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OBJECTIVE: The term "mood stabilizer" is controversial in the literature and criticized for being imprecise and overly inclusive, having its retirement suggested to avoid misuse. Nevertheless, it continues to be employed as it may still carry important meaning. METHODS: We employed document analysis for reviewing relevant definitions of mood stabilizer employed in the literature. Then, we clarify the meanings associated with the term by employing evolutionary concept analysis. Based on its results, we present a theoretical model for a mood stabilizer and further match it with evidence gathered from published meta-analyses and other sources for drugs used in the treatment of bipolar disorder. RESULTS: Concept analysis unearthed four attributes of a mood stabilizer that were nested into the following ascending hierarchy: "not worsening," "acute effects," "prophylactic effects," and "advanced effects." "Prophylactic effects" were often considered the core aspect of a legitimate mood stabilizer. CONCLUSION: The proposed model uses a hierarchy of attributes that take into account the complexity of the term and help to determine whether a drug is a mood stabilizer. Prophylaxis is pivotal to the concept, whose utility lies in implying a drug able to truly treat bipolar disorder, as opposed to merely targeting symptoms. Consistent use of the term could encourage investigation of drugs that modify long-term outcomes and illness trajectory, instead of simply approaching symptom clusters.
Assuntos
Antipsicóticos , Transtorno Bipolar , Humanos , Transtorno Bipolar/diagnóstico , Antipsicóticos/uso terapêutico , Antimaníacos/uso terapêuticoRESUMO
Lentinus crinitus bioaccumulates lithium in mycelia, but bioaccumulation may be affected by pH of the culture medium. Lithium is used in clinical practice as a mood stabilizer and antidepressant. This study aimed to assess the effect of culture medium pH and lithium source (LiCl or Li2CO3) on lithium bioaccumulation in vegetative mycelia of L. crinitus grown in malt extract broth. Lentinus crinitus U9-1 was cultured in malt extract broth supplemented with Li2CO3 or LiCl (50 mg L-1 lithium) in the pH range of 3.0 to 6.0. The pH was adjusted using HCl solution. The results showed that medium pH affected mycelial biomass production, lithium bioaccumulation in mycelial biomass, and lithium transfer from the culture medium to mycelial biomass. The effect of lithium source on the bioaccumulation capacity of mycelial biomass varied according to pH. At pH 4.0, both lithium sources stimulated mycelial biomass production compared to the control without the addition of lithium. At pH 5.5, Li2CO3 provided the highest lithium bioaccumulation in mycelial biomass. Lithium transfer from the culture medium to mycelia was highest in Li2CO3-supplemented cultures at pH 4.5. LiCl reduced hyphal width compared with Li2CO3 and the control. However, pH and lithium sources did not affect the formation of clamp connections in hyphae. For the first time, the influence of the pH of the culture medium on lithium bioaccumulation by Lentinus crinitus is reported. Finally, we conclude that the culture medium pH affected lithium transfer and bioaccumulation in mycelial biomass differently depending on the lithium source. Additionally, we report the presence of clamp connections in the hyphae of L. crinitus as an indicator of even growth.
