mood stabilisers and anxiolytics

Question 1

1st line mood stabiliser

Answer 1

Lithium carbonate

Question 2

adverse effects of lithium

Answer 2

nausea, vomitting, diarrhoea, tremor, dry mouth/strange taste, nephrotoxicity, t wave inversion

Question 3

when should lithium levels be checked

Answer 3

after starting- weekly and after each dose change until concs become stable - then every 4 weeks for 1st 6months
once established- lithium blood level every 3 months (12hrs post dose)
thyroid and renal function every 6 months

Question 4

what plasma level are you aiming for with lithium

Answer 4

0.6- 1 mol/L 12hr post dose

Question 5

what else can be used as a mood stabilser

Answer 5

anticonvulstants- semisodium valproate or carbamazepine, lamotrigine
antipsychotics- olanzapine,

Question 6

Anxiolytics

Answer 6

1. SSRIs- panic disorder, OCD, PTSD, phobias, GAD
2. Tricyclics- clompipramine, imipramine 2nd line for panic disorder, OCD
3. Venlafaxine- GAD

Question 7

Benzos for anxiety- problems

Answer 7

cause dependence- should only prescribed for 1-4weeks

Question 8

withdrawal from benzos- symptoms

Answer 8

insomnia, irritability, anxiety, tremor, loss of appetite, tinnitus, perspiration, perceptual disturbances, seizures, loss of appetite

Question 9

how to withdraw from benzos

Answer 9

transfer to equivalent dose of diazepam
decrease dose every 2-3weeks in steps of 2-2.5mg
if withdraw symptoms occur- maintain this dose until symptoms improve
reduce dose futher
stop completely