Lesson 4: Mood Stabalizers

Question 1

Typical manifestations of Bipolar Disorder (BPD):

Answer 1

Recurrant fluctuations (over the course of a year or longer) in mood

1) Mania
2) Hypomania
3) Euythmia (normal)
4) Dysthmia (bad)
5) Depresssion

Question 2

BPD is treated by which types of drugs:

Answer 2

1) Mood Stabilizers
2) Antipsychotics
3) Antidepressants

Question 3

What is the drug of choice amongst Mood Stabilizers?

Answer 3

Lithium

Question 4

What are the pros of Lithium?

Answer 4

• gold standard mood stabilizer

- works from the bottom (improves depression) and the top (improves mania)

Question 5

What are the cons of Lithium?

Answer 5

• narrow therapeutic inde
• needs to be checked often
• Body treats it like Sodium, so dehydration can lead body to conserve Lithium, leading to toxic levels
• May be teratogenic

Question 6

What are expected side effects from Lithium?

Answer 6

• Fine hand tremor
• Polyuria
• Mild thirst
• Mild nausea/GI discomfort
• Weight Gain (~10-20 lbs)

Question 7

Other complications w/ Lithium?

Answer 7

• Hypothyroidism

- Renal impairment

Question 8

What is the best way to determine therapeutic Lithium levels?

Answer 8

Measure plasma lithium levels

- blood should be drawn in the morning (12 hrs after lithium dose)

Question 9

Why is sodium balance in the body important when taking Lithium?

Answer 9

The kidneys process Lithium in the same way they process Sodium. If there is a drastic change in sodium body balance, it could increase/decrease the concentration of Lithium in the body

Question 10

What are diet considerations when taking Lithium?

Answer 10

• don’t consume foods that could lead to dehydration

- don’t change your sodium intake

Question 11

What are drug considerations when taking Lithium?

Answer 11

• Avoid Diuretics
• NSAIDs can increase Lithium levels by 60% (except Aspirin)
• Anticholinergics an cause urinary hesitancy which can cause discomfort when taking w/ Lithium

Question 12

What should we educate the patient on when evaluating the therapeutic effects of Lithium?

Answer 12

• Rigid adherence (mild changes in dosing can have severe effects)
• From the text:
  “To promote adherence, educate pateints and families about the nature of BPD and the importance of taking lithium as prescribed. Encourage family members to oversee lithium use, and advise them to urge the patient to visit the prescriber or a psychiatric clinic if a pattern of nonadherence develops.”

Question 13

What should we educate the patient on when managing the adverse effects of Lithium?

Answer 13

• drink 8-12 glasses of water daily
• counsel women about importance of avoiding pregnancy and advise lactating patients to avoid breast feeding
• remind patients that diarrhea can cause significant sodium loss