Assuntos
Lítio , Micélio , Bioacumulação , Biomassa , Concentração de Íons de Hidrogênio , Extratos Vegetais , Meios de CulturaRESUMO
Este estudo objetivou avaliar os potenciais efeitos adversos nos rins associado ao tratamento de longo prazo com lítio em pacientes com transtorno bipolar, a partir de uma revisão integrativa literatura. Os artigos foram identificados nas bases de dados SciELO, Medline (Pubmed) e Biblioteca Virtual em Saúde (BVS), publicados entre 2010 e 2021. Aplicados os critérios de inclusão e exclusão, identificaram-se 18 artigos para a análise. Verificou-se que o tratamento com lítio durante um período prolongado está associado à redução da taxa de filtração glomerular, porém, outras variáveis devem ser consideradas como idade e comorbidades associadas. Por outro lado, não foi associado evolução da doença renal crônica em estágio terminal por uso do medicamento. A investigação dos estudos revelou que a droga em doses terapêuticas e com monitoramento laboratorial contínuo não demonstrou toxicidade ou efeitos colaterais severos nos rins sendo a sua descontinuação relacionada com exarcebações do humor. [au]
This study aimed to assess the potential adverse effects on the kidneys associated with long-term lithium treatment in patients with bipolar disorder, based on an integrative literature review. The articles were identified in the SciELO, Medline (Pubmed) and Virtual Health Library (VHL) databases, published between 2010 and 2021. After applying the inclusion and exclusion criteria, 18 articles were identified for analysis. It was found that treatment with lithium for a prolonged period is associated with a reduction in the glomerular filtration rate, however, other variables must be considered, such as age and associated comorbidities. On the other hand, evolution of end-stage chronic kidney disease due to drug use was not associated. The investigation of the studies revealed that the drug at therapeutic doses and with continuous laboratory monitoring did not show toxicity or severe side effects in the kidneys and its discontinuation was related to mood exacerbations. [au]
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Increase in the quality of life, combined with drug strategies, has been studied as possibilities for improving memory and delaying the onset of neurodegenerative diseases. A previous study published by the group of the authors has shown that microdose lithium and enriched environment can improve memory in both mice and humans. To elucidate this relationship better, this study aimed to evaluate whether the chronic combination of these two strategies could increase healthy aging in Senescence Accelerated Mouse-Prone 8 (SAMP8). Animals were submitted to either one or both of these strategies until the age of 10 months when they were anesthetized and killed and their hippocampus was extracted. The untreated SAMP-8 group exhibited worse memory and reduced neuronal density with greater neurodegeneration and increased amyloid-ß plaque density compared with the control group. Moreover, significant alterations in proteins related to long-term potentiation, such as, synaptophysin and brain-derived neurotrophic factor (BDNF), were observed in this group. The strategies used in the study maintained long-term memory, reduced anxiety, and increased neuroprotection. Both strategies were efficient in reducing neurodegeneration and increasing parameters related to memory maintenance. In many experiments, the combination of the two strategies was more effective in improving healthy aging. This study sheds light on the combination of strategies that choose to improve the quality of life and drugs with low side effects. Moreover, it opens perspectives for a new field of study for healthy aging.
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In this work, structural and active corrosion inhibition effects induced by lithium ion addition in organic-inorganic coatings based on poly(methyl methacrylate) (PMMA)-silica sol-gel coatings have been investigated. The addition of increasing amounts of lithium carbonate (0, 500, 1000, and 2000 ppm), yielded homogeneous hybrid coatings with increased connectivity of nanometric silica cross-link nodes, covalently linked to the PMMA matrix, and improved adhesion to the aluminum substrate (AA7075). Electrochemical impedance spectroscopy (EIS), performed in 3.5% NaCl aqueous solution, showed that the improved structural properties of coatings with higher lithium loadings result in an increased corrosion resistance, with an impedance modulus up to 50 GΩ cm2, and revealed that the lithium induced self-healing ability significantly improves their durability. Time-of-flight secondary ion mass spectrometry (ToF-SIMS) and X-ray photoelectron spectroscopy (XPS) suggest that the regeneration process occurs by means of lithium ions leaching from the adjacent coating toward the corrosion spot, which is restored by a protective layer of precipitated Li rich aluminum hydroxide species. An analogue mechanism has been proposed for artificially scratched coatings presenting an increase of the impedance modulus after salt spray test compared to the lithium free coating. These results evidence the active role of lithium ions in improving the passive barrier of the PMMA-silica coating and in providing through the self-restoring ability a significantly extended service life of AA7075 alloy exposed to saline environment.
