CC BY-NC-ND 4.0 · Pharmacopsychiatry 2023; 56(05): 188-196
DOI: 10.1055/a-2117-5200
Original Paper

Lithium Therapy in Old Age: Recommendations from a Delphi Survey

Julia Christl
1   Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
,
Bruno Müller-Oerlinghausen
2   Charité Universitätsmedizin Berlin, Berlin, Germany
3   Brandenburg Medical School Theodor Fontane, Faculty of Medicine and Psychology, Neuruppin, Germany
,
Michael Bauer
4   Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
,
Daniel Kamp
1   Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
,
Fabian Fußer
5   Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum Klingenmünster, Klingenmünster, Germany
,
Jens Benninghoff
6   Zentrum für Altersmedizin und Entwicklungsstörungen, kbo-Isar-Amper-Klinikum München-Ost, Haar, Germany
7   LVR-Universitätsklinik Essen, Kliniken und Institut der Universität Duisburg-Essen, Essen, Germany
,
Rosa A. Fehrenbach
8   Saarland-Heilstätten GmbH, SHG-Kliniken Sonnenberg, Klinik für Gerontopsychiatrie, Saarbrücken, Germany
,
Christian Lange-Asschenfeldt
1   Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
9   Oberberg Fachklinik Düsseldorf Kaarst, Kaarst, Germany
,
Michael Rapp
10   University of Potsdam, Research Area Cognitive Sciences, Division of Social and Preventive Medicine, Potsdam, Germany
,
Bernd Ibach
11   Zentrum für Alterspsychiatrie und Privé, Clienia Littenheid AG, Littenheid und Universität Zürich, Zürich, Schweiz
,
Rainer Schaub
12   Klinik für Gerontopsychiatrie und Psychotherapie, Klinikum am Weissenhof, Weinsberg, Germany
,
Axel Wollmer
13   Klinik für Gerontopsychiatrie und Psychotherapie, Asklepios Klinik Nord-Ochsenzoll, Hamburg, Germany
,
Timm Strotmann-Tack
14   Klinik für Gerontopsychiatrie und Psychotherapie, LVR-Klinik Viersen, Viersen, Germany
,
Michael Hüll
15   Zentrum für Psychiatrie Emmendingen, Emmendingen, Germany
,
Susanne Biermann
16   LWL-Klinik Lengerich, Lengerich, Germany
,
Katharina Roscher
17   Psychiatrische Klinik Lüneburg, Lüneburg, Germany
,
Bernd Meissnest
18   LWL-Klinikum Gütersloh, Gütersloh, Germany
,
Alexander Menges
19   Klinikum Freudenstadt, Freudenstadt, Germany
,
Bernd Weigel
20   Bezirksklinikum Mainkofen, Mainkofen, Deggendorf, Germany
,
Dorothee Maliszewski-Makowka
21   LVR-Klinik Bedburg-Hau, Bedburg-Hau, Germany
,
Christian Mauerer
22   Bezirkskrankenhaus Bayreuth, Bayreuth, Germany
,
Martin Schaefer
23   Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin, Evang. Kliniken Essen-Mitte, Essen, Germany
,
Beate Joachimsmeier
24   LWL Klinik Paderborn, Paderborn, Germany
,
Sarah Kayser
25   Klinik für Allgemeine Psychiatrie und Psychotherapie mit Poliklinik Universitätsklinikum Tübingen, Tübingen, Germany
,
Lars Christian Rump
26   Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
,
Tillmann Supprian
1   Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Correction: Lithium Therapy in Old Age: Recommendations from a Delphi SurveyPharmacopsychiatry 2023; 56(05): e1-e1
DOI: 10.1055/a-2158-9744

Abstract

Introduction While lithium (Li) has been well established for the treatment of bipolar disorder, geriatric patients require special attention when it comes to issues of drug safety. Declining renal function, amongst other medical conditions, and polypharmacy may pose increased risks. Only a few previous studies have addressed the management of Li in geriatric patients.

Methods Twenty-four German medical experts on geriatric medicine and Li treatment participated in a Delphi survey, consisting of two rounds of questionnaires and a final formulation of treatment recommendations. Three major issues of Li therapy were outlined: initiation of treatment, monitoring of ongoing therapy, and withdrawal due to medical reasons. Final recommendations were consented to at a threshold of at least 80% expert agreement.

Results Final consensus was achieved on 21 clinical recommendations. The approved recommendations covered aspects of necessary laboratory checks, concomitant medication, and target Li serum concentration in geriatric patients. Concerning the termination of Li therapy, an agreement was reached on the appropriate time span for tapering and on potential alternatives to Li. No consensus was achieved on whether concomitant dementia or frailty should be considered contraindications for Li treatment and the appropriate threshold of the estimated glomerular function rate for withdrawing Li.

Conclusion According to the view of German experts, Li may be used in geriatric patients, but it should be monitored carefully. However, the lack of consent in several specific treatment situations underlines the need for research on specific issues of Li therapy.

Key words

lithium - old age - maintenance therapy - reference serum level - drug monitoring - geriatric patients - withdrawal - renal function


Publication History

Received: 25 April 2023
Received: 13 June 2023

Accepted: 16 June 2023

Article published online:
28 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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