Pérez de Mendiola Xabier, Hidalgo-Mazzei Diego, Vieta Eduard, González-Pinto Ana
Bioaraba, Research Group on Severe Mental Illness; Osakidetza, Araba University Hospital, Psychiatry Service; Faculty of Medicine, Department of Neurosciences, University of the Basque Country UPV / EHU, Vitoria-Gasteiz, Spain.
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Centre for Biomedical Research Network on Mental Health (CIBERSAM), Barcelona, Spain.
Int J Bipolar Disord. 2021 Mar 9;9(1):10. doi: 10.1186/s40345-020-00215-z.
Lithium is considered the gold standard treatment for bipolar disorder (BD). Current clinical guidelines and scientific evidence support its use as a first-line treatment in BD. However, over the last two decades, there has been a downward tendency in lithium's use in several developed countries. Based on a nationwide survey, this study's objective is to analyze in a large sample of psychiatrists relevant issues of the use of lithium salts in BD.
Data were collected through an anonymous survey sent by email among 500 psychiatrists who belong to a National Society of Psychiatry (Spanish Society of Biological Psychiatry). The survey is a self-administered questionnaire consisting of 21 items on the most key aspects of lithium's use (indication, dosage, monitoring, and information for patients).
212 psychiatrists completed the survey. 70% of psychiatrists prescribe lithium to more than 50% of patients diagnosed with BD. Adverse effects are the main reason not to use lithium salts. Over 75% of the participants consider lithium salts the treatment of choice for the maintenance phase of BD, both in women and men. Most of the participants (> 50%) start lithium after the first affective episode, use conservative plasma concentrations (0.6-0.8 mmol/L), and generally prescribe it twice a day. 57% of psychiatrists who treat patients under 18 do not use lithium in this population. About 70% of the survey respondents use official protocols to inform and monitor patients on lithium treatment.
From the results of the present study, it can be concluded that the use of lithium in Spain is in line with the recommendations of the main international clinical guidelines and current scientific literature. The first reason not to prescribe lithium in our country is the perception of its adverse effects and not the aspects related to its practical use or its effectiveness. Considering that BD is a chronic disease with a typical onset in adolescence, the low rate of prescription of lithium salts in patients under 18 must be thoroughly studied.
锂盐被认为是双相情感障碍（BD）的金标准治疗药物。当前的临床指南和科学证据支持其作为BD的一线治疗药物。然而，在过去二十年中，几个发达国家锂盐的使用呈下降趋势。基于一项全国性调查，本研究的目的是在大量精神科医生样本中分析BD患者使用锂盐的相关问题。
通过电子邮件向隶属于国家精神病学协会（西班牙生物精神病学协会）的500名精神科医生发送匿名调查问卷收集数据。该调查问卷是一份自我管理的问卷，包含21个关于锂盐使用最关键方面（适应症、剂量、监测以及患者信息）的问题。
212名精神科医生完成了调查。70%的精神科医生给超过50%被诊断为BD的患者开锂盐。不良反应是不使用锂盐的主要原因。超过75%的参与者认为锂盐是BD维持期男性和女性的首选治疗药物。大多数参与者（>50%）在首次情感发作后开始使用锂盐，采用保守的血浆浓度（0.6 - 0.8 mmol/L），并且通常每天开两次药。治疗18岁以下患者的精神科医生中，57%不在该人群中使用锂盐。约70%的调查受访者使用官方方案对接受锂盐治疗的患者进行告知和监测。
从本研究结果可以得出结论，西班牙锂盐的使用符合主要国际临床指南和当前科学文献的建议。在我国，不开具锂盐处方的首要原因是对其不良反应的认知，而非与其实际使用或有效性相关的方面。鉴于BD是一种典型发病于青春期的慢性疾病，必须深入研究18岁以下患者锂盐处方率低的问题。
