Effects of pharmaceutical care in patients using lithium, psychiatric clinic, Sisaket Hospital

Abstract

Background: Lithium is indicated for treatment of acute manicdisorder and also used for long-term treatment in bipolar disease. The most common problem from the use of lithium is the relatively slow effect from treatment. The medication using this drug results in many side effects, However. It has a significantly narrow therapeutic index. Reported information from Sisaket Hospital illustrates that lithium intoxication occured with a patient using this drug and some patients have asub-therapeutic lithium blood level. Consequently, Pharmacists should pay careful attention to providing information about the use of medication to patients to allow patients to be safe from using lithium drugs and improve problems that may result from the use of lithium.
Objective: To study the effects of pharmaceutical care in patients treated with lithium in the Psychiatric Clinic, Sisaket Hospital.
Methods: This research is quasi-experimental research, pre-test and post-test study in 40 subjects receiving lithium. Assessment of outcome was conducted by using questionnaires on knowledge regarding lithium use and descriptive statistics (frequency, percentage, mean, standard deviation) and Inferential statistics (pair t-test) were used to evaluate the result.
Results: The majority of subjects is female (80%), mean age 32.3 years that has received lithium (90%) and has not had comorbidity (87.5%).As a result, The mean dose of lithium is 667.5 mg and has other relevant 5.3 concomitant medications averagely. Additionally, After patients received pharmaceutical care, It is found that the mean total scores of the patient s' knowledge on lithium drug are significantly increased (0.85 ± 0.95, and 7.98 ± 1.12, respectively, p-value < 0.001) and the mean test scores for each item is also statistically significant increased (p-value < 0.001). 70% of patients have been more compliance in the use of lithium. The results of the drug safety follow-up also discovers that a patient (2.5%) had palpitations and tremors. There were similar reports of lithium concomitant with NSAIDs that lead to an increase in lithium level in blood in 7 patients (17.8%) and lithium used in combination with enalapril was reported in 1 patient who had palpitations, tremors, nausea, vomit, and increased blood pressure.
Conclusion: Pharmaceutical care by pharmacists in patients receiving lithiumenables patients to be more knowledgeable and compliance. It is able to decrease and prevent side effects or drug interactions that may occur. As a result, patients would be saferwhile using the drug.
Keywords: Lithium, Pharmaceutical care, Bipolar disease