Psychotropics

Question 1

Side effects of lithium? (Poem)

Answer 1

Lithium: metal tongue, inflamed tum.
Your hair won’t grow,
Your thyroid’s low (but you might not know),
Pimples, psoriasis and vertigo,
Weight gain, head pain, kidney strain, benign T wave change, calcium and/or PTH high range
Lethargy, poor memory,
High white cells, and that’s all from me.

Metallic taste, gastritis, N/D
Alopecia
Hypothyroidism (usually asymptomatic), hyperthyroidism (rarely),
Acne, psoriasis
Vertigo, dizziness, tremor
Weight gain, headache
Renal: nephrotoxicity, nephrogenic diabetes insipidus (uncommon), >10yrs tx increases risk of renal tumours
Cardio: benign T wave changes on ECG, arrhythmias (rarely)
Hypercalcaemia, hyperparathyroidism
Fatigue, memory impairment, nystagmus (rarely)
Leucocytosis

Question 2

Symptoms of lithium toxicity?

Answer 2

Mild-to-mod: 
blurred vision, 
flu-like illness,
apathy,
increasing diarrhoea, nausea, vomiting, 
muscle weakness, drowsiness, ataxia,

Severe: increased muscle tone, hyperreflexia, myoclonic jerks, coarse tremor, dysarthria, disorientation, psychosis, seizures, coma

Question 3

Lithium dose ranges?

Answer 3

Acute mania: 0.5–1.2mmol/L.
Prophylaxis: 0.4–1mmol/L.
Symptoms of toxicity are common when concentration >1.5mmol/L (>1.2mmol/L in the elderly). Sometimes clinical toxicity can occur at lower concentrations, particularly in those with organic neurological damage or other CNS illness (eg epilepsy).