Mood Stabilisers Flashcards
Indication for mood stabilisers?
Bipolar
Cyclothymia
Schizoaffective disorder
What are the classes of mood stabilisers?
Lithium
Anticonvulsants
Antipsychotics
What is the indication for lithium use?
Mania
Depression
What are factors indicating good response to lithium?
Prior family remember who responds well
Classic pure mania
Mania followed by depression
What tests need to be done before prescribing lithium?
Baseline U+Es
TSH
Pregnancy test
What is lithium associated with causing in a foetus?
Ebsteins anomaly
What is ebsteins anomaly?
Tricuspid valve does not close properly
When is a steady state achieved in lithium therapy?
5 days
When are tests done after starting lithium therapy?
12 hours after last dose at 5 days
How often are tests once stable in lithium therapy?
3 monthly
What is tested at the 3 monthly checks?
TSH
Creatinine
What is the blood lithium level target?
Between 0.6 - 1.2
What are the SE of lithium?
GI
- Reduced appetite
- Diarrhoea
- Nausea/vomiting
Thyroid problems
Reduced seizure threshold
Cognitive slowing
Tremor
What hormone does lithium antagonise?
ADH
- leads to polyuria and polydipsia
What may be seen on FBC in lithium?
Nonsignificant leukocytosis
What are signs of mild lithium toxicity and what blood lithium levels define it?
Blood lithium 1.5 - 2.0
- Vomiting
- Ataxia
- Dizziness
- Nystagmus
- Slurring speech
What are signs of moderate lithium toxicity and what blood lithium levels define it?
Blood lithium 2.0 - 2.5
- Vomiting
- Anorexia
- Blurred vision
- Clonus
- Convulsions
- Syncope
What are signs of severe lithium toxicity and what levels define it?
Blood lithium >2.5
- Generalised seizures
- Oliguria
- Renal failure
What anti-convulsants are good in psych?
Valproate
Carbamezapine
Lamotrigine
When is valproate used?
Mania
What predicts good response to valproate?
Rapid cycling
Substance issues
Anxiety disorders
SE valproate?
Thrombocytopenia and platelet dysfunction Weight gain Sedation Tremor Risk of neural tube defect in pregnancy
What is carbamezapine used for?
first line acute mania and prophylaxis
Good for rapid cyclers in bipolar disorder
What bloods should be done before prescribing carbamezapine?
LFTs
FBC
ECG
When should carbamezapine levels be re-tested and why?
At 1 month
There is a metabolic adjustment
SE carbamezapine?
Rash very common
Nausea/vomiting
Sedation
AV conduction delat
Agranulocytosis
Urinary retention
What type of anaemia may be caused by carbamezapine?
Aplastic
What are side effects of lamotrigine?
Sedation Dizzines Ataxia Confusion TEN/SJS
What drugs may increase levels of lamotrigine?
Sertraline
Valproate
Antipsychotic for manic, mixed and maintainance bipolar?
Aripiprazole
Olanzapine
Antipsychotic for manic and mixed but not for mainainence of bipolar?
Risperidone
Antipsychotic for manic and mainanence but not mixed?
Quitiapine
Antidepressent for manic, mainainance and depressive bipolar?
Quitiapine XR
How do typical antipsychotics work?
D2 dopamine receptor antagonists
What is the big SE of typicals?
Extrapyramidal side effects
What are extrapyramidal se?
Tardive dyskinesia
Restlessness
Akithisia
What are examples of typicals?
Haloperidol
Fluphenazine
What are other types of typicals?
Low potency typicals
How do low potency typicals work?
Have a lower D2 affinity but can interact with other non-dopaminergic receptors
What are the SE of low potency atypicals?
Cardiotoxicity
Anticholinergic
- Sedation
- Hypotension
How do atypical antipsychotics work?
Serotonin-dopamine 2 antagonists
What pathways are said to be worked on by atypical antipsychotics?
The 4 major dopamine pathways of the brain
