Mood Stabilisers

Question 1

What condition are mood stabilisers used in?

Answer 1

Bipolar disorder

Question 2

Acute treatment of manic episodes?

Answer 2

Anti-psychotics (atypical)

Question 3

Anti-psychotics can be used in both elevated and depressed states in bipolar disorder. True or false?

Answer 3

True

Question 4

What is the gold standard treatment for long term bipolar disorder?

Answer 4

Lithium

Question 5

Litium is effective in both elevated and depressed mood states. True or false?

Answer 5

True

Question 6

Lithium monitoring - prior to initiation

Answer 6

U+E - check renal function
TFT
Blood level
ECG

Question 7

Lithium monitoring - during initiation

Answer 7

U+E

Blood lithium level - narrow therapeutic window

Question 8

Lithium - side effects

Answer 8

Dry mouth
Strange taste
Polydipsia 
Polyuria
Tremor
Hypothyroidism
Weight gain 
Long term reduced renal function

Question 9

Lithium - lithium toxicity signs

Answer 9

Vomiting 
Diarrhoea 
Tremor
Ataxia 
Drowsiness
Convulsions
Coma

Question 10

Management of lithium toxicity

Answer 10

Stop lithium
IV fluids
Monitor renal function

Question 11

Lithium can be given safely in pregnancy. True or false?

Answer 11

False

Question 12

Lithium interactions with other drugs

Answer 12

ACE inhibitors
NSAIDs
ARBs
Diuretics

Question 13

Anti-convulsants - name 3

Answer 13

Lamotrigine
Carbamazepine
Sodium Valproate

Question 14

Anti-convulsants are used in the short term/long term treatment of bipolar disorder?

Answer 14

Long term

Question 15

Lamotrigine - side effects

Answer 15

Rash
GI upset
Insomnia

Question 16

Which anti-convulsant can result in steven johnston syndrome?

Answer 16

Lamotrigine

Question 17

Carbamazepine - side effects

Answer 17

Drowsiness
Cardiovascular effects
Ataxia

Question 18

Sodium valproate - side effects

Answer 18

Teratogenicity
Sedation
Tremor
Dizziness

Question 19

Sodium valproate is better for depressive / manic episodes?

Answer 19

Manic

Question 20

Anti-depressants should be avoided in the treatment of bipolar disorder. True or false?

Answer 20

True (ish)

• they can be useful in short term severe depressive episodes
• don’t give an antidepressant without a mood stabiliser.