Lithium

Question 1

What is lithium used for?

Answer 1

Lithium is a mood stabiliser used in the management of bipolar disorder

Question 2

What are some side effects of lithium treatment?

Answer 2

Hypothyroidism
Polyuria
Diabetes insipidus
Thirst
Tremor
Weight gain

Question 3

What is the target range for lithium levels in the blood?

Answer 3

0.6-1.0

Question 4

What are some features of lithium toxicity?

Answer 4

Coarse tremor
Seizure
Ataxia
Confusion
Slurred speech
Dehydration
Diarrhoea and vomiting

Question 5

What monitoring is required for patients taking lithium?

Answer 5

Lithium levels
TFTs- can cause hypothyroidism
Renal Function - Can cause nephrogenic DI

Question 6

What are some things that increase lithium levels?

Answer 6

Dehydration
ARBs/ACEi
NSAIDs
Thiazide diuretics 
AKI/CKD

Question 7

What other agents might be used for mood stabilisation in BPD?

Answer 7

Anti-psychotics

Anti-convulsants- Sodium Valproate and Lamotrigine

Question 8

What is an important side effect of lamotrigine?

Answer 8

Rash- must observe as it can progress to steven johnsons syndrome

Question 9

What monitoring needs to be done for sodium valproate?

Answer 9

Sodium valproate can cause hepatotoxicity so monitoring of LFTs is required

Question 10

What should be used to treat acute mania?

Answer 10

Antipsychotics should be used to manage acute mania- either haloperidol, olanzapine and quetiapine

Question 11

What should be stopped if patients with BPD develop mania?

Answer 11

Should consider stopping antidepressants for acute mania

Question 12

How should depression be managed in bipolar?

Answer 12

Psychological therapies- CBT, IPT, FT

Optimise mood stabilisers- lithium, lamotrigine, valproate