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El uso de litio es tan antiguo como su historia generándose en el tiempo voces detractoras e como importantes defensores. En Ecuador, no está exenta esta controversia soslayándose el uso de litio para tratar cuadros el trastorno bipolar, eventos suicidas y como coadyuvante en casos de depresión resistente al tratamiento, pese a ser un medicamento básico de comprobada eficacia en estas patologías. Un manejo y monitoreo adecuados, evitaría su sustitución por medicamentos de mayor costo sobre todo para el Sistema Nacional de Salud Pública, que asiste a un importante segmento poblacional de bajos recursos económicos.(AU)
The use of lithium is as old as its history, generating in time detractor voices and as important defenders. In Ecuador, this controversy is not exempt from the use of lithium to treat bipolar disorder, suicidal events and as an adjuvant in cases of treatment-resistant depression, despite being a basic drug with proven efficacy in these pathologies. Adequate management and monitoring would avoid its substitution by drugs of greater cost, especially for the National Public Health System, which assists an important segment of the population with low economic resources. (AU)
Assuntos
Humanos , Animais , Masculino , Feminino , Adulto , Saúde Mental , Carbonato de Lítio , Disciplinas e Atividades Comportamentais , Fenômenos Psicológicos , Lítio , Serviços de Saúde MentalRESUMO
INTRODUCTION: Lithium is the drug of choice for the treatment of bipolar affective disorder. OBJECTIVE: To define lithium therapeutic profile and adverse reactions to its use in patients with bipolar affective disorder in Colombia. MATERIALS AND METHODS: We conducted an observational retrospective cohort study between January 1 and December 31, 2013, which included patients with a diagnosis of bipolar disorder treated with lithium carbonate in 25 Colombian cities; we evaluated socio-demographic variables, lithium dose, co-medication, drug interactions and adverse reactions. A multivariate analysis was done using SPSS 22.0. RESULTS: The 331 patients had an average age of 44.5 ± 13.9 years; 59.2% were women. The mean dose of lithium was 898 ± 294 mg/day; 22% received doses lower than recommended, and patients had received lithium for 38.0 ± 39.5 months (range: 12-159 months). Lithium levels in blood had been measured only in 13.5% of patients; 71.3% of them had received adjuvant therapy for bipolar disorder with other drugs, especially clozapine (16.6%) and valproic acid (16.6%). The main comorbidities were hypothyroidism (18.1%) and hypertension (12.7%); 390 potentially toxic drug interactions were found, and adverse reactions were reported in 1.2% of patients. A statistically significant association was found between a lower risk of combination therapy and receiving treatment in the cities of Bogotá (OR=0.4, p=0.025), Cartagena (OR=0.3, p=0.015) and Ibagué (OR=0.3, p=0.025). CONCLUSION: Lithium was generally used at recommended doses and intervals, but a significant percentage of patients received lower doses than those recommended, and it was not possible to compare with lithium levels in blood. Adverse reactions and blood lithium levels reporting should be improved in patients with bipolar disorder in Colombia.
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Transtorno Bipolar/tratamento farmacológico , Hipotireoidismo/complicações , Carbonato de Lítio , Ácido Valproico/uso terapêutico , Transtorno Bipolar/diagnóstico , Colômbia , Humanos , Carbonato de Lítio/uso terapêutico , Estudos Retrospectivos , Ácido Valproico/químicaRESUMO
Resumen Introducción. El litio es el medicamento de elección para el tratamiento del trastorno afectivo bipolar. Objetivo. Determinar el perfil de uso y las reacciones secundarias del litio en pacientes con trastorno afectivo bipolar en Colombia. Materiales y métodos. Se hizo un estudio observacional de cohorte retrospectiva entre el 1° de enero y el 31 de diciembre de 2013, en pacientes con diagnóstico de trastorno afectivo bipolar tratados con carbonato de litio en 25 ciudades colombianas. Se evaluaron las variables sociodemográficas, las dosis del litio, la medicación simultánea con otros fármacos, las interacciones medicamentosas y las reacciones adversas. Se hizo un análisis multivariado utilizando el programa SPSS 22.0®. Resultados. La edad promedio de los 331 pacientes fue de 44,5 ± 13,9 años, 59,2 % de ellos eran mujeres, la dosis promedio de litio fue de 898 ± 294 mg/día, y 22 % recibía dosis inferiores a las recomendadas; los participantes habían recibido el medicamento durante 38,0 ± 39,5 meses en promedio (rango: 12-159 meses), y solo a 13,5 % de ellos se les había hecho el análisis de litio en sangre. El 71,3 % recibía otros medicamentos como tratamiento coadyuvante para el trastorno afectivo bipolar, especialmente clozapina (16,6 %) y ácido valproico (16,6 %). Las principales enfermedades concomitantes fueron el hipotiroidismo (18,1 %) y la hipertensión arterial (12,7 %). Se encontraron 390 interacciones medicamentosas potencialmente tóxicas y se reportaron reacciones secundarias en 1,2 % de los casos. Se encontró una asociación estadísticamente significativa con un menor riesgo de recibir tratamiento combinado en pacientes tratados en las ciudades de Bogotá (odds ratio, OR=0,4; p=0,025), Cartagena (OR=0,3; p=0,015) e Ibagué (OR=0,3; p=0,025). Conclusiones. El litio se administraba en las dosis e intervalos recomendados, pero un porcentaje significativo recibía dosis inferiores a las recomendadas y no fue posible contrastar el efecto con los niveles de litio en suero. Se debe mejorar el reporte de reacciones adversas y la medición de los niveles de litio en suero en los pacientes con trastorno afectivo bipolar en Colombia.
