2 - PSY - Mood stabilisers

Question 1

The 4 common mood stabilisers

Answer 1

lithium
sodium valproate
lamotrigine
carbamazepine

Question 2

Indications for mood stabilisers

Answer 2

• Prophylaxis of Bipolar relapse
• Tx of acute mania/hypomania (generally not first line)
• Tx of bipolar depression
• augmentation for ADs in Tx res dep

Question 3

Why essential to titrate and monitor lithium levels?

what range are you aiming for?

Answer 3

bc of narrow Tx window - monitor after minumum of 5 days

range - 0.4-1.2 mmol/L

Question 4

Lithium common (non-toxic) SE’s

Answer 4

GI upset, fine tremor, polyuria, polydipsia, metallic taste in mouth, weight gain, oedema

Question 5

Lithium toxicity - over what lithium conc? Sx of toxicity

Answer 5

>1.5 mmol/L
Sx of toxicity
-diarrhoea
-course tremor
-ataxia
-dysrthria
-nystagmus
-confusion
-convulsions

Question 6

Monitoring for patients on lithium should include…

Answer 6

Lithium level (3 monthly)
U+E (6 monthly - Renal Fx)
Thyroid Fx test (6 monthly - thyroxicity)

Question 7

Lithium and pregnancy - what malformations mostly occur?

Answer 7

cardiac defects (ASD and VSDs)
Ebsteins is most widely quoted (tricuspid valve)

Question 8

Valproate indications

Answer 8

acute mania/hypomania

prophylaxis in Bipolar (weaker evidence than lithium)

Question 9

Two most common adverse teratogenic outcomes from valproate

Answer 9

low verbal IQ 30%

congenital malformation 8-10%

Question 10

Lamotrigine indications

Answer 10

Bipolar depression
Prophylaxis in bipolar disorder (limited evidence)
Augmentation of ADs in Tx res dep

Question 11

Lamotrigine SE + teratogenicity

Answer 11

generally well tolerated
SJS concerns mean titrating up is needed
probably least teratogenic mood stabiliser - possible increased risk of cleft lip/palate with frist trimester exposure

Question 12

Carbamezapine indications

Answer 12

acute mania/hypomania (weaker ev than lithium/valproate)
Prophylaxis in bipolar depression (weak ev)
bipolar depression