Management of Mood Disorders

Question 1

What is the mode of action of lithium?

Answer 1

Blocks phosphatidylinositol pathway

Inhibits glycogen synthase kinase

Question 2

Why must bloods be monitored when patient is on lithium?

Answer 2

lithium has a narrow therapeutic window

Can have very toxic side effects

Question 3

List some of the toxic side effects of lithium

Answer 3

Vomiting
Diarrhea
Ataxia
Course tremor
Drowsiness
Convulsions
Coma
Nephrotoxicity

Question 4

List some of the common side effects of lithium:

Answer 4

Dry mouth
Polydipsia and polyuria
Hypothyroidism
Weight gain 
Nephrogenic diabetes insipidus

Question 5

What syndrome can develop as a side effect from Lamotrigine?

Answer 5

Stevens-Johnson Syndrome

Question 6

When should you take lithium?

Answer 6

At night

Has sedatory side effects

Question 7

What drugs interact with lithium?

Answer 7

ACE inhibitors
NSAIDs
ARBs
Diuretics - especially thiazides

Question 8

What is lithium used to treat?

Answer 8

Bipolar disorder

Can be used as an add on in resistant depression

Question 9

What investigations need to be done before prescribing lithium?

Answer 9

Us and Es
TFTs
ECG

Question 10

When do check the lithium level in the blood?

Answer 10

12 hours after latest dose

Question 11

What do you do if a patient on lithium develops hypothyroidism?

Answer 11

Add on levothyroxine

Tend not to stop lithium if possible

Question 12

Describe the mechanism of action of sodium valproate:

Answer 12

Blocks voltage sensitive sodium channels and increases levels of GABA

Question 13

What group of people do you avoid sodium valproate and why?

Answer 13

Women of childbearing age

Teratogenic

Question 14

List some side effects of sodium valproate:

Answer 14

Sedation
Tremor
Dizziness
GI upset
Tiredness
Weight gain

Question 15

What is sodium valproate used to treat?

Answer 15

Epilepsy
Bipolar
Mania / Hypomania

Question 16

What investigations should be done prior to starting sodium valproate?

Answer 16

Platelet count

LFTs

Question 17

What is lamotrigine used to treat?

Answer 17

Epilepsy

Prophylaxis of bipolar depression

Question 18

List some side effects of lamotrigine?

Answer 18

Rash (10%)
GI upset
Insomnia
Dizziness
Ataxia
Tiredness

Question 19

How is lamotrigine given

Answer 19

Titrated dose slowly over first 6 weeks to reduce risk of SJS / rash.
Then twice daily dosing

Question 20

List some examples of atypical antipsychotics:

Answer 20

Olanzipine 
Risperidone 
quetiapine, 
amisulpride, 
paliperidone, 
clozapine

Question 21

Which atypical antipsychotics are available as IM depots?

Answer 21

Olanzapine

Risperidone

Question 22

List some side effects of antipsychotics:

Answer 22

Sedation / lethargy 
Weight gain
Constipation & urinary retention 
EPSE
QT prolongation
Venous thromboembolism
Neuroleptic malignant sydrome

Question 23

Which anti-psychotic has different side effects and what are they?

Answer 23

Aripiprazole
Insomnia
GI upset
Agitation
Akathisia
Orthostatic hypotension
Headache
Constipation

Question 24

What investigations need to be done before prescribing an atypical anti-psychotic

Answer 24

ECG
FBC
Us and Es
LFTs
BP 
Weight
Lipids
Blood glucose

Question 25

List some examples of typical antipsychotics:

Answer 25

``` Haloperidol Chlorpromazine Flupentixol Sulpiride Zuclopentixol ```

Question 26

What is a typical antipsychotics main mechanism of action

Answer 26

Dopamine 2 receptor blockage

Question 27

List some side effects of typical antipsychotics

Answer 27

``` EPSE Sedation Dizziness QT prolongation Neuroleptic malignant syndrome ```

Question 28

What are used more, typical or atypical anti-psychotics

Answer 28

Atypical

Question 29

What is the mechanism of action for atypical anti psychotics?

Answer 29

Dopamine antagonism and 5-HT antagonism

Question 30

When can clozapine be used in the treatment of schizophrenia?

Answer 30

When the patient has not responded to adequate therapy with at least two different anti-psychotic medications

Question 31

What can be offered alongside medication in the management of schizophrenia?

Answer 31

CBT

Question 32

Can ECT be used in the treatment of schizophrenia?

Answer 32

No

Question 33

What is a serious side effect of clozapine that must be monitored for?

Answer 33

Agranulocytosis

Question 34

What medications lower the seizure threshold?

Answer 34

Anti-psychotics

Question 35

Define torticollis:

Answer 35

"wry neck" | This is a dystonic condition defined by an abnormal, asymmetrical head or neck position