Lithium counselling Flashcards
focussed hx bipolar
mania - ++ mood & energy; – need for sleep; irritable, impulsive, delusions, auditory hallucinations
depression - low mood, low energy, lack of enjoyment, poor sleep, appetite, concentration, risk
overview previous tx (compliance, feelings, side effects, ongoing)
once established px understanding move on to ATHLETICS
Action - block release of brain neurotransmitters –> stabilise mood & prevent prolapse in bipolar & severe depression (80% have good response)
Timing - OD at night
How to use - tablet or liquid
Length -
Effects -
Tests -
SEs -
CIs -
length
takes weeks to work
long-term; at least two years; many people on it forever
stopping & missed dose lithium
compliance is essential
do NOT suddenly stop (relapse) - reduce over 4 weeks
if 1 dose missed –> continue as normal & take if <10hrs
if 2 doses missed–> retitrate, do NOT take 2 doses
SEs
LITHIUM
lethargy
insipidious (polydypsia & polyuria)
tremor
hypothyroidism
insides (GI upset - N/V/D/C)
urea - increased
metalic taste
weight gain
serious SEs
damage to kidneys & thyroid
drink regularly & avoid NSAIDs/diuretics
explore toxicity
Li >1.5
causes: nephrotoxins; UTI, renal failure, dehydration
warning symptoms: worsening Sx, confusion, coarse tremor, hyperreflexia, choreoathetoid movements
safety-netting: get help in illness (modify dose) or toxicity call 999
monitoring (baseline & ongoing)
Li levels (0.5-1) at 12hrs post-dose –> 5 days later –> weekly until stable –> (weekly for) 4 weeks once stable –> 3-monthly once levels steady
U+Es + creatinine: baseline & 6-monthly
weight: baseline + 6 monthly
TFTs
Ca: baseline & annual
concurrent use with antidepressants
can be used sometimes
antidepressants in isolation increase risk of relapse
pregnancy
avoid lithium in 1st trimester
offer contraception
