4.2. Psychopharmacology - Mood Stabilizers Flashcards
What are the Indications for Mood Stabilizers?
- Bipolar
- Cyclothymia
- Schizoaffective
What are the Classes of Mood Stabilizers?
- Lithium
- Anti-Convulsants
- Anti-Psychotics
- When is Lithium used?
2. What Factors predict a Positive Response to Lithium?
- Long-Term Prophylaxis of Mania and Depressive Episodes
- a) Prior Long-Term Response
- b) Family member with a Good Response
- c) Classic Pure Mania
- d) Mania is followed by Depression
How is Lithium used?
- Get baseline U&E’s & TSH / Check Pregnancy
2. Monitor - Goal Blood Level = 0.6-1.0 - after 5 days
What are the Side Effects of Lithium?
- G.I. Distress - Appetite / Nausea / Vomiting / Diarrhoea
- Thyroid Abnormalities
- Non-Significant Leukocytosis
- Polyuria / Polydypsia
- Hair Loss / achne
- Reduces Seizure Threshold / Cognitive Slowing
- Lithium Toxicity:
- a) Mild - N&V / Ataxia / Dizziness / Slurred Speech
- b) Moderate - N&V / Blurred Vision / Delirium / Syncope
- c) Severe - Generalized Convulsions / Renal Failure
What are the forms of Anti-Colnvulsants used as Mood Stabilizers?
- Valproic Acid (Depakote) - Bipolar Disorder
- Carbemazipine (Tegretol)
- Lamotrigine (Lamictal)
What are the Side effects of Valproic Acid?
- Thrombocytopenia and Platelet Dysfunction
- Nausea / Vomiting / Weight Gain
- Sedation / Tremor
- Increased Risk of Neural Tube Defects
- Hair Loss
What is Carbemazipine 1st line for?
Acute Mania and Mania Prophylaxis
What are the Side Effects of Carbemazipine?
- Rash
- Nausea / Vomiting / Diarrhoea
- Sedation / Dizziness / Ataxia / Confusion
- AV Condutions Delays
- Aplastic Anaemia and Agranulocytosis
- Water Retention
- Drug-Drug Interactions
What are the Side Effects of Lamotrigine?
- Nausea / Vomiting
- Sedation / Dizziness / Ataxia / Confusion
- Rash - Toxic Epidermal Necrolysis / SJS
- Blood Dyscrasias
What are the Indications for using Antipsychotics?
- Schizophrenia
- Schizoaffective Disorder
- Bipolar Disorder - for Mood Stabilization +/- Psychotic Features are present
What causes Psychosis?
Key Pathways affected by Dopamine in the Brain:
- Mesocortical - Negative Symptoms / Cognitive Disorders arise from here - Too Little Dopamine
- Mesolimbic - Positive Symptoms (Hallucinations…) arise from here - Too Much Dopamine
- Nigrostriatal - Parkinsonian Symptoms can arise from here - Dopamine Hypoactivity
- Tuberoinfundibular - Hyperprolactinaemia Symptoms - Too Much Dopamine
How do Typical Antipsychotics work?
D2 Dopamine Receptor Antagonists:
What are the Types of Typical Antipsychotics?
High D2-Receptor Affinity: 1. Haloperidol 2. Primozide 3. Fluphenazine Low D2-Receptor Affinity: 1. Chlorpromazine 2. Thioridazine
How do Atypical Antipsychotics work?
Serotonin-Dopamine 2 Antagonists (SDA’s)
Note - Hit D1, D3, D4, D5 Receptors (Typical Hit D2)
