ArticleNeuropsychiatric disease and treatment2026
Serum Lithium Monitoring, Short-Term Outcomes, and Treatment Barriers in Bipolar Disorder: A Real-World Study.
Article in Neuropsychiatric disease and treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To characterize serum lithium monitoring, clinician-recorded short-term outcomes, and treatment barriers in a clinically selected outpatient cohort of patients with bipolar disorder that was enriched for suicide risk. Patients and Methods: We retrospectively reviewed consecutive routine-care records from a specialist mood-disorders clinic between January 2024 and March 2025. The monitoring dataset comprised 188 patients and 562 valid serum lithium measurements. The outcome dataset comprised 124 patient-level records from initial or follow-up encounters, and a separate implementation dataset contained 13 patients with documented discontinuation or non-initiation. The serum lithium value closest to the clinical outcome assessment was used in exploratory analyses. Results: Among monitored patients, 124/188 (66.0%) had at least two measurements. Median serum lithium concentration was 0.62 mmol/L (interquartile range 0.50-0.84), and 18/562 measurements (3.2%) were >1.2 mmol/L. Clinician-recorded remission was documented in 72/124 outcome records (58.1%) and any improvement in 114/124 (91.9%). Any improvement was 90.0%, 96.1%, and 81.5% in the <0.4, 0.4-<0.8, and ≥0.8 mmol/L groups, respectively (exploratory unadjusted P=0.053). Remission did not differ across groups (P=0.952), and the continuous serum lithium value was not associated with remission (odds ratio per 0.1 mmol/L, 1.01; 95% confidence interval 0.86-1.18). Documented barriers included adverse effects, testing or logistical burden, toxicity concerns, and poor palatability. Conclusion: A single routine-care serum lithium concentration recorded near a clinical assessment was not associated with clinician-recorded remission. The analysis did not evaluate longitudinal exposure or confirmed steady-state trough concentrations, and improvement during comprehensive care cannot be attributed to lithium alone. These findings support an integrated lithium-care pathway that combines interpretable monitoring, accessible testing, early management of adverse effects, clear toxicity education, and suicide-specific safety planning.
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