Lithium is a mood stabiliser that is generally regarded as ‘gold standard’ for the treatment of bipolar affective disorder. However, lithium has a narrow therapeutic index. This necessitates regular testing of lithium levels as well as of renal and thyroid function, which can be affected by chronic lithium use. An audit was conducted by the Bedfordshire Community Mental Health Team (BCMHT) to investigate the monitoring of lithium therapy. Blood tests (for lithium levels, renal function and thyroid function) were conducted more infrequently than is currently recommended. However, there was also some evidence for alternative explanations for the apparent lack of monitoring, such as the fact that blood tests were now being conducted by GPs rather than psychiatrists. Lithium therapy falls into the remit of shared care: the responsibility for the management of patients is shared between hospital specialists and GPs. One tool to improve communication between the various teams involved in patient care is the shared-care card.
Keywords: lithium, bipolar affective disorder, drug monitoring, shared-care