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Question 1

Information for patient for lithium commencement

Answer 1

Treatement course - start ASAP, continue for 3-5years without any episodes or indefinitely, maintain 0.4-0.8 levels or 0.6-1.2 acutely
Indication - 1 severe manic episode or 2 manic episodes
Tests - blood before (UEC, CMP, TFT, bHCG), BMI before, weekly lithium levels until stable then 3-6monthly bloods
Benefits - most effective mood stabiliser, reduces highs and lows, reduces recurrence of episodes
Risks - toxicity (narrow therapeutic index), teratogenic, changes in thyroid function, nephrogenic DI
Alternative - anti-epileptics or ECT

Question 2

ECT treatment counselling

Answer 2

Benefits - highly effective fore severe MDD, BPAD an schizophrenia, but high relapse
Risks - confusion, n&v, headache, short term memory loss
Alternatives - more meds or new psychotherapy (not as effective)
Before - bloods, NBM, anaesthetic
During - small electrical shock to brain, controlled seizure
After - taken to recovery, groggy 30mins, return 2-3 times / week for 6-12 treatments