Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Australia.
Bipolar Disord. 2019 Mar;21(2):117-123. doi: 10.1111/bdi.12714. Epub 2018 Nov 16.
Despite the growing numbers and proportion of older adults with bipolar disorder (OABD), there are very limited guidelines for the use of lithium with its double-edged potential for effectiveness and toxicity in this population. The primary aims of this Delphi survey were: (a) To determine the place of lithium among the preferred choices for maintenance treatment of OABD. (b) To provide detailed clinical guidelines for the safe and effective use of lithium in OABD.
In the face of limited evidence, the Delphi survey method was used to achieve consensus by a group of 25 experts in OABD from nine countries. An oversight committee monitored and analyzed the results of each survey and formulated more focused questions with each subsequent iteration.
A 100% response rate was achieved for all three iterations of the survey. Lithium was the preferred choice for maintenance monotherapy in OABD. Serum levels of 0.4-0.8 mmol/L were recommended for ages 60-79 and serum levels of 0.4-0.7 mmol/L were recommended for ages 80 and over. Specific recommendations achieved consensus for second line monotherapy as well as for other drugs to be used in combination with lithium if necessary. Guidelines for routine monitoring of lithium in OABD were provided for laboratory investigations and clinical assessments.
Lithium remains the preferred choice for maintenance monotherapy in OABD. Laboratories should report the therapeutic range for serum levels of lithium separately for older adults.
尽管患有双相情感障碍的老年患者（OABD）人数和比例不断增加，但对于锂在该人群中的双重有效性和毒性的应用，仅有非常有限的指南。本德尔菲调查的主要目的是：（a）确定锂在 OABD 维持治疗的首选方案中的地位。（b）为锂在 OABD 中的安全有效使用提供详细的临床指南。
鉴于证据有限，采用德尔菲调查方法，由来自 9 个国家的 25 名 OABD 专家组成小组，以达成共识。监督委员会监测和分析每次调查的结果，并在随后的每次迭代中制定更有针对性的问题。
调查的所有三个迭代都实现了 100%的响应率。锂是 OABD 维持单药治疗的首选。推荐的血清水平为 60-79 岁时为 0.4-0.8mmol/L，80 岁及以上时为 0.4-0.7mmol/L。二线单药治疗以及如果需要与锂联合使用的其他药物也达成了共识。还为 OABD 中锂的常规监测提供了实验室检查和临床评估的指南。
锂仍然是 OABD 维持单药治疗的首选。实验室应分别报告老年人群血清锂水平的治疗范围。
