Mood Stabilisers

Question 1

Which anti-psychotics are used in acute mania?

Answer 1

Olanzapine
Aripiprazole
Quetiapine
Zuclopenthixol

Question 2

What are some contraindications for lithium use?

Answer 2

Pregnancy, planned - cautious - epistein’s anomaly (congenital cardiac defect)

Question 3

What are the mood stabilisers?

Answer 3

Lithium
Sodium valproate
Carbamazepine
Lamotrigine

Question 4

What mood stabiliser can you use in pregnancy?

Answer 4

Lithium is the best of the regular three but epistein’s anomaly can occur

Olanzapine can be used instead

Question 5

What are some options in treatment resistance?

Answer 5

Combine multiple mood stabilisers

Trial anti-psychotics

Question 6

What do you use before prescribing lithium?

Answer 6

Renal function - UECs

Thyroid function - TFT

Question 7

What are the difficulties with using lithium?

Answer 7

Small therapeutic window
Levels need to be monitored sometimes
Thyroid and renal SEs

Question 8

With are the side effects of lithium?

Answer 8

Nausea/Vomiting
Nephrotoxicity - diabetes insipidus (Nephrogenic), polyuria
Hypothyroidism
Psoriasis
Metallic taste
Weight gain
Memory impairment

Question 9

How does lithium toxicity present?

Answer 9

Mild-to-moderate: blurred vision, increasing diarrhoea, nausea, vomiting, muscle weakness, drowsiness, apathy, ataxia, flu-like illness

Severe: increased muscle tone, hyperreflexia, myoclonic jerks, coarse tremor, dysarthria, disorientation, psychosis, seizures, coma

Question 10

How does lithium cause diabetes insipidus?

Answer 10

Nephrogenic - chronic elevated serum lithium can lead to resistance to ADH