Management

Question 1

Before starting antipsychotics, what investigation should be requested?

Answer 1

Bedside: Weight, HR and BP
Bloods: FBC, U&E, LFT, HbA1c, Prolactin, Lipids & cholesterol
Special: ECG

Question 2

Before starting Lithium, what investigations should be requested?

Answer 2

Bedside: Weight
Bloods: U&E, TFT, Calcium

Question 3

Antidote to benzodiazepine overdose:

Answer 3

Flumazenil

Question 4

What are the side effects of lithium:

Answer 4

Tiredness
Metallic taste in the mouth
Dry Mouth
A slight shaking of the hands

Weight gain
Thirst
Urinating more often
Under active thyroid

Question 5

What are the symptoms of Lithium toxicity?

Answer 5

You feel very thirsty 
You have bad diarrhoea and Vomiting 
Obvious shaking of the hands and legs 
Twitching of your muscles
You get muddles of confused 

Contact your doctor immediately

Question 6

Risks of Lithium:

Answer 6

Lithium is a safe drug when taken at the correct dose

Not drinking enough water or losing too much through sweating or urinating can cause the levels in the body to go up putting you at a risk of lithium toxicity

Some drugs and medicines may interfere with lithium so never take any medications without discussing with a doctor make sure to inform any doctor treating you that you are on lithium

Question 7

Monitoring for lithium:

Answer 7

Blood tests done beforehand to check your kidney and thyroid gland are working properly

Blood tests done weekly, 12 hours after the last dose of lithium, until levels are stable. Then only need to be done every 3 or 4 months

Question 8

Side effects of Sodium Valproate:

Answer 8

Sleepiness
Dizziness
Nausea and vomiting
Skin rash
Change in blood count
Irregular periods

Very rare: Pancreatitis (1-10,000)
Even rarer: Liver failure (1-50,000)