Zeeshan Mansuri1, Shailesh Jain2, Kaushal Shah3. 1. Department of Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA. 2. Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA. 3. Department of Psychiatry, Griffin Memorial Hospital, Norman, OK, USA.
We read the article “Lithium in late-life mania: a systematic review” by Fazio et al with great interest.1 The authors conducted this systematic review to evaluate lithium’s role in treating mania in late-life onset bipolar disorder (BD). The study assessed the efficacy and tolerability of lithium for treating late-life onset BD based on the published literature utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.1However, we humbly like to bring the reader’s attention to the study’s methodology section that can influence the study results. We have mentioned these concerns below in the order of their appearance in the article:Medical Subject Headings (MeSH) Terms: Contrary to the author’s claim, five out of ten terms utilized to search literature are not MeSH terms. The MeSH is the controlled term developed by the National Library of Medicine (NLM).2 It provides a robust search experience that can include synonyms. Search terms that are not MeSH, “geriatric,” “elderly,” “late-life,” “efficacy,” and “tolerability.”Boolean Operators and Search String: Authors have used “AND” and “OR” boolean operators in the search string, “Bipolar Disorder OR Mania AND Lithium AND geriatric OR elderly OR aged OR late-life AND efficacy AND tolerability OR safety.” However, the authors did not use parentheses for nesting the concept per the study objective.3,4 Unfortunately, not utilizing parentheses would command databases to search literature not as per the study’s objective and yield an incorrect number of articles in the literature search.4,5Selection Criteria: While searching the literature, authors have used the MeSH term “aged,” defined as a person between 65 and 79 as per NLM. However, the study’s selection criteria include a population above 55, which potentially excludes several pieces of literature on this topic.PRISMA Flowchart: The number of articles screened (n=1065) is less than identified literature after duplication removal (n=442,570), and the authors did not provide the rationale on this either in the methods section or in Figure 1.1We believe that these findings and comments are constructive and would help improve the quality of the manuscript.