{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T20:19:02Z","timestamp":1792959542294,"version":"4.5.0"},"reference-count":50,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lithium has long been considered the gold standard mood stabilizer in the treatment of acute mood episodes related to bipolar (BD) and schizoaffective disorder. Previous research has primarily focused on lithium loading strategies and their effects on symptom severity and inpatient length of stay (LOS). However, less is known about specific prescribing practices at lithium initiation that may influence LOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study aimed to evaluate three initiation-related prescribing factors of lithium and their association with changes in LOS among adult inpatients experiencing acute mood episodes of BD or schizoaffective disorder. The factors were lithium initiation within 48 hours of admission, achieving a therapeutic level-producing dose within 48 hours of admission, and receiving intensive initial lithium dosing (\u2265900 mg\/day). The Mann-Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test was used to assess statistical significance. The timing of antipsychotic coprescribing in mania was also evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty-eight patients were included in this study. Lithium initiation within 48 hours of admission significantly decreased hospital LOS (7.2 vs 13.4 days;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009\u2009&lt;\u2009\u20090.001). Lithium optimization to a dose that produced a therapeutic drug level within 48 hours of admission also significantly decreased LOS (6.2 vs 9.1 days;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009\u2009&lt;\u2009\u20090.01). Intensive initial dosing did not significantly affect LOS. Of patients with mania, 51.5% were trialed on antipsychotics before starting lithium.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early lithium initiation and optimization in patients with acute bipolar mood episodes significantly reduced hospital LOS. Prospective studies are needed to address potential confounders to confirm whether early lithium optimization directly reduces LOS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.9740\/mhc.2026.06.129","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T01:42:05Z","timestamp":1780364525000},"page":"129-134","source":"Crossref","is-referenced-by-count":1,"title":["Prescribing factors influencing hospital length of stay in patients initiating lithium therapy for acute bipolar or schizoaffective mood episodes"],"prefix":"10.9740","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2637-482X","authenticated-orcid":true,"given":"William G.","family":"Cordell","sequence":"first","affiliation":[{"name":"(Corresponding Author) Clinical Pharmacist, Psychiatry\/Internal Medicine, The University of Kansas Health System, Kansas City, Kansas, wcordell@kumc.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0965-5703","authenticated-orcid":true,"given":"Claire","family":"Herbst","sequence":"additional","affiliation":[{"name":"Clinical Pharmacist - Psychiatry, The University of Kansas Health System, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8929-9734","authenticated-orcid":true,"given":"Taylor","family":"Kelsey","sequence":"additional","affiliation":[{"name":"Clinical Pharmacist - Psychiatry, Banner Health - University Medical Center South, Tucson, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6994-753X","authenticated-orcid":true,"given":"Brittany L.","family":"Melton","sequence":"additional","affiliation":[{"name":"Professor, Department of Pharmacy Practice, The University of Kansas School of Pharmacy, Lawrence, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2863-8335","authenticated-orcid":true,"given":"Karen E.","family":"Moeller","sequence":"additional","affiliation":[{"name":"Clinical Professor, Department of Pharmacy Practice, The University of Kansas School of Pharmacy, Lawrence, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","reference":[{"issue":"4","key":"i2168-9709-16-3-129-b01","series-title":"Focus (Am Psychiatr Publ)","article-title":"The CANMAT and ISBD guidelines for the treatment of bipolar disorder: summary and a 2023 update of evidence","volume":"21","author":"Keramatian","year":"2023","unstructured":"Keramatian K,\nChithra NK,\nYatham LN. The CANMAT and ISBD guidelines for the treatment of bipolar disorder: summary and a 2023 update of evidence. Focus (Am Psychiatr Publ). 2023;21(4):344-53. DOI: 10.1176\/appi.focus.20230009"},{"key":"i2168-9709-16-3-129-b02","article-title":"Bipolar disorder: assessment and management","author":"Clinical guideline CG185","year":"2023","unstructured":"Clinical guideline CG185. Bipolar disorder: assessment and management. [Internet]. National Institute for Health and Care Excellence (NICE); 2023 [cited 2025 Dec 11]. Available from: https:\/\/www.nice.org.uk\/guidance\/cg185\/resources\/bipolar-disorder-assessment-and-management-35109814379461"},{"issue":"6","key":"i2168-9709-16-3-129-b03","series-title":"J Psychopharmacol","first-page":"495","article-title":"Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology","volume":"30","author":"Goodwin","year":"2016","unstructured":"Goodwin GM,\nHaddad PM,\nFerrier IN,\nAronson JK,\nBarnes TRH,\nCipriani A, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2016;30(6):495-553. DOI: 10.1177\/0269881116636545"},{"issue":"2","key":"i2168-9709-16-3-129-b04","series-title":"World J Biol Psychiatry","first-page":"85","article-title":"The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania","volume":"10","author":"Grunze","year":"2010","unstructured":"Grunze H,\nVieta E,\nGoodwin GM,\nBowden C,\nLicht RW,\nM\u04e7ller HJ, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. World J Biol Psychiatry. 