{
  "abstract": "Background: Lithium is a first-line maintenance treatment for bipolar disorder, but real-world persistence varies widely across health systems, and no incident-initiator cohort analysis of lithium has been reported from any Gulf Cooperation Council bipolar disorder population. We aimed to characterise lithium initiation, observed within-service treatment persistence, and post-discontinuation treatment pathways in a multinational tertiary psychiatric service in the United Arab Emirates.\n\nMethods: A retrospective cohort study at a tertiary psychiatric service in the United Arab Emirates from 2018 to 2025. Among adults with a recorded ICD-10 F31 diagnosis, the incident initiator subset comprised adults whose first recorded lithium-bearing encounter occurred more than 90 days after their first service contact. The primary outcome was observed treatment persistence within the health-system record. A patient was classified as having discontinued lithium when at least 90 days elapsed with no lithium-bearing encounter; a 90-day grace period, reflecting routine dispensing intervals, was then added before the discontinuation date. Secondary outcomes included peri-initiation co-prescription and documented next-line treatment within 180 days of discontinuation. Incident initiation was apparent within the study service only; prior or out-of-network lithium exposure could not be excluded.\n\nResults: Among 135 incident initiators (median age 35 years, 48.1% female, 31.1% Emirati), lithium was initiated a median of 556 days after first service contact, most commonly during inpatient (43.0%) or outpatient (35.6%) encounters. Only 11.9% received lithium as a single recorded psychotropic; 82.2% had a concurrent antipsychotic, most commonly aripiprazole (40.0%). Estimated observed persistence was 25.0% (17.7 to 32.9) at 6 months, 4.6% (1.7 to 9.8) at 12 months, and 0.0% at 24 months. The documented next-line treatment was most commonly an antipsychotic, with individually reported second-generation antipsychotics accounting for approximately three fifths of discontinuers. In exploratory adjusted analyses, no prespecified covariate was statistically associated with observed discontinuation.\n\nConclusions: Observed health-system-record persistence on lithium in this multinational cohort was very limited and substantially below international benchmarks, consistent with a mixture of true discontinuation, care transfer, out-of-network prescribing, and incomplete within-service medication capture. Strategies maintaining within-service visibility and cross-provider record linkage are warranted.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40345-026-00434-w.",
  "abstract_shown": true,
  "affiliations": [
    "Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, United Arab Emirates",
    "Department of Psychiatry, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 15551, Al Ain, United Arab Emirates",
    "Department of Psychiatry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan",
    "Department of Psychiatry, Al Ain Hospital, SEHA, Al Ain, United Arab Emirates"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Syed Ali Bokhari"
    },
    {
      "affs": [
        0
      ],
      "name": "Muhanad Elnoor"
    },
    {
      "affs": [
        1,
        2,
        3
      ],
      "name": "Mohamed A. Alnor"
    },
    {
      "affs": [
        1
      ],
      "name": "Syed Fahad Javaid",
      "orcid": "0000-0001-6467-8150"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cprt98cvz9y8j.bib",
  "cited_by": 0,
  "doi": "10.1186/s40345-026-00434-w",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13713959/",
  "id": "cprt98cvz9y8j",
  "issns": [
    "2194-7511"
  ],
  "landing_url": "https://doi.org/10.1186/s40345-026-00434-w",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2738|Bipolar Disorder and Treatment"
    ]
  ],
  "openalex": "W7171811204",
  "pdf_url": null,
  "pmcid": "PMC13713959",
  "pmid": "42946952",
  "published": "2026-07-30",
  "publisher": "Springer",
  "ris": "https://research.draconitic.com/paper/cprt98cvz9y8j.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:21:32Z",
      "native_id": "PMC13713959",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s40345-026-00434-w"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2738|Bipolar Disorder and Treatment",
      "subfield": "psychiatry"
    }
  ],
  "title": "Electronic health record–observed lithium persistence after within-service initiation in bipolar disorder: an incident-initiator cohort study from a multinational tertiary psychiatric service in the United Arab Emirates",
  "title_text": "Electronic health record–observed lithium persistence after within-service initiation in bipolar disorder: an incident-initiator cohort study from a multinational tertiary psychiatric service in the United Arab Emirates",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:32Z",
  "url": "https://research.draconitic.com/paper/cprt98cvz9y8j",
  "venue": "International Journal of Bipolar Disorders",
  "versions": []
}