Mood Stablisers

Question 1

What are they used to treat?

Answer 1

Mood stabilisation and prevention of relapse

Acute Mania

Question 2

What are the two types of lithium?

Answer 2

Carbonate

Citrate

Question 3

What conditions are associated with long term use of lithium?

Answer 3

Thyroid disorders

Mild cognitive memory impairment

Question 4

How often should thyroid function be monitored whilst taking lithium?

Answer 4

Every 6 months or more often if evidence of deterioration

Question 5

What makes lithium toxicity worse and means it should not be used with diuretics?

Answer 5

Sodium depletion increased lithium toxicity

Question 6

Why should people who have to have a low sodium diet not take lithium?

Answer 6

Sodium depletion increases lithium toxicity

Question 7

Is it safe to stop treatment with lithium abruptly?

Answer 7

It is recommended to withdraw gradually over a period of at least 4 weeks but ideally up to 3 months to avoid rebound relapse.

Question 8

Why must serum lithium levels be closely monitored?

Answer 8

Lithium salts have a very a narrow therapeutic/toxic ratio

Question 9

What is the target serum lithium concentration?

Answer 9

0.4-1 mmol/litre taken after 12 hours (lower end of range for maintenance therapy and elderly)

Question 10

What is the target serum lithium concentration in acute episodes of mania and for patients who have previously relapsed or have sub-syndromal symptoms?

Answer 10

0.8-1 mmol/Litre

Question 11

What is a serious side effect of Lithium?

Answer 11

Renal Impairment

Question 12

How often should renal function be checked?

Answer 12

Renal function should be checked against baseline every 6 months.

Question 13

What is a common side effect with this class of drugs?

Answer 13

Weight gain

Question 14

Which drug is dangerous to pregnant women?

Answer 14

Sodium Valproate

Question 15

Why is sodium valproate not recommended for use during pregnancy?

Answer 15

Highest risk of major and minor congenital malformations and long term neurodevelopmental effects.
Risk of neonatal bleeding/neonatal hepatotoxicity

Question 16

What medications could be used instead of lithium to stabilise mood?

Answer 16

Sodium Valproate (control mania)
Valproic Acid (Manic episodes associated with Bipolar)
Carbemazepine (prophylaxis of bipolar where other drugs have failed)

Question 17

In the treatment of bipolar disorder, how long before a full prophylactic effect of lithium occurs?

Answer 17

6-12 months

Question 18

What are common side effects of Lithium?

Answer 18

Gastro-intestinal disturbances (anorexia, D&V)
Polyuria (increase urine)/polydipsia(excessive thirst)
Tremor
Oedema
Blurred vision (toxic)
CNS disturbances drowsiness, sluggishness, giddiness & ataxia, tremor, lack of co-ordination, dysarthria (impaired speech).

Question 19

Other alternatives to Lithium?

Answer 19

Calcium Channel Antagonists

ECT

Question 20

What three alternative/adjunctive treatments does NICE recommend for use with Mood stabilisers?

Answer 20

Interpersonal and Social rhythm therapy
Cognitive behavioural therapy
Family intervention