Therapy with lithium salts in child and adolescent psychiatry - Clinical efficacy and practical recommendations

Therapy with Lithium Salts in Child and Adolescent Psychiatry - Clinical Efficacy and Practical Recommendations Lithium salts are pharmacologically classified as mood stabilizers and are medications of first choice for the treatment of manic episodes and the prevention of relapse in bipolar disorders in children and adolescents. Moreover, these drugs can be used to treat episodic impulsive aggressiveness. With regard to their use in the treatment of children and adolescents, however, there are limitations to several preparations on the market in Germany. The evidence level for the treatment of acute mania in adolescents is II, while it is only III-IV for treatment of the same disorder in children. There is only anecdotal evidence of relapse prevention in bipolar disorder in childhood (level of evidence: V), whereas the level of evidence for adolescence is higher (IV). With respect to episodic impulsive aggressiveness, there is a good evidence base (II) for treatment of the disorder in both children and adolescents. An evidence level of II indicates that at least one well designed, randomized, controlled study has been carried out; an evidence level of III is based upon non-randomized studies, an evidence level of IV upon non-experimental studies, and an evidence level of V indicates that evidence is limited to reports or opinions stated by expert circles and consensus conferences, and to clinical experience. Due to the narrow therapeutic window, the dosage should be based on serum concentrations of lithium between 0.6 and 1.2 mmol/l and should be adapted according to the clinical picture. Usually, lithium preparations are administered twice a day: in the morning and in the evening. Side effects have to be monitored very carefully. Serum concentrations higher than 1.5 mmol/l are dangerous. All potential side effects, with the exception of very infrequently occurring renal damage, are reversible by means of dose reduction or, if necessary, by discontinuation of medication with lithium.