Question

scenario: a patient with bipolar disorder is not achieving therapeutic benefit with a serum lithium level of 0.6 meq/l. question: what should be the next step? discontinue lithium. increase the dose of lithium. switch to valproate. add an antipsychotic.

Explanation:

The therapeutic range for lithium in bipolar disorder is typically 0.6 - 1.2 mEq/L. Since the patient has a lithium level of 0.6 mEq/L (at the lower end of the range) and is not achieving therapeutic benefit, the next step is to increase the dose of lithium to try to reach a more effective level within the therapeutic range. Discontinuing lithium (first option) is not appropriate as it's at a therapeutic - level lower end. Switching to valproate (third option) or adding an antipsychotic (fourth option) would be considered later if increasing lithium dose is not effective or has side - effect issues, but the first step is to optimize the lithium dose.

Answer:

B. Increase the dose of lithium.