Profiles of lithium prescriptions and serum concentrations among patients with bipolar disorder based on latent
Yuanhan Bai1, Jindong Chen2, Lina Wang3
1Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen, China.
Background:
The advantages of lithium in treating bipolar disorder (BD) are inconsistent with a declining trend in lithium prescriptions worldwide. Understanding lithium prescription patterns and serum concentrations could improve lithium clinical practices.
Methods:
This multicentre study used latent variable analysis to explore lithium prescription patterns and changing trends in lithium serum concentrations. A regression model was used to identify their underlying associated factors.
Results:
High- and low-dose prescription patterns were discovered in patients with mania and bipolar depression (BD-D), respectively. Patients with BD-D tended to receive lower lithium dosages. Lithium combination therapy was mainstream for BD. Factors associated with prescription patterns differed between patients with mania and BD-D. The lithium concentration-to-dose (C/D) ratio initially decreased but then increased. The final lithium serum concentration was mainly associated with dose titration.
Conclusions:
In this study, lower lithium dosage combined with second-generation antipsychotics is commonly used in the treatment of BD, and lithium prescription patterns fail to follow the guideline recommendations for BD. There are episode-specific factors associated with lithium prescriptions. A non-linear trend in the C/D ratio appears to be one of the factors contributing to lithium delay effects. Adjusting the lithium dosage is a direct way to change its serum concentration. Key PointsLower lithium dosage combined with SGAs is commonly used in the treatment of BD, and lithium prescription patterns fail to follow the guideline recommendations for BD.Factors associated with lithium prescription patterns differed between patients with mania and BD-D.In the context of a standardised lithium dosage (1 g), lithium plasma levels initially decrease before gradually increasing, which appears to be one of the factors contributing to lithium delay effects.
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