IQMH is pleased to announce the publication of a scientific paper in The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (eJIFCC) by members of the IQMH Chemistry Scientific Committee, and Julia Stemp, IQMH Consultant Technologist. The article, Age-stratified lithium therapeutic ranges for older adults with bipolar disorder – from awareness to an action plan, brings awareness and promotes the adoption of standardized therapeutic ranges for serum lithium to treat bipolar disorder.
Lithium is the first-line treatment and maintenance therapy in bipolar disorder. It is used as an effective mood stabilizer with potential benefits in neuroprotection, reducing the risk of suicide. However, lithium toxicity, particularly in older adults, has raised patient safety concerns. In 2019, recommendations for age-stratified lithium therapeutic ranges for therapy of Older Age Bipolar Disorder (OABD) was published by the International Society for Bipolar Disorder (ISBD) Older Adults Task Force. The paper states that clinical laboratory practice surveys in Canada indicate the adoption and implementation of their recommended ranges have been limited to date.
A feasibility assessment for the adoption of standardized therapeutic ranges for serum lithium was examined in the IQMH article. IQMH proficiency testing survey data to determine lithium method performance agreement among clinical laboratories reporting lithium levels to clinicians, and hospital serum lithium data for association with age were used to evaluate the feasibility of adopting and implementing standardized age-stratified therapeutic ranges for lithium. Findings in the IQMH article generally align with the OABD Task Force recommendations.
The lack of age-stratified lithium therapeutic ranges may put older adults at risk of developing lithium toxicity as some potentially toxic results may be disregarded as “within the therapeutic range”. Adoption and implementation of clinically appropriate, age-stratified therapeutic ranges for OABD have been slowly but steadily increasing in Canada. A small group of clinical laboratories in Ontario have championed the implementation of revised therapeutic lithium ranges for OABD and are now sharing their experiences with other clinical laboratories in other provinces. Champion leaders have also been identified in provincial laboratory groups in British Columbia and Alberta to drive implementation across Canada where applicable.
While the work is being done to transform awareness of the ISBD OABD Task Force recommendations into action in Canada, the data presented in the IQMH article will help raise awareness and promote the safe and effective use of lithium in OABD patients globally.
The IQMH article is complementary to and reinforces the importance of quality standards such as the recently published Health Standards Organization standards CAN/HSO 22004:2023 – Mental Health and Addictions Services, and CAN/HSO 5064:2023 – Suicide Prevention Program.
Together with our affiliates, Health Standards Organization, and Accreditation Canada, IQMH proudly demonstrates its commitment to our shared vision for safer care and a healthier world.
Read the full article in The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine.