Psych

Question 1

What pharmacological treatment might be used as prophylaxis/maintenance therapy in BPAD?

Answer 1

mood stabilisers

e.g. sodium valproate, lithium, carbamazepina

Question 2

What pharmacological agents are used to treat episode of acute mania?

Answer 2

atypical antipsychotics
e.g. olanzapine, haloperidol
benzodiazepines to control agitation
e.g. lorazepam, diazepam

Question 3

When is maintenance treatment for BPAD indicated?

Answer 3

in patients who have had more than one episode

Question 4

What is the role of antidepressants in BPAD?

Answer 4

sometimes used for treatment of severe depressive episodes i.e. when at risk of suicide
in general should be avoided as they can trigger mania
if req use SSRIs not TCAs

Question 5

Why does lithium use need to be monitored carefully?

Answer 5

narrow therapeutic window: 0.5-1mmol/L
toxic level >1.5mmol/L
dangerously toxic: >2mmol/L

Question 6

What investigations are required prior to onset of Lithium treatment and during?

Answer 6

prior: FBC, U+E, TFT, ECG, betaHCG
during:
3monthyl: lithium levels
6monthly: renal function
12 monthy: TFT

Question 7

What are contraindications for lithium treatment?

Answer 7

pregnancy 
breastfeeding
renal insufficiency
thyroid disease
cardiac condition
neuro pathology