Bipolar, schizophrenia and other psychoses: target organ damage
Indicator
The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months.
Indicator type
General practice indicator for use outside the Quality and Outcomes Framework (QOF).
Corresponding QOF indicator MH009 was retired from the QOF in 2019 as data showed average numbers of eligible patients per practice to be less than 20 per year.
This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators.
To find out how to use indicators and how we develop them, see our NICE indicator process guide.
Rationale
Bipolar affective disorder is a condition characterized by episodes of mania (abnormally elevated mood or irritability and related symptoms with severe functional impairment or psychotic symptoms for 7 days or more) or hypomania (abnormally elevated mood or irritability and related symptoms with decreased or increased function for 4 days or more) and episodes of depressed mood. The adult psychiatric morbidity survey in 2014 found that 2% of people in the UK screened positive for bipolar affective disorder. Lithium is one of the pharmacological treatments used in bipolar affective disorder but is associated with adverse effects such as thyroid dysfunction, hypercalcaemia, diabetes insipidus and renal insufficiency.
The indicator supports regular monitoring of biochemical parameters to identify lithium toxicity and avoid associated morbidity and irreversible organ damage. Regular measurement of thyroid stimulating hormone (TSH) can identify hypothyroidism and hyperthyroidism, and regular measurement of creatinine can help identify acute kidney injury before it progresses to chronic kidney disease.
Source guidance
Bipolar disorder: assessment and management (2014, updated 2018), NICE guideline CG185, recommendations 1.10.21 and 1.10.22.
Specification
Numerator: The number of patients in the denominator with a record of serum creatinine and TSH in the preceding 9 months.
Denominator: The number of patients on lithium therapy.
Calculation: Numerator divided by the denominator, multiplied by 100.
Exclusions: None.
Minimum population: The indicator would be appropriate to assess performance of collaborations or networks of GP practices serving populations of around 30,000 to 50,000.
ISBN: 978-1-4731-6067-5