Source: DGNews  |  Posted 1 year ago

By Ed Susman

NEW ORLEANS -- May 25, 2010 -- Although screening patients on lithium therapy at least every 6 months is recommended, there appear to be gaps in performing these assessments, researchers said here at the 2010 Annual Meeting of the American Psychiatric Association (APA).

Even though lithium monotherapy for bipolar disorder has declined with the advent of newer drugs, the use of lithium continues as a frequent choice for adjunct or combination treatment, said Radha Agepati, MD, Bergen Regional Medical Center, Paramus, New Jersey.

"Many adverse effects associated with lithium treatment occur at varying times after treatment is started," she said during a poster presentation on May 24. "Some are harmless, but it is important to be alert to adverse events that may signify impending serious toxic reactions."

Dr. Agepati and colleagues retrospectively scrutinised charts of patients with bipolar disorder on some sort of lithium therapy in an attempt to highlight how their institution can improve compliance with recommendations. She said the next study would see if the hospital staff improved its treatments.

The researchers identified 101 patients in their study who were treated between October 2008 and June 2009. "We reviewed the electronic medical records, focusing on the laboratory tests that were ordered at once during a 6-month period of the inpatient admission.

The researchers reported:
· 72% of patients had their lithium levels checked.
· 50% of the patients underwent an electrocardiogram.
· 89% had calcium levels checked.
· 81% of women had pregnancy tests.
· 74% of patients underwent thyroid function tests.
· 90% underwent tests to determine kidney function.
· 90% had a complete blood count performed.

"All these figures probably should be at 100%," Dr. Agepati said. However, she said the lack of electrocardiogram testing "was worrisome. The bradycardia-tachycardia syndrome is a definite contraindication to the use of lithium because the ion further depresses the sinus node."

She was also concerned that lithium levels were not checked in more than one-fourth of patients, giving doctors no way of knowing if dosages were too high or if patients were even taking their medications.

Similarly, more than 255 patients did not receive a thyroid function test in 6 months. Lithium probably depresses thyroid function, and a test for those on treatment is recommended every 6 to 12 months.

"Our data suggest that a large majority of patients started on lithium therapy do have their blood work monitored for possible complications and side effects of lithium," Dr. Agepati said. "However, the results demonstrate that the tendency to monitor the various areas of possible complications is far from 100%."

[Presentation title: A Quality Improvement Project to Assess the Importance of Screening Variables in Patients Being Treated With Lithium. Abstract NR2-53]