Mood stabilisers

Question 1

What are the 3 main classes of mood stabiliser?

Answer 1

Anti-convulsants

Anti-psychotics

Lithium

Question 2

Features of 1st gen antipsychotics?

Answer 2

First generation ‘typical’ – e.g. haloperidol

Primarily block dopamine (D2) receptors

Side effects:
- Extrapyramidal – dystonia, akathisia

Question 3

Features of 2nd gen antipsychotics?

Answer 3

Second generation ‘atypical’ – e.g. quetiapine, olanzapine, aripiprazole, clozapine

• Block dopamine (D2) and serotonin (5-HT) receptors
• Better side effect profile
• More likely to cause metabolic abnormalities – raised glucose, lipids, weight gain

Question 4

What is first line for acute mania or depression in bipolar disorder?

Answer 4

Quetiapine

Olanzapine

These can be prescribed alongside other medications.

Question 5

How are anti-convulstants thought to function as a mood stabiliser?

Answer 5

Thought to block overactive pathways (reduce hyperactivity in the brain)

Possible Method of action: increased GABA neurotransmission (GABA is an inhibitory neurotransmitter)

Question 6

Examples of anti-convulsants?

Answer 6

Carbamazepine, lamotrigine, valproate

Question 7

How can valproate be used in bipolar disorder?

Answer 7

Bipolar maintenance if primarily manic/hypomanic

Question 8

Why must valproate NOT be used in pregnant women or women of childbearing age?

Answer 8

Causes neural tube defects in foetus leading to spina bifida

Question 9

How can lamotrigine be used in bipolar disorder?

Answer 9

Bipolar maintenance if primarily depression

Question 10

What is a potential risk of lamotrigine use?

Answer 10

Small risk of Steven-Johnson syndrome (rare disorder of skin and mucous membranes)

Question 11

What is the gold standard for maintenance of bipolar disorder?

Answer 11

Lithium

Also licensed for severe, recurrent depression

Question 12

What are the 2 types of lithium?

Answer 12

Lithium carbonate (most common form)

Lithium citrate

Question 13

Should lithium be avoided in pregnancy?

Answer 13

If possible avoid in pregnancy (particularly 1st trimester) and breast feeding

Possibility of Ebstein’s anomaly in child. Tricuspid valve is incorrectly formed and located lower than usual in the heart.

Question 14

Side effects of lithium?

Answer 14

Dry mouth

Strange taste (metallic)

Tremor

Polyuria

Weight gain

Hypothyroidism

Question 15

What can lead to lithium toxicity?

Answer 15

Sodium and lithium ions are very similar to the kidneys
- Dehydration or hyponatremia can lead to lithium toxicity

Question 16

When should blood testing for lithium be taken and why?

Answer 16

Only prescribe if serum-lithium monitoring is available

Samples should be taken 12 hours after the dose

This is due to lithium having a narrow therapeutic index.

Question 17

Symptoms of lithium toxicity?

Answer 17

Vomiting

Diarrhoea

Ataxia

Drowsiness

Convulsions

Coma