Mood Stabilisers Flashcards
What are the possible indications for mood stabilisers?
Bipolar disorder
Cyclothymia
Schizoaffective disorder
What are the classes of mood stabilisers?
Lithium
Anticonvulsants
Antipsychotics
In what situations is lithium helpful?
Only medication to reduce suicide rate
Effective in long term prophylaxis of depressive and manic episodes
What factors predict a good response to lithium?
Prior long-term response or family member with good response
Classic pure mania
Mania is followed by depression
What monitoring should be done with a lithium prescription?
Before lithium is started a baseline Us&Es and TSH should be done, as well as a pregnancy test in women of child bearing age. Lithium can cause Ebstein’s anomaly is prescribed during the first trimester and is nephrotoxic and can cause hypothyroidism. The goal blood level is 0.6-1.2, which can be achieved after five days and should be checked 12 hours after the last dose at this point. Levels should be checked at 3 months and creatinine and TSH checked at 6 months.
What are the side effects of lithium?
GI distress- reduced appetite, nausea and vomiting, diarrhoea
Thyroid abnormalities
Nonsignificant leukocytosis
Polyuria/polydipsia secondary to ADH antagonism
Reduces seizure threshold
Cognitive slowing
Intention tremor
What blood levels define each type of lithium toxicity?
Mild = 1.5-2.0
Moderate = 2.0-2.5
Severe = >2.5
What are the symptoms of mild lithium toxicity?
Vomiting
Diarrhoea
Ataxia
Dizziness
Slurred speech
Nystagmus
What are the symptoms of moderate lithium toxicity?
Nausea
Vomiting
Anorexia
Blurred vision
Clonic limb movements
Convulsions
Delirium
Syncope
What are the symptoms of severe lithium toxicity?
Generalised convulsions
Oliguria
Renal failure
What factors predict a good response to valproic acid?
Rapid cycling patients
Comorbid substance issues
Mixed patients
Patients with comorbid anxiety disorders
What monitoring should be done with a valproic acid prescription?
Before the medication is started baseline LFTs, FBC and a pregnancy test are done. The drug is generally not started in anyone of child bearing age, but a folic acid supplement should be given if it is started in women. A steady state is achieved after 4-5 days and levels should be checked 12 hours after this dose. LFTs should also be repeated at this point. The target level is 50-125
What are the side effects of valproic acid?
Thrombocytopenia and platelet dysfunction
N&V
Weight gain
Sedation
Tremor
Hair loss
Risk of neural tube defect in pregnancy
What are the uses of carbamazepine?
First line medication for patients with acute mania and mania prophylaxis. It is indicated in rapid cyclers and mixed patients
What monitoring is required with a carbamazepine prescription?
Baseline LFTs, FBC and an ECG
Check levels after reaching therapeutic doses- five days later and then again at a month
What are the side effects of carbamazepine?
Rash (most common side effect)
N&V
Diarrhoea
Sedation, dizziness, ataxia and confusion
AV conduction delays
Aplastic anemia and agranulocytosis
Water retention
Drug-drug interactions (many contraindications)
What are the side effects of lamotrigine?
N&V
Sedation, dizziness, ataxia and confusion
Toxic epidermal necrolysis/steven johnsons syndrome (if ANY rash develops- stop drug)
Blood dyscrasias (rare)
What antipsychotics can be used in manic patients?
Aripiprazole
Risperdone
Quetiapine
Quetiapine XR
Olanzapine
What antipsychotics can be used in mixed patients?
Aripiprazole
Risperdone
Olanzapine
What antipsychotics can be used in maintenance situations?
Aripiprazole
Quetiapine
Quetiapine XR
Olanzapine
What antipsychotics can be used in depressed patients?
Quetiapine XR
