[Methodological experiences in the treatment supervision of lithium prophylaxis of manic-depressive illnesses]

During lithium treatment it was observed that a larger evening dose, due to the definite increase of lithium in the blood, leads to a slight drop of the blood level during the night; and that to maintain a therapeutically defined serum lithium level during the day a smaller dose of lithium is sufficient, particularly in more elderly patients. By plotting a 24-hour the profile best individual dosage can be arranged and a reduction in side-effects thereby achieved. This profile provides numerous advantages for the further strictly organized out-patient care for patients under lithium therapy. By filling out a proforma comparing the amount of serum lithium administered at each set time of the day with the appropriate daily profile, the point where lithium prophylaxis is indicated can be extended even to patients with a slight renal insufficiency, and above all to more elderly patients, for whom a therapeutic serum lithium level can be achieved with a very low dose of 4--4--8 mval/die. After a set period of supervision other fellow specialists can at first be drawn into the system of treatment, and later the general practitioner as well.