Evaluation of Lithium Use in Tertiary Psychiatric Hospital

Abstract

Background: Lithium is an antimanic drug that has been used for the first-line therapy of bipolar disorder, and it also could be used to treat other mental disorder as a mood stabilizer, where treatment with other drugs has not worked. This drug has a narrow therapeutic index so it potentially causes subtherapeutic or drug toxicity. Lithium is often combined with other drugs so that it is possible to cause drug interactions. Therefore, an evaluation of lithium use is needed. Objective: To evaluate the suitability of lithium use, as well as knowing the combination use and possibility of drug interactions occurring in patients that received lithium therapy. Method: This is non-experimental research with a cross-sectional design. This study includes all outpatients receiving lithium therapy at RSJ Prof. Dr. Soerojo, Magelang. This research was conducted using retrospective method with secondary data obtained from medical records of RSJ Prof. Dr. Soerojo Magelang within 2022. The data was analyzed using both univariate and bivariate analysis. The possibility of interactions were analyzed theoritically based on the literature. The study involves 236 patients that included as inclusion criteria. Results: Within 2022, there was 236 patients who met the inclusion criteria, 42.7% were diagnosed with schizophrenia, 31.6% were diagnosed with schizoaffective disorder, and 16.2% with bipolar disorder. The doses received by patients with bipolar disorder were in accordance with the literature, which are 200 mg to 800 mg per day. The most often drug combined with lithium was clozapine (37.38%), and the most likely interactions that could occur is interactions between lithium and clozapine (43%) with major severity. Conclusions: Patients with bipolar disorder have received lithium with appropriate diagnosis mentioned in literature. The combination of lithium with clozapine and other drugs is also appropriate and is indeed recommended for certain mental disorders. The most likely interaction that could happen is the major-level interaction between lithium and clozapine.