2010;10(2):85-116. 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Department of Veterans Affairs\/Department of Defense; 2023 [cited 2025 Dec 11]. Available from: https:\/\/www.healthquality.va.gov\/HEALTHQUALITY\/guidelines\/MH\/bd\/VA-DOD-CPG-BD-Full-CPGFinal508.pdf"},{"issue":"4","key":"i2168-9709-16-3-129-b07","series-title":"Schizophr Bull","article-title":"Long-Term Real-World Effectiveness of Pharmacotherapies for Schizoaffective Disorder","volume":"47","author":"Lintunen","year":"2021","unstructured":"Lintunen J,\nTaipale H,\nTanskanen A,\nMittendorfer-Rutz E,\nTiihonen J,\nL\u00e4hteenvuo M. Long-Term Real-World Effectiveness of Pharmacotherapies for Schizoaffective Disorder. Schizophr Bull. 2021;47(4):1099-107. DOI: 10.1093\/schbul\/sbab004"},{"issue":"Suppl 2","key":"i2168-9709-16-3-129-b08","series-title":"Bipolar Disord","first-page":"4","article-title":"The history of lithium therapy","volume":"11","author":"Shorter","year":"2009","unstructured":"Shorter E. The history of lithium therapy. Bipolar Disord. 2009;11 Suppl 2(Suppl 2):4-9. DOI: 10.1111\/j.1399-5618.2009.00706.x"},{"issue":"7","key":"i2168-9709-16-3-129-b09","series-title":"Int J Mol Sci","first-page":"2143","article-title":"A history of the pharmacological treatment of bipolar disorder","volume":"19","author":"L\u00f3pez-Mu\u00f1oz","year":"2018","unstructured":"L\u00f3pez-Mu\u00f1oz F,\nShen WW,\nD\u2019Ocon P,\nRomero A,\n\u00c1lamo C. A history of the pharmacological treatment of bipolar disorder. Int J Mol Sci. 2018;19(7):2143. DOI: 10.3390\/ijms19072143"},{"issue":"6","key":"i2168-9709-16-3-129-b10","series-title":"JAMA Psychiatry","article-title":"Self-harm, unintentional injury, and suicide in bipolar disorder during maintenance mood stabilizer treatment: a UK population-based electronic health records study","volume":"73","author":"Hayes","year":"2016","unstructured":"Hayes JF,\nPitman A,\nMarston L,\nWalters K,\nGeddes JR,\nKing M, et al. 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Erratum in: Bipolar Disord. 2007;9(3):314."},{"issue":"8","key":"i2168-9709-16-3-129-b12","series-title":"Am J Psychiatry","article-title":"20-Year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings","volume":"177","author":"Rhee","year":"2020","unstructured":"Rhee TG,\nOlfson M,\nNierenberg AA,\nWilkinson ST. 20-Year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings. Am J Psychiatry. 2020;177(8):706-15. DOI: 10.1176\/appi.ajp.2020.19091000"},{"issue":"1","key":"i2168-9709-16-3-129-b13","series-title":"Int J Bipolar Disord","first-page":"10","article-title":"Overview of lithium\u2019s use: a nationwide survey","volume":"9","author":"P\u00e9rez de Mendiola","year":"2021","unstructured":"P\u00e9rez de Mendiola X,\nHidalgo-Mazzei D,\nVieta E,\nGonz\u00e1lez-Pinto A. Overview of lithium\u2019s use: a nationwide survey. Int J Bipolar Disord. 2021;9(1):10. Erratum in: Int J Bipolar Disord. 2024;12(1):26."},{"key":"i2168-9709-16-3-129-b14","author":"Dailymed [Internet]","unstructured":"Dailymed [Internet]. Bethesda: National Library of Medicine [updated 2022 Jul; cited 2025 Dec 11]. Lithium carbonate tablet; [about 2 screens]. Available from: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=525a9d9b-cbb1-4644-a28a-8bba96f09348"},{"key":"i2168-9709-16-3-129-b15","series-title":"Applied Clinical Pharmacokinetics","first-page":"1","article-title":"Lithium","author":"Bauer","year":"2015","unstructured":"Bauer LA. Lithium. In: \nWeitz M,\nThomas CM, eds. Applied Clinical Pharmacokinetics. 3rd ed. New York: McGraw-Hill Medical; 2015. p. 1-30."},{"key":"i2168-9709-16-3-129-b16","series-title":"Hum Psychopharmacol","article-title":"Rapid lithiumization in acute manic patients","volume":"7","author":"Moscovich","year":"1992","unstructured":"Moscovich DG,\nShapira B,\nLerer B,\nBelmaker RH. Rapid lithiumization in acute manic patients. 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DOI: 10.4088\/JCP.08m04995gre"},{"issue":"4","key":"i2168-9709-16-3-129-b20","series-title":"Exp Ther Med","article-title":"Lithium efficacy in bipolar depression with flexible dosing: a six-week, open-label, proof-of-concept study","volume":"8","author":"Machado-Vieira","year":"2014","unstructured":"Machado-Vieira R,\nZanetti MV,\nDe Sousa RT,\nSoeiro-De-Souza MG,\nMoreno RA,\nBusatto GF, et al. Lithium efficacy in bipolar depression with flexible dosing: a six-week, open-label, proof-of-concept study. Exp Ther Med. 2014;8(4):1205-8. DOI: 10.3892\/etm.2014.1864"},{"issue":"2","key":"i2168-9709-16-3-129-b21","series-title":"J Am Med Inform Assoc","article-title":"Serving the enterprise and beyond with informatics for integrating biology and the bedside (i2b2)","volume":"17","author":"Murphy","year":"2010","unstructured":"Murphy SN,\nWeber G,\nMendis M,\nGainer V,\nChueh HC,\nChurchill S, et al. 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