Masteronderzoek Psychiatrie Parnassus groep

Title: Lithium maintenance treatment in elderly with bipolar disorder 

Department: Psychiatry, Parnassia Group 

Contact :  
O. Paans, psychiatrist, Parnassia Group, Rotterdam, The Netherlands 
Telephone: 06 - 2205 6537 
E-mail: o.paans@anteszorg.nl 

Co-investigators: 
Dr. R. M. Kok, psychiatrist, Parnassia Group, Department of Old Age Psychiatry, The Hague Dr. A. M. Kamperman, Erasmus Medical Center, Rotterdam 
Prof. dr. R. W. Kupka, psychiatrist, Amsterdam University Medical Center, Vrije Universiteit, dept. of  Psychiatry, Amsterdam 

Contents/objective: 
Bipolar disorder is a chronic and severe condition characterized by manic/hypomanic, mixed, and depressive episodes. It is not only an illness of younger adults, but also of the elderly.  (Oosterfink,Nolen & Kok, 2014) . Because of the severity of the symptoms, treatment is very important. Lithium is a well- nown mood stabilizer for maintenance and acute treatment of bipolar disorder. In younger adults the lithium level for maintenance treatment is between 0.6 -0.8 mmol/l. These limits are controversial in the elderly. For example Sajatovic and Blow (2007) state in their  influential book: “To reduce potential side effects and toxicities, clinicians should target moderate plasma concentration ranges 0.4-0.8 mmol/l; however higher concentrations may be necessary.” The authors did not mention if these levels are for maintenance or acute treatment. A literature search  revealed a lack of studies comparing these lower with more conventional serum levels. Therefore, in this study our aim is to compare the effectivity of lithium in the range < 0.6 mmol/l with ≥ 0.6  mmol/l. Our hospital has a dataset containing records of 166 older adults and 100 younger adults with a bipolar disorder, using lithium from 2010-2020. The student is expected to collect and correct data about lithium efficacy from this dataset and the EPD (electronic patient record) and specify his/her question based on a literature study. The student is also expected to write a research report and provide a verbal presentation of the findings at the department of Psychiatry. 

References: 

• Oostervink, F., Nolen, W. A., & Kok, R. M. (2014). Two years' outcome of acute mania in bipolar disorder: different effects of age and age of onset. International journal of geriatric psychiatry. 
• Sajatovic, M., & Blow, F. C. (Eds.). (2007). Bipolar disorder in later life. JHU Press.