Abstract Introduction: Lithium is the drug of choice for the treatment of bipolar affective disorder. Objective: To define lithium therapeutic profile and adverse reactions to its use in patients with bipolar affective disorder in Colombia. Materials and methods: We conducted an observational retrospective cohort study between January 1 and December 31, 2013, which included patients with a diagnosis of bipolar disorder treated with lithium carbonate in 25 Colombian cities; we evaluated socio-demographic variables, lithium dose, co-medication, drug interactions and adverse reactions. A multivariate analysis was done using SPSS 22.0. Results: The 331 patients had an average age of 44.5 ± 13.9 years; 59.2% were women. The mean dose of lithium was 898 ± 294 mg/day; 22% received doses lower than recommended, and patients had received lithium for 38.0 ± 39.5 months (range: 12-159 months). Lithium levels in blood had been measured only in 13.5% of patients; 71.3% of them had received adjuvant therapy for bipolar disorder with other drugs, especially clozapine (16.6%) and valproic acid (16.6%). The main comorbidities were hypothyroidism (18.1%) and hypertension (12.7%); 390 potentially toxic drug interactions were found, and adverse reactions were reported in 1.2% of patients. A statistically significant association was found between a lower risk of combination therapy and receiving treatment in the cities of Bogotá (OR=0.4, p=0.025), Cartagena (OR=0.3, p=0.015) and Ibagué (OR=0.3, p=0.025). Conclusion: Lithium was generally used at recommended doses and intervals, but a significant percentage of patients received lower doses than those recommended, and it was not possible to compare with lithium levels in blood. Adverse reactions and blood lithium levels reporting should be improved in patients with bipolar disorder in Colombia.
Assuntos
Humanos , Transtorno Bipolar/tratamento farmacológico , Ácido Valproico/uso terapêutico , Carbonato de Lítio , Hipotireoidismo/complicações , Transtorno Bipolar/diagnóstico , Estudos Retrospectivos , Ácido Valproico/química , Carbonato de Lítio/uso terapêutico , ColômbiaRESUMO
Machado-Joseph disease (MJD) or spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant neurodegenerative disorder caused by expansion of the polyglutamine domain of the ataxin-3 (ATX3) protein. MJD/SCA3 is the most frequent autosomal dominant ataxia in many countries. The mechanism underlying MJD/SCA3 is thought to be mainly related to protein misfolding and aggregation leading to neuronal dysfunction followed by cell death. Currently, there are no effective treatments for patients with MJD/SCA3. Here, we report on the potential use of lithium carbonate and coenzyme Q10 to reduce cell death caused by the expanded ATX3 in cell culture. Cell viability and apoptosis were evaluated by MTT assay and by flow cytometry after staining with annexin V-FITC/propidium iodide. Treatment with lithium carbonate and coenzyme Q10 led to a significant increase in viability of cells expressing expanded ATX3 (Q84). In addition, we found that the increase in cell viability resulted from a significant reduction in the proportion of apoptotic cells. Furthermore, there was a significant change in the expanded ATX3 monomer/aggregate ratio after lithium carbonate and coenzyme Q10 treatment, with an increase in the monomer fraction and decrease in aggregates. The safety and tolerance of both drugs are well established; thus, our results indicate that lithium carbonate and coenzyme Q10 are good candidates for further in vivo therapeutic trials.
