Monitoring patients on lithium – a good practice guideline

Abstract

Aims and MethodTo develop a guideline that would encourage a systematic approach for both psychiatrists and general practitioners in the provision of safe, effective and consistent management of patients who are prescribed lithium. A multi-disciplinary working group developed the guideline following literature review and consultation with lithium clinics and specialist centres nationally.ResultsThe Lothian lithium guidelines include three sections: (a) a lithium treatment plan; (b) advice for clinicians on managing lithium levels; and (c) pointers for counselling patients on lithium. The treatment plan is a key document in the guidelines which, once completed, ensures continuity of care with the transfer of patient-specific information.Clinical ImplicationsThis development has provided the opportunity for primary and secondary care services to work together in producing a guideline that will improve patient care and minimises risk.

Bipolar disorder and medication: adherence, patients' knowledge and serum monitoring of lithium carbonate

“…Patients need to receive information from the healthcare team in order to identify these toxic side effects because the toxicity caused by lithium brings serious complications and can be deadly (5,10,12) .…”

“…Although effective, this substance requires specific care as it has a narrow therapeutic range, high risk of intoxication (9)(10)(11)(12) and slow onset of action, is subject to serum variation levels due to pharmacological interactions, and presents elimination and dosage-plasma level variations among people (7) . The serum monitoring of lithium carbonate levels is important for treatment effectiveness and patients' safety (9)(10)(11)(12) . Therefore, it is necessary to investigate whether this is being regularly carried out at psychological healthcare services.…”

“…The whole context shows that adherence to treatment (3)(4)8) , knowledge about the drug therapy (6)(7)(8) and serum monitoring of lithium carbonate levels (9,(10)(11)(12) are essential for the safety of patients who make use of this medication. These aspects are strictly related to the nursing practice, which plays a unique role in patients' For the collection of data, a review of medical records and structured interviews were performed, using a guide developed by the authors of the study with questions about socio-demographic information and patients' treatment, as well as a test evaluating patients' adherence to drug therapy (13) including lithium carbonate, and a scale to evaluate the interviewees' knowledge concerning the prescribed drug therapy (14) .…”

Best practice in primary care pathology: review 5

“…The 3-month interval also appears in several locally derived guidelines. 52 59 60 Despite these, there is good evidence that medical systems and practices often result in inadequate monitoring. [61][62][63][64] Lithium has also been a topic of several large medical negligence claims.…”

“…As the half life of elimination of lithium in young patients with normal renal function may be only 8-10 h, it would also seem logical to keep as close as practicable to the same timing for successive samples to limit variability. 52 Although the guidance found does not refer to monitoring for the possible development of nephrogenic diabetes insipidus in long-term use, prescribers should be aware of this possibility in any patients presenting with polyuria.…”