Savage Nicholas, Green Jessica, Seshadri Madhavan, Thalitaya Madhusudan Deepak
Post Graduate Medical Centre, Hereford County Hospital, Hereford, UK.
Psychiatr Danub. 2017 Sep;29(Suppl 3):481-486.
Lithium is widely used as a mood stabilizer in managing Bipolar Disorder. It is also licensed as an augmenting agent for recurrent depression and treatment resistant depression. However, it has a narrow therapeutic index with potentially significant side effects and adverse drug interactions. Toxicity is one of the main concerns for prescribers and serum levels should be checked regularly. Also, due to the adverse effects on Kidneys and Thyroid, there are strict guidelines to monitor the kidney as well as thyroid functions periodically. Whilst the need to monitor blood biochemistry is well established, less well recognized is the need to monitor patients' physical health by means of annual checks of Body Mass Index (BMI) and waist circumference.
The purpose of this study was to investigate compliance against the NICE CG185 guidelines. Hereford is a rural town in England with a population of about 180000. Currently, the Herefordshire part of 2gether Mental Health NHS Foundation Trust does not have clearly agreed shared care protocols for Lithium monitoring. Lithium monitoring is done by GPs as part of QOF targets. As Psychiatrists recommend treatment with lithium, they have the responsibility to have an updated results and act on these appropriately. Therefore, an important aspect of this audit was to identify monitoring gaps that may result from the dual ownership of patient care.
We found that 80% of cases complied with NICE guidance as regards blood monitoring however, only 40% of cases were compliant as regards checks on the physical health parameters of BMI and weight.
The blood biochemistry of patients on lithium is generally well monitored however, physical health assessment is rarely completed with the required annual frequency and, waist circumference is almost never measured; either on initiation of lithium therapy or, on an on-going basis. More needs to be done to promote awareness of the need to monitor the physical health of patients on lithium and, in particular, to ensure that these checks include measurement of waist circumference. We believe that to improve monitoring of patients on lithium, shared care protocols should be developed between mental health services and GP services.
锂盐作为一种心境稳定剂，在双相情感障碍的治疗中被广泛应用。它也被批准作为复发性抑郁症和难治性抑郁症的增效剂。然而，其治疗指数较窄，存在潜在的显著副作用和药物不良反应。毒性是处方医生主要关注的问题之一，应定期检查血清水平。此外，由于对肾脏和甲状腺有不良影响，有严格的指南要求定期监测肾脏和甲状腺功能。虽然监测血液生化指标的必要性已得到充分认可，但通过每年检查体重指数（BMI）和腰围来监测患者身体健康的必要性却较少被认识到。
本研究的目的是调查对英国国家卫生与临床优化研究所（NICE）CG185指南的依从性。赫里福德是英格兰的一个乡村小镇，人口约18万。目前，2gether精神健康国民保健服务基金会信托基金的赫里福德郡部分没有明确商定的锂盐监测共享护理协议。锂盐监测由全科医生作为质量与结果框架（QOF）目标的一部分进行。由于精神科医生推荐锂盐治疗，他们有责任获取最新结果并据此采取适当行动。因此，本次审核的一个重要方面是确定可能因患者护理的双重责任而导致的监测缺口。
我们发现，80%的病例在血液监测方面符合NICE指南，但在BMI和体重等身体健康参数检查方面，只有40%的病例符合要求。
锂盐治疗患者的血液生化指标总体上得到了较好的监测，但身体健康评估很少按要求的年度频率完成，腰围几乎从未测量过；无论是在开始锂盐治疗时，还是在治疗过程中。需要做更多工作来提高对监测锂盐治疗患者身体健康必要性的认识，特别是要确保这些检查包括腰围测量。我们认为，为了改善对锂盐治疗患者的监测，精神健康服务机构和全科医生服务机构之间应制定共享护理协议。
