Response to Lithium in Patients with Bipolar Disorder: What are Psychiatrists’ Experiences and Practices Compared to Literature Review?

Abstract

Abstract Background This study aims at characterizing French psychiatrists’ opinions regarding definition criteria and factors associated with lithium prophylactic response in patients with bipolar disorders. Methods After a literature review, an online survey targeted French psychiatrists in 2016. Results Literature review showed inconsistencies in reported definition criteria and clinical predictors of lithium prophylactic response. A total of 104 psychiatrists, mostly working in hospitals, completed the survey. The inconsistencies regarding definition criteria and predictors of lithium response were confirmed. Five factors were commonly reported by psychiatrists as positively associated with successful response (family history of lithium response and of bipolar I disorder, and lithium efficacy in acute mood phases treatment) or with an unsuccessful response (rapid cycling and alcohol misuse). Discussion The divergence in psychiatrists’ opinions surely plays a major role in the variability of lithium prescriptions among psychiatrists. Currently, the large variations in response definitions, and in study designs used to quantify each factor’s effect, preclude synthesizing the findings. A standardization of response measures is needed to explore factors that influence the prophylactic lithium efficacy.