Selecting a patient for long-term lithium treatment in clinical practice is an important decision that may lead to a profound change in the lives of those affected by recurring affective illness. Marked benefits may be derived from lithium stabilization; on the other hand, we are becoming increasingly aware of various risks that may be involved in long-term treatment with lithium salts. It is therefore striking that to date no clear-cut and generally accepted guidelines have been developed for selecting a patient for treatment with lithium.
Clearly, selecting a patient for long-term lithium treatment in psychiatric practice involves a complex decision. Whether to treat or not to treat a particular patient with lithium depends on the therapist's assessment of two issues. First, what are the chances of further episodes in the near future, and second, what would be the impact of another episode on the patient, his job, his family, and