Mood-stabilisers Flashcards
When are mood stabilisers used?
- Bipolar disorder
- Schizoaffective disorder
- Cylothymia - rare mood disorder
What are the 3 main mood-stabiliser medications you need to know?
- Lithium
- Anti-convulsants
- Anti-psychotics
Lithium is the only medication shown to reduce _____ _____ in relation to psychiatric disorders?
suicide rates
Lithium is effective in long-term prophylaxis of what disorder?
It is effective in long-term prophylaxis of both mania and depressive episodes in bipolar affective disorders
Name some factors that predict a good/positive response to lithium treatment?
- Prior long-term response or family member with good response
- If mania is the only episode someone has (a one off epsidoe of mania = bipolar disorder)
- Or if they have mania first and the depression follows it
Prescribing Lithium:
- What do you need to do prior to starting someone on Lithium medication?
- How do you monitor patients on Lithium?
- Before starting you need:
- Baseline bloods (U&E and TSH) done because this drug affects renal and thyroid function.
- Consider pregnancy test in women of child bearing age, as in the first trimester Lithium can cause increased risk of Ebstein Anomaly (heart defect)
- Monitoring:
- A steady state is achieved after 5-7 days then check bloods 12 hours after last dose.
- Once stable (blood conc. between 0.6-1.2) then check bloods every 3 months.
Side effects of lithium?
Lithium is pretty toxic and lethal in overdose!
- GI distress – reduced appetite, nausea/vomiting, diarrhoea
- Thyroid abnormalities
- Non-significant leukocytosis
- Polyuria/polydipsia – antagonism of ADH
- Hair loss
- Acne
- Reduces seizure threshold, cognitive slowing, intention tremor
Severe – generalised convulsions, oliguria and renal failure
Name 3 key anti-convulsants = anti-epileptics / anti-seizure
- Valproic acid
- Carbamazepine
- Lamotrigine
Side effects of Valproic acid
- Nausea
- Vomiting
- Weight gain
- Lowers threshold for seizure/fit
What do you need to do prior to starting someone on Valproic acid? And how do you monitor them?
Before starting
- Baseline liver function tests
- Pregnancy test - avoid in women of child-bearing age due to neural tube defects
- FBC
Monitoring
- A steady state is achieved after 4-5 days then…
- Check bloods 12 hours after last dose and repeat FBC and lfts.
*
Side effects of Carbamazepine
- Nausea
- Vomiting
- Rash
- Lots of drug-to-drug interactions!
- Dizziness
- Sedation
- Diarrhoea
- AV conduction delays
- Aplastic anemia and agranulocytosis (<0.002%)
- Water retention due to vasopressin-like effect which can result in hyponatremia
What do you need to do prior to starting someone on Carbamazepine? And how do you monitor them?
Before starting:
- LFTs
- ECG
- FBC
Monitoring:
- A steady state is achieved after 5 days then…
- Check bloods 12 hours after last dose and repeat FBC and LFTs.
- Need to check level and adjust dosing after around a month because it induces own metabolism.
Carbamazepine is 1st line in the treatment of what?
Acute mania and mania prophylaxis
Indicated for rapid cyclers (frequent, distinct episodes in bipolar disorder) and mixed patients (both depression and mania)
What is Lamotrigine commonly used for?
Neuropathic / chronic pain
What must you do before starting someone on Lamotrigine?
LFTs
