MOOD 14

Question 1

What is the absolute risk of Ebsteins anomaly with Li exposure in first trimester? How many time increase in risk does this represent?

What is the baseline risk of Ebsteins in general population?

Answer 1

2:1000, 5-20 x increased risk (so RR is high but absolute risk is still low)

1/20,000 (general)

Question 2

What symptoms are associated with the following Lithium levels?

1. 2
2. 5-2

> 2

> 2.5

Answer 2

1. 2 = nausea, diarrhea, tremor, ataxia
2. 5-2 = Seizures

> 2 = Acute Renal failure

> 2.5 = Coma, death.

Question 3

During pregnancy you increase Lithium levels as fluid volume increases due to pregnancy….but how do you adjust to prevent toxicity after birth?

Answer 3

Immediately prior to birth decrease by 1/2 or stop temporarily.

Question 4

What are the common SE of Valproic Acid?

What are the serious SE of Valproic Acid?

Answer 4

COMMON SE:
N/V/D
Alopecia 
Weight gain
Sedation 
Tremor
Transient transaminitis 

SERIOUS SE:

1. Hepatotoxicity
2. Hemorrhagic pancreatitis
3. Thrombocytopenia
4. PCOS

Question 5

What is the black box warning for VPA?

What is the treatment for this?

Answer 5

Potentially fetal hepatotoxicity.

TRX = IV L carnitine

Question 6

With fetal VPA exposure and Neural Tube defects what is the absolute risk and what fold increase risk does this represents?

Answer 6

1-5% of babies will have NT, this is 20-50X increased risk.

Question 7

Other than NT defect… what other teratogenic effects are know for VPA?

Answer 7

1. Craniofacial abnormalities
2. Cardiac abnormalities
3. Lower IQ.

Question 8

Carbamazepine has a black box warning for what?

Answer 8

steven johnsons syndrome.

risk for asians can be 10X higher than whites, due to HLA B 1502 allele variant

Question 9

What is the target level of Carbamazepine?

Answer 9

8-12

Question 10

What are the teratogenic effects of Carbamazepine and what is the % associated with each?

Answer 10

Craniofacial abnormalities (11%)

Fingernail hypoplasia (26%)

Developmental delay (20%)

NT defects (1%)

Question 11

What psychotherapy is most beneficial for BPAD?

Answer 11

Interpersonal Social rhythm therapy

• Daily routine, sleep regulation, activities focus.
• Interpersonal component for grief over dx and interpersonal deficits in role transition and grief.

Question 12

Substance induced mood disorder can be dx if mood symptoms develop within how long of acute intoxication or withdrawal symptoms?

Answer 12

1 month of intoxication or withdrawal symptoms.

Question 13

How many failed medication trials before considering TMS? Vagal N stimulation?

Answer 13

1 failed med trial before TMS

4 failed med trials before Vagal N stimulation.