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Lithium monitoring in clinical practice

Published online by Cambridge University Press:  13 August 2021

E. Sciberras*
Affiliation:
Psychiatry, Mount Carmel Hospital, Attard, Malta
A. Bellizzi
Affiliation:
Psychiatry, Mount Carmel Hospital, Attard, Malta
L. Rapa
Affiliation:
Psychiatry, Mount Carmel Hospital, Attard, Malta
C. Vassallo
Affiliation:
Psychiatry, Mount Carmel Hospital, Attard, Malta
A. Grech
Affiliation:
Psychiatry, Mount Carmel Hospital, Attard, Malta
*
*Corresponding author.

Abstract

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Introduction

Lithium is widely used for the treatment of bipolar disorder. Owing to its narrow therapeutic index and side-effect profile, regular monitoring is recommended by all major guidelines on lithium use.

Objectives

The aim of this study was to determine whether routine lithium monitoring practice at the local mental hospital in Malta reaches the standard set by the most recent NICE guidelines (NICE, 2014a).

Methods

All patients on lithium maintenance treatment for bipolar disorder at the local Mental Hospital were included. Blood tests within the last one year were collected using iSOFT clinical manager (iCM). After the first audit cycle, a lithium monitoring sheet was created in accordance with the NICE guideline and after 6 months of implementation, the second audit cycle was conducuted.

Results

In the first cycle, 28 patients met the NICE criteria for increased risk of toxicity and have a recommended testing frequency for lithium levels of every 3 months. However, only 1 patient was observed to meet this criteria. When assessing the last lithium level only 35.7% were within 0.4-0.8 mmol/L. In the second audit cycle, 28 patients met the NICE criteria for increased risk of toxicity and have a recommended testing frequency for lithium levels of every 3 months. Almost half of the patients (12 patients, 42%) were to observed to meet this criteria. When assessing the last lithium level, 50% were within 0.4-0.8 mmol/L

Conclusions

After the introduction of the lithium monitoring sheet, monitoring improved substantially especially in high risk patients. Moreover, the majority of test results for lithium levels were within the therapeutic range.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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