Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.
Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.
Bipolar Disord. 2016 Dec;18(8):631-641. doi: 10.1111/bdi.12455.
The Lithiumeter was developed as a visual and practical guide for determining lithium levels in the management of bipolar disorder (BD). It appears to have been well received, as evidenced by its increasing popularity amongst doctors as a deskside clinical aide, and adoption and reproduction of the schematic in clinical guidelines and texts. However, since its publication 5 years ago, key basic neuroscience and clinical research developments pertaining to lithium have significantly advanced our understanding, necessitating further refinement of guidance concerning the practicalities of lithium therapy.
Literature concerning the indications for, and therapeutic levels of, lithium and the associated acute and chronic risks of therapy was scrutinized as part of updating clinical practice guidelines. We have reviewed these updates and identified significant areas of change with respect to the previous Lithiumeter (version 1.0).
Since 2011, updated clinical practice guidelines have narrowed the indicated plasma lithium concentration for maintenance therapy, suggesting that additional guidance is necessary for optimizing treatment. Relevant updated clinical guidance was integrated to constitute the Lithiumeter 2.0, which provides a more comprehensive overview of the practical aspects of lithium therapy while maintaining a focus on optimization of lithium levels, such as differential titration of lithium depending on the current mood state.
The Lithiumeter 2.0 is an update that clinicians will find useful for their practice. By addressing some of the issues faced in clinical practice, translational clinical research will continue to inform the Lithiumeter in future updates.
Lithiumeter 是为了帮助医生在管理双相情感障碍（BD）患者时直观地判断锂盐血药浓度而开发的。从 Lithiumeter 在医生中越来越受欢迎，成为床边临床助手，以及临床指南和教科书采纳并复制其示意图这一事实来看，它似乎很受欢迎。然而，自 5 年前发表以来，与锂相关的关键基础神经科学和临床研究进展显著提高了我们对锂治疗的理解，需要进一步完善有关锂治疗实际情况的指导。
作为更新临床实践指南的一部分，对有关锂的适应证、治疗水平以及相关的急性和慢性治疗风险的文献进行了仔细审查。我们审查了这些更新内容，并确定了与之前的 Lithiumeter（版本 1.0）相比发生显著变化的领域。
自 2011 年以来，更新的临床实践指南缩小了维持治疗的推荐血浆锂浓度范围，这表明需要进一步优化治疗的指导。将相关的更新临床指导纳入其中，构成了 Lithiumeter 2.0，它提供了一个更全面的锂治疗实际方面的概述，同时仍侧重于优化锂水平，例如根据当前的情绪状态进行锂的差异化滴定。
Lithiumeter 2.0 是一个更新版本，临床医生会发现它对自己的实践很有用。通过解决临床实践中面临的一些问题，转化临床研究将继续为未来的更新提供信息。
