhigher in lithium treated group compared to control (9.67±12.47 vs. 3.41±3.69, p<0.005). Conclusion: Our findings indicate that use of lithium therapy is associated with higher degree of primary hypothyroidism and subclinical hypothyroidism and female are more susceptible for the thyroid dysfunction associated with lithium therapy.


Author(s):  
Susana Gomes-da-Costa ◽  
Wolfgang Marx ◽  
Filippo Corponi ◽  
Gerard Anmella ◽  
Andrea Murru ◽  
...  

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