mood stabilisers (lithium)

Question 1

What are the indications of lithium?

Answer 1

bipolar disorder, acute mania, recurrent depression, aggressive or self harming behaviour

Question 2

Contraindications of lithium?

Answer 2

cardiac or renal insufficiency, dehydration, addisons disease, low sodium diets, any history of brugada syndrome, hypothyroidism, rhythm disorders

Question 3

What is the method of action of lithium?

Answer 3

widely distributed in the central nervous system where it works on multiple neurotransmitters and receptors, increases serotonin synthesis and decreases norepinephrine release

Question 4

What are the side effects of lithium?

Answer 4

weight gain, nausea, vomiting, diarrhoea, leucocytosis, thyroid function disturbances, high levels of calcium glucose and magnesium, hyperparathyroidism, confusion, delirium, ataxia, slurred speech, dizziness, memory impairment, tremor, vertigo, extrapyramidal disorders, hypotension, ECG changes, acne, alopecia, muscle weakness, impaired renal function, sexual dysfunction

Question 5

Monitoring requirements for lithium?

Answer 5

determine cardiac, thyroid and renal function before commencement. blood serum lithium levels need to be taken 12 hours after the dose and should be between 0.4-1mmol/l and 0.8-1mmol/l for acute mania. routine monitoring should be done weekly after each initiation and dose change, then every 3 months after. body weight, BMI, electrolytes, eGFR and thyroid function every 6 months during treatment

Question 6

Treatment cessation for lithium?

Answer 6

abrupt discontinuation increases risk of relapse

Question 7

Patient and carer advice for those on lithium?

Answer 7

report signs and symptoms of lithium toxicity - persistent headache, impaired renal function, visual disturbances, hypothyroidism. avoid dietary changes which affect sodium intake, maintain adequate fluid intake