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Recommendations in International Clinical Practice Guidelines for Lithium Therapy of Bipolar Disorder

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The Science and Practice of Lithium Therapy

Abstract

Lithium is the gold-standard treatment for prophylaxis in bipolar disorder and has remained in pole position for the past 60 years in international guidelines. However, in practice, the perception that lithium is complicated to prescribe and associated with acute and long-term side effects constitutes a barrier to its effective prescription and management. In this chapter, we examine the positioning of lithium within current clinical practice guidelines for the treatment of bipolar disorder and describe how it is effective in quelling the acute symptoms of mania, as well as sustaining full and functional remission in prophylaxis, alongside conferring antisuicidal and neuroprotective benefits. We then discuss the specificity of lithium as a mood stabiliser and the recognition of an ideal lithium responder. The chapter also includes clinical advice regarding the prescription of lithium—emphasising the role of monitoring and measuring lithium plasma levels and using the ‘lithiumeter’ to optimise therapeutic levels and avoid toxicity.

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Authors and Affiliations

  1. Academic Department of Psychiatry, Sydney Medical School, The University of Sydney and CADE Clinic, Royal North Shore Hospital, Sydney, Australia

    Gin S. Malhi MBChB BSc FRCPsych FRANZCP MD, Danielle Gessler, Kristina Fritz, Tim Outhred & Pritha Das

  2. Clinic for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Langerstrasse 3, Munich, 81675, Germany

    Christine Allwang

Authors
  1. Gin S. Malhi MBChB BSc FRCPsych FRANZCP MD
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  2. Danielle Gessler
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  3. Kristina Fritz
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  4. Christine Allwang
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  5. Tim Outhred
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  6. Pritha Das
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Corresponding author

Correspondence to Gin S. Malhi MBChB BSc FRCPsych FRANZCP MD .

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Editors and Affiliations

  1. Academic Department of Psychiatry, Sydney Medical School The University of Sydney, Sydney, Australia

    Gin S. Malhi

  2. Nightingale Hospitals Paris-Clinique du Château de Garches, Consultant Service Hospitalo-Universitaire Centre Hospitalier Sainte-Anne, Paris, France

    Marc Masson

  3. Publique – Hôpitaux de Paris, INSERM UMR-S1144 Paris-Diderot University, Paris, France

    Frank Bellivier

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Malhi, G.S., Gessler, D., Fritz, K., Allwang, C., Outhred, T., Das, P. (2017). Recommendations in International Clinical Practice Guidelines for Lithium Therapy of Bipolar Disorder. In: Malhi, G., Masson, M., Bellivier, F. (eds) The Science and Practice of Lithium Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-45923-3_11

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