title: Comparison of three a-priori models in the prediction of serum lithium concentration.
abstract: BACKGROUND
  Mathematical models are valuable for optimizing drug dose and dosing regimens.
  
  
  OBJECTIVE
  To compare the precision and bias of three a-priori methods in the prediction of serum level of lithium in patients with bipolar disorder, and to determine their sensitivity and specificity in detecting serum lithium levels outside the therapeutic range.
  
  
  METHODS
  Hospital-based, retrospective study.
  
  
  METHODS
  In a retrospective study of 31 in-patients, the serum level of lithium was calculated using three different a-priori methods. Mean Prediction Error was used as a measure of bias while Mean Absolute Error and Root Mean Squared Error were used as a measure of precision. The sensitivity and specificity of the methods was calculated.
  
  
  RESULTS
  All three models underestimated serum lithium level. Precision was best with the model described by Pepin et al., while bias of prediction was the least with the method of Abou Auda et al. The formula by Pepin et al. was able to predict serum lithium level with a mean error of 36.57%. The sensitivity and specificity of the models in identifying serum lithium levels outside the therapeutic range was 80% and 76.19% for Pepin et al., 90% and 74.19% for Zetin et al., and 90% and 66.67% for Abou-Auda et al., respectively.
  
  
  CONCLUSIONS
  The study demonstrates the difference in precision and bias of three a-priori methods, with no one method being superior to the other in the prediction of serum concentration.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Radhakrishnan
authors.forename: Milanduth
authors.initials: M
authors.lastname: Kanigere
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Menon
authors.forename: Sam
authors.initials: S
authors.lastname: Calvin
authors.forename: Krishnamachari
authors.initials: K
authors.lastname: Srinivasan