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Humanos , Ataxina-3/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Carbonato de Lítio/farmacologia , Doença de Machado-Joseph , Proteínas Repressoras/efeitos dos fármacos , Ubiquinona/análogos & derivados , Diferenciação Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Doença de Machado-Joseph/tratamento farmacológico , Ubiquinona/farmacologiaRESUMO
OBJECTIVES: The prevalence of obesity has dramatically increased in many countries and it is particularly high in patients with bipolar disorder (BD). A region in the first intron of the fat mass- and obesity-associated (FTO) gene, encompassing markers rs9939973, rs8050136, and rs9939609, has been consistently associated with obesity and body mass index (BMI) in different populations. We sought to determine whether FTO is associated with BMI and/or obesity in patients with BD. METHODS: The sample included 129 Mexican Mestizo patients with bipolar I or bipolar II disorder. After obtaining informed consent, participants were evaluated with the Structured Clinical Interview for DSM-IV Axis I Disorders and weight, height, and body measurements were recorded. DNA was extracted from a 5-mL blood sample and real-time polymerase chain reaction was performed. The results were analyzed with Haploview v4.2 and SPSS v21. RESULTS: Differences in mean BMI were explained by rs8050136 and rs9939609 genotypes, especially by comparing non-carriers and carriers of two copies of the risk allele (Tukey's p ≤ 0.019), with a mean difference in BMI as high as 7.81 kg/m(2) . Differences in BMI were also explained by the interaction of the genotype (rs8050136 and/or rs9939609), the use of second-generation antipsychotics, and the use of mood stabilizers (p ≤ 0.41). Obesity was also associated with these two markers when patients with and without obesity were compared. CONCLUSIONS: In patients with BD, differences in BMI may be affected by the presence of FTO risk alleles, especially in homozygous individuals for these variants. Besides evaluating the possible metabolic effects of certain antipsychotics or mood stabilizers, it is important to evaluate the role of other factors such as FTO risk alleles.
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Antipsicóticos/farmacologia , Transtorno Bipolar , Índice de Massa Corporal , Obesidade , Proteínas/genética , Alelos , Dioxigenase FTO Dependente de alfa-Cetoglutarato , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/genética , Transtorno Bipolar/fisiopatologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Genótipo , Humanos , Masculino , México , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/genética , Obesidade/psicologiaRESUMO
Introdução: a cefaleia em salvas (CS) é um subtipo de cefaleia primária caracterizado por crises de dor entre 15 e 180 minutos diárias por semanas a meses, geralmente intercalados por períodos de remissão. As crises álgicas são muito intensas, de localização orbital ou periorbital, associadas à sintomatologia de disfunção autonômica. Apesar de sua singular apresentação clínica, a CS permanece afecção pouco reconhecida e subdiagnosticada. Objetivos: descrever e discutir os desafios diagnósticos e terapêuticos da CS a partir de casos clínicos. Material e método: trata-se de uma série de cinco casos de CS em acompanhamento clínico. Resultados: dos 467 pacientes assistidos em ambulatório neurológico, cinco possuíam diagnóstico de CS, correspondendo a 1,07% do total. A apresentação clínica variou pouco em relação à descrição da literatura, com predomínio em homens e da forma episódica, além de haver grande latência entre seu surgimento e o diagnóstico. Conclusão: mesmo em centro terciário de atendimento neurológico, o número de pacientes diagnosticados é pequeno, colaborando para o desconhecimento a respeito da CS, o que contribui para o seu atraso diagnóstico e tratamento específico.
Introduction: cluster headaches (CS) are a subtype of primary headache disorder characterized by daily pain attacks of 15-180 minutes for weeks to months, usually interspersed with periods of remission. Painful crises are very intense, of periorbital or orbital location, associated with symptoms of autonomic dysfunction. Despite its unique clinical presentation, CS remains under-recognized and underdiagnosed. Objectives: To describe and discuss the diagnostic and therapeutic challenges of CS based on clinical cases. Methods: this is a series of fivecases of CS under clinical monitoring. Results: Of the 467 patients treated at the neurological clinic five had a diagnosis of CS, corresponding to 1.07% of the total. The clinical presentation varied little in relation to the description in the literature; it affected predominantly men, episodically. Time elapsed between onset and diagnosis was usually long. Conclusion: Even in a tertiary care neurological center, the number of diagnosed patients is small, which reflects on ignorance about CS and contributes to late diagnosis and lack of specific treatment.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Cefaleia Histamínica/diagnóstico , Cefaleia/diagnóstico , Cefaleia/terapiaRESUMO
Our aim was to show the clinical characteristics of 25 patients with hypnic headache. We reviewed the medical records of 11,360 patients who complained of headache and selected those with hypnic headache, according to the criteria of the International Classification of Headache Disorders-2. Twenty-five patients (20 women and 5 men) were diagnosed with hypnic headache. The average age at the headache onset was 65.6 ± 11.4 years (95% CI 61.1-70.1), ranging from 51 to 89 years. The diagnosis of hypnic headache was made 3.0 ± 2.7 years (95% CI 1.9-4.0) after the headache started. Fourteen patients (56.0%) were awakened between 4:00 and 6:00 a.m. The headache lasted for more than 2h in 16 (64.0%) patients. The headache was bilaterally localized (16/25; 64.0%), had a dull character (18/25; 72.0%) and a moderate intensity (17/25; 68.0%). The frequency was greater than 15 days per month (14/25; 56.0%). Associated symptoms were reported by 7 patients: nausea (71.4%) and phonophobia (28.6%). There was successful treatment with lithium carbonate in 16/22 (72.7%) of the patients. Hypnic headache occurs exclusively during sleep in the elderly and especially in women. Lithium is an effective drug for its treatment.
