1 Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
3 Department of Psychiatry, Thammasat University Hospital, Pathum Thani, Thailand.
J Psychopharmacol. 2018 Apr;32(4):408-415. doi: 10.1177/0269881118760663. Epub 2018 Mar 19.
Lithium is widely used for the treatment of bipolar disorder. Owing to its narrow therapeutic index and side-effect profile, regular monitoring of serum levels, renal and thyroid function has been recommended by all major guidelines on lithium use.
We investigated whether lithium monitoring during maintenance phase treatment in clinical practice meets the latest recommendation by the National Institute for Health and Clinical excellence (i.e. lithium levels between 0.6 and 1.0 mmol/L and lithium level, thyroid and renal function tests every 6 months) in one of the largest mental health organizations in Europe, the South London and Maudsley (SLaM) NHS Foundation Trust.
Retrospective data were extracted from SLaM's Clinical Record Interactive Search (CRIS) system. Adult patients with a psychiatric disorder who were on lithium at any point during the period January 2012-January 2016 and had at least one lithium level test result in the system were included in the analyses.
A total of 2639 lithium level tests results were retrieved for 412 patients. Overall, the serum level was within the recommended range in 50.7% of all tests, below the range in 42.4% and above in 6.9%. Lithium level, renal and thyroid function tests were performed at the recommended frequency of 6 months (or less) in 76.2%, 72.7% and 60.2% of patients, respectively.
These data demonstrate that there is a gap between the NICE 2014 recommendation and lithium monitoring practice in secondary care, with a high number of lithium level results below the therapeutic minimum. Reminder strategies for secondary care practitioners, shared care agreements or a central registry for lithium users could improve monitoring performance.
锂广泛用于治疗双相情感障碍。由于其治疗指数较窄且副作用明显，所有关于锂使用的主要指南都建议定期监测血清水平、肾功能和甲状腺功能。
我们调查了在欧洲最大的心理健康组织之一南伦敦和莫兹利 NHS 基金会信托（South London and Maudsley NHS Foundation Trust）的临床实践中，锂维持治疗期间的监测是否符合国家健康与临床卓越研究所（National Institute for Health and Clinical excellence，NICE）的最新建议（即 0.6 至 1.0mmol/L 的锂水平，每 6 个月进行一次锂水平、甲状腺和肾功能检查）。
从南伦敦和莫兹利的临床记录互动搜索（Clinical Record Interactive Search，CRIS）系统中提取回顾性数据。纳入分析的患者为在 2012 年 1 月至 2016 年 1 月期间任何时候使用锂的精神障碍成年患者，且系统中至少有一次锂水平检测结果。
共检索到 412 名患者的 2639 次锂水平检测结果。总体而言，所有检测中有 50.7%的血清水平处于推荐范围内，42.4%的检测结果低于推荐范围，6.9%的检测结果高于推荐范围。锂水平、肾功能和甲状腺功能检查在推荐的 6 个月（或更短）频率下进行，分别有 76.2%、72.7%和 60.2%的患者进行了这些检查。
这些数据表明，在二级保健中，NICE 2014 年的建议与锂监测实践之间存在差距，大量的锂水平结果低于治疗最低值。针对二级保健从业者的提醒策略、共享护理协议或锂使用者的中央登记册，可能会提高监测效果。
