Mood Stabilizers

Question 1

woman is hospitalised with first episode of mania, no Hx of depressive epsiode, no drug or alcohol Hx, no PMH. What medication do you start on

Answer 1

lithium

Question 2

things to do before starting lithium

Answer 2

check TSH, U&Es and do a pregnancy test

Question 3

thing to monitor in lithium

Answer 3

creatinine every 6 months

TSH every 3 months

Question 4

why avoid pregnancy on lithium

Answer 4

risk of Ebstein’s anomaly in 1st trimester

Question 5

what is a rapid cycler

Answer 5

4+ depressive or manic episodes a year

Question 6

what drugs are good for rapid cyclers?

Answer 6

valproic acid and carbemazepine

Question 7

what drug is good for patients who have substance misuse

Answer 7

valproic acid

Question 8

what drug is good for patient who have comorbid anxiety

Answer 8

valproic acid

Question 9

true/false - more than a 3x increase in LFTs on anticonvulsants is normal

Answer 9

false - normal for them to increase but no more than 3x the normal. Change therapy if it is over