Bipolar, schizophrenia and other psychoses: lithium levels in therapeutic range
Indicator
The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the previous 4 months.
Indicator type
General practice indicator for use outside the Quality and Outcomes Framework (QOF).
Corresponding QOF indicator MH010 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 characterised 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.
The indicator supports regular monitoring of serum lithium levels. Lithium monitoring is essential as it has a narrow therapeutic index and there is potential for toxicity from intercurrent illness, declining renal function, co-prescription of drugs such as non-steroidal anti-inflammatory drugs or thiazide diuretics which may reduce lithium excretion. Regular monitoring of lithium aims to help identify when dose adjustment is required to reduce the risk of these adverse effects.
Source guidance
Bipolar disorder: assessment and management (2014, updated 2018) NICE guideline CG185, recommendations 1.10.15, 1.10.19, 1.10.20 and 1.10.22
Specification
Numerator: The number of patients in the denominator with a record of lithium levels in the therapeutic range within the preceding 4 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: 978-1-4731-6068-2