| Summary: | Lithium is currently licensed for the treatment and prophylaxis of recurrent affective disorders, treatment of bipolar depression where the use of antidepressants has been ineffective, and the treatment of aggressive or self-mutilating behaviour. Lithium requires therapeutic drug monitoring (TDM) during treatment and evidence is lacking to support the recommended monitoring frequencies of lithium levels. A retrospective analysis of a monitoring database was run to establish the association of single and double exposures of various lithium levels on renal function. Interviews were also conducted with prescribers to establish the factors affecting prescribing decisions related to lithium. This study suggests there is a short-term negative association on renal function after exposures to single, high lithium levels but due to the small patient groups in the multiple exposures analysis the results from this are not statistically reliable. These results did, however, raise the considerations that changes in lithium levels may impact on renal function. This work added to the factors influencing prescribing decisions surrounding knowledge, learning and competence of prescribers with concerns around a lack of knowledge of older drugs seen in newer doctors. Guidance surrounding at what points during the patient’s journey the initial prescribing choice and a decision should be made is also needed. This would help overcome the barrier of split services within mental health and give clearer roles to the various consultants involved in a patient’s care and aid in the involvement of the patient with their treatment. iii The roll out of a centralised lithium monitoring system with access for all those involved in the patients care could be considered to aid in the long-term monitoring of lithium. . This sort of system would also allow for all those involved being able to retain oversight over patients whether or not they are still directly under their care.
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