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Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Tomógrafos ComputadorizadosRESUMO
OBJECTIVES: this study featured patients with affective bipolar disorder who were making use of lithium and received care at an outpatient care center located in a country town in the state of Sao Paulo in 2009; it assessed the adherence and knowledge of these patients in relation to the medication prescribed to them and verified the proportion of blood tests performed per year in the service, for each individual, to measure lithium levels in the blood. METHOD: descriptive study with quantitative approach, involving 36 participants. Structured interviews and review of medical records were used for data collection and descriptive statistics for data analysis. RESULTS: difficulties in reporting the dosage of the medication prescribed and a high rate of non-adherence were identified among the participants. None of the participants in the study was submitted to two tests a year to measure lithium levels in the blood, which is the minimum proportion of tests recommended by the literature for maintenance treatment using lithium carbonate. CONCLUSION: this study highlights the critical factors for the promotion of patients' safety in monitoring lithium drug therapy. .
OBJETIVOS: este estudo teve como objetivo caracterizar pacientes com transtorno afetivo bipolar, em uso de lítio, atendidos no ano 2009 em um serviço ambulatorial do interior de São Paulo, Brasil; avaliar a adesão e conhecimento dos mesmos sobre medicamentos prescritos e verificar a proporção de litemias/ano realizadas, no serviço, para cada indivíduo. MÉTODO: trata-se de estudo descritivo, com abordagem quantitativa, do qual participaram 36 pessoas. Foram utilizadas entrevistas estruturadas e revisão de prontuários para coleta de dados e estatística descritiva para análise dos mesmos. RESULTADOS: entre os participantes, foram identificadas dificuldades em relatar a dose dos fármacos prescritos e alta taxa de não adesão. Em nenhum participante do estudo foi atingida a proporção de duas litemias/ano, que representa a quantidade mínima de litemias preconizada pela literatura para o tratamento de manutenção com carbonato de lítio. CONSIDERAÇÕES FINAIS: este estudo aponta fatores críticos na promoção da segurança do paciente no seguimento da terapêutica medicamentosa com lítio. .
OBJETIVOS: este estudio caracterizó pacientes con trastorno afectivo bipolar, tratadas con litio, atendidos en el año de 2009 en un servicio de ambulatorio del interior del estado de Sao Paulo, en Brasil; evaluó la adhesión y conocimiento de los mismos sobre medicamentos prescritos y verificó la proporción de litemias/año realizadas, en el servicio, para cada individuo. MÉTODO: se trata de estudio descriptivo, con abordaje cuantitativo, del cual participaron 36 personas. Fueron utilizadas entrevistas estructuradas y revisión de fichas para recolección de datos y estadística descriptiva para análisis de los mismos. RESULTADOS: entre los participantes, fueron identificadas dificultades en relatar la dosis de los fármacos prescritos y una alta tasa de no adhesión. En ningún participante del estudio fue alcanzada la proporción de dos litemias/año, que representa la cantidad mínima de litemias preconizada por la literatura para el tratamiento de mantenimiento con carbonato de litio. CONCLUSIÓN: este estudio apunta factores críticos para la promoción de la seguridad del paciente en el seguimiento de la terapéutica medicamentosa con litio. .