{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:53:04Z","timestamp":1783075984772,"version":"3.54.6"},"reference-count":56,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare differences in efficacy during maintenance treatment for bipolar disorder (BD) according to lithium serum levels. A multicenter retrospective cohort study and a dose\u2010response meta\u2010analysis were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The cohort study was conducted in Taiwan from 2001 to 2019 to identify patients with euthymic BD according to different serum levels (&lt;0.4, 0.4\u20130.8, and 0.8\u20131.2\u00a0mmol\/L). We adopted adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for time to the recurrence of mood episodes having the &lt;0.4\u00a0mmol\/L group as the reference group. Moreover, we systematically searched for related articles in major databases before January 31, 2021 (PROSPERO: CRD42021235812). We used random\u2010effects modeling to estimate the dose\u2010response relationships between lithium serum levels and recurrence of mood episodes, which were depicted as odds ratios (ORs) with 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1406 participants (cohort: 466; meta\u2010analysis: 940) were included. In the cohort study, the 0.4\u20130.8\u00a0mmol\/L group was associated with a significantly lower risk of recurrences (aHR: 0.75), while the 0.8\u20131.2\u00a0mmol\/L group had a lower risk without statistical significance (aHR: 0.77). The dose\u2010response meta\u2010analysis showed that with the increase in lithium serum levels, the risk decreased (linear model OR: 0.85, for every 0.1\u00a0mmol\/L increase; non\u2010linear model OR: 1.00 at 0.0\u00a0mmol\/L, 0.42 at 0.4\u00a0mmol\/L, and 0.27 at 0.8\u00a0mmol\/L).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although confounding by indication cannot be excluded, the combined results suggest a significant preventative effect on the recurrence of major affective episodes among those with serum levels of 0.4\u20130.8\u00a0mmol\/L.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13346","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T04:36:08Z","timestamp":1625546168000},"page":"368-378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Lithium concentration and recurrence risk during maintenance treatment of bipolar disorder: Multicenter cohort and meta\u2010analysis"],"prefix":"10.1111","volume":"144","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8650-4060","authenticated-orcid":false,"given":"Chih\u2010Wei","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Psychiatry Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan"},{"name":"Department of Computer Science and Information Engineering National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2500-5671","authenticated-orcid":false,"given":"Andre F.","family":"Carvalho","sequence":"additional","affiliation":[{"name":"IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre School of Medicine Barwon Health Deakin University Geelong VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5662-0055","authenticated-orcid":false,"given":"Shang\u2010Ying","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Psychiatry School of Medicine College of Medicine Taipei Medical University Taipei Taiwan"},{"name":"Department of Psychiatry and Psychiatric Research Center Taipei Medical University Hospital Taipei Medical University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5320-1151","authenticated-orcid":false,"given":"Liang\u2010Jen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan"},{"name":"Department of Chinese Medicine College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5761-7800","authenticated-orcid":false,"given":"Ping\u2010Tao","family":"Tseng","sequence":"additional","affiliation":[{"name":"Prospect Clinic for Otorhinolaryngology &amp; Neurology Kaohsiung Taiwan"},{"name":"Institute of Biomedical Sciences National Sun Yat\u2010sen University Kaohsiung Taiwan"},{"name":"Department of Psychology College of Medical and Health Science Asia University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1394-4567","authenticated-orcid":false,"given":"Pao\u2010Yen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan"},{"name":"Institute for Translational Research in Biomedical Sciences Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2461-474X","authenticated-orcid":false,"given":"Yu\u2010Kang","family":"Tu","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology &amp; Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan"},{"name":"Department of Dentistry National Taiwan University Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0548-0053","authenticated-orcid":false,"given":"Eduard","family":"Vieta","sequence":"additional","affiliation":[{"name":"Bipolar and Depressive Disorders Unit Hospital Clinic IDIBAPS CIBERSAM University of Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4877-7233","authenticated-orcid":false,"given":"Marco","family":"Solmi","sequence":"additional","affiliation":[{"name":"Neurosciences Department University of Padua Padua Italy"},{"name":"Neuroscience Centre University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi\u2010Fa","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8890-8544","authenticated-orcid":false,"given":"Hung\u2010Yu","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Information Engineering National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269881116636545"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004867420979353"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12609"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.161.2.217"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f3646"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2021.03.034"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.2174\/0929867325666180904124733"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2007.00475.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674370104600402"},{"key":"e_1_2_9_11_1","first-page":"180","article-title":"The International College of Neuro\u2010Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP\u2010BD\u20102017), Part 3: the clinical guidelines","volume":"20","author":"Fountoulakis KN","year":"2017","journal-title":"Int J Neuropsychopharmacol"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12805"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12427"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1906193"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12690"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12714"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(19)30132-4"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1590\/1516-4446-2020-1246"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.12.072"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52221.x"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40360-016-0101-x"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4713"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bj.2017.08.002"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12027"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.4103\/0253-7176.135399"},{"key":"e_1_2_9_27_1","first-page":"121","article-title":"The International College of Neuro\u2010Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP\u2010BD\u20102017), part 2: Review, grading of the evidence, and a precise algorithm","volume":"20","author":"Fountoulakis KN","year":"2017","journal-title":"Int J Neuropsychopharmacol"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.133.5.567"},{"key":"e_1_2_9_29_1","unstructured":"JohnsonFN JohnsonS.Lithium in Medical Practice: Proceedings of the First British Lithium Congress University of Lancaster England 15\u201019 July 1977. University Park Press;1978."},{"key":"e_1_2_9_30_1","first-page":"1323","article-title":"Determination of the optimal concentration of lithium for the prophylaxis of manic\u2010depressive disorder","volume":"17","author":"Waters B","year":"1982","journal-title":"Biol Psychiatry"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"e_1_2_9_33_1","first-page":"l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"JaC S","year":"2019","journal-title":"BMJ"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-004-5025-x"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a116237"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwr265"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3841"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X0600600103"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v072.c01"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1017280"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-020-00215-z"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00115-019-00852-5"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcma.2013.06.013"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2007.00549.x"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1979.01780080040011"},{"key":"e_1_2_9_47_1","first-page":"127","article-title":"Maintenance lithium treatment: side effects and compliance","volume":"50","author":"Gitlin MJ","year":"1989","journal-title":"J Clin Psychiatry"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2019.11.006"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0346-9"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009758"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.19030228"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2018.07.012"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1633"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2021.03.005"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.133.5.429"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.134.4.382"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"}],"container-title":["Acta Psychiatrica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acps.13346","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acps.13346","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acps.13346","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T21:27:03Z","timestamp":1693344423000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acps.13346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,16]]},"references-count":56,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1111\/acps.13346"],"URL":"https:\/\/doi.org\/10.1111\/acps.13346","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/ACPS.13346\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/ACPS.13346\/v2\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/ACPS.13346\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/ACPS.13346\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/ACPS.13346\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/ACPS.13346\/v2\/decision1","asserted-by":"object"}]},"ISSN":["0001-690X","1600-0447"],"issn-type":[{"value":"0001-690X","type":"print"},{"value":"1600-0447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,16]]},"assertion":[{"value":"2021-06-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}