Problems of lithium prophylaxis: efficacy, serum lithium, selection of patients.

For safe and effective lithium prophylaxis the following points should be given attention: (1) selection of patients, (2) treatment management, (3) treatment monitoring, and (4) information and instruction. Indications for lithium treatment depend not only on diagnosis but also on factors predicting the extent to which the patient would be at risk of relapse without lithium. The criteria used for prophylactic trials seem too narrow, since they exclude patients who might benefit from the treatment. Treatment management involves gradual adjustment of doses and 12-hour serum lithium levels to values that for the individual patient give a maximum of prophylactic protection and a minimum of side effects. In some patients serum lithium may with advantage be maintained around 0.6-0.8 mmol/l instead of the usually recommended 0.8.-1.1 mmol/l. Patients, relatives and health personnel should be carefully instructed about the aims, the management, and the risks of lithium treatment.