Lithium counselling

Question 1

Check for contraindications

Answer 1

• 1st trimester pregnancy
• Breast-feeding
• Cardiac insufficiency/ rhythm disorder
• Significant renal impairment
• Addison’s disease
• Low sodium diets
• Untreated hypothyroidism

Question 2

How the treatment works

Answer 2

• Mood stabiliser
• Exact mechanism unknown
• Thought to interfere with neurotransmitter release and receptors
• Treatment course and how it’s taken
• Once or twice daily tablet/liquid
• Taken long-term if effective
• Takes 1-2 weeks to work

Question 3

Monitoring required

Answer 3

• Before starting - FBC, U&Es, TFTs, Beta-HCG, ECG
• Check lithium level after 5 days, then every week until stable for 4 weeks, then every 3 months
• Check TFTs, U&Es, Ca2+ every 6 months

Question 4

Side effects

Answer 4

• GI (abdominal pain, nausea)
• Metallic taste
• Fine tremor
• Water symptoms (thirst, polyuria, impaired urinary concentration, weight gain and oedema)
• Renal toxicity
• Nephrogenic diabetes insipidus
• Hypothyroidism
• Lithium toxicity symptoms GI(anorexia, diarrhoea, vomiting)
• Neuromuscular (dysarthria, dizziness, ataxia, impaired co-ordination, muscle twitching, tremor)
• Others (drowsiness, apathy, restlessness)