Some New Thoughts on Lithium-Presentation Slides

Presentation Slides
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The document is an educational resource from the American Psychiatric Association (APA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), focusing on the use of lithium in the treatment of bipolar disorder. The initiative aims to provide clinical support for serious mental illness through the Clinical Support System for Serious Mental Illness (CSS-SMI).<br /><br />Key points covered in the presentation include:<br /><br />1. <strong>Lithium Utilization</strong>: Benefits of lithium for patients with bipolar spectrum disorder, including reduced recurrence risk for mood episodes during pregnancy and neuroprotective properties that might decrease dementia risk.<br /><br />2. <strong>Lithium Monitoring</strong>: <br />    - <strong>Before Starting Treatment</strong>: Screening for CKD risk factors, baseline eGFR, thyroid function tests, pregnancy tests in women of reproductive age, and optionally, early morning urine osmolality.<br />    - <strong>Ongoing Monitoring</strong>: Regular checks for eGFR, 24-hour fluid intake records (FIR), early morning urine osmolality (EMUO), albumin-to-creatinine ratio (ACR), and lithium blood levels.<br /><br />3. <strong>Adverse Effects and Management</strong>:<br />    - <strong>Renal Effects</strong>: Regular monitoring of renal function with emphasis on the importance of spotting early signs of polyuria to prevent long-term damage.<br />    - <strong>Non-Renal Effects</strong>: Tremors managed by propranolol, potential cardiovascular changes, skin conditions, and thyroid or parathyroid dysfunction.<br />    - <strong>Pregnancy and Breastfeeding</strong>: Highlighting the need for careful monitoring during pregnancy to avoid subtherapeutic lithium levels and potential adverse effects on the fetus and neonate.<br /><br />4. <strong>Dosing Strategies</strong>:<br />    - <strong>Single Nightly Dosing</strong>: Recommended to reduce renal impact, with specific target serum levels for different treatment stages.<br />    - <strong>Adjustments for Interactions</strong>: Adjust lithium dose when combined with medications that influence its levels.<br /><br />5. <strong>Neuroprotective Effects</strong>: Studies indicate lithium may halve the dementia risk for bipolar patients and shows efficacy in increasing gray matter volume.<br /><br />6. <strong>Polyuria Management</strong>: Use of amiloride and, if necessary, acetazolamide to combat lithium-induced polyuria.<br /><br />7. <strong>Educational Tools and References</strong>: Equipped with numerous studies and textbooks such as "The Lithium Handbook," providing a rigorous basis for clinical guidelines and best practices.<br /><br />The document seeks to educate practitioners on the comprehensive management of lithium therapy, emphasizing both its psychiatric benefits and the importance of vigilant monitoring to mitigate risks.
Keywords
Lithium
Bipolar Disorder
Clinical Support System for Serious Mental Illness
Lithium Monitoring
Adverse Effects
Dosing Strategies
Neuroprotective Effects
Polyuria Management
Pregnancy and Breastfeeding
Educational Tools