Mood Stabilisers

Question 1

Indication for mood stabilisers?

Answer 1

Bipolar
Cyclothymia
Schizoaffective disorder

Question 2

What are the classes of mood stabilisers?

Answer 2

Lithium
Anticonvulsants
Antipsychotics

Question 3

What is the indication for lithium use?

Answer 3

Mania

Depression

Question 4

What are factors indicating good response to lithium?

Answer 4

Prior family remember who responds well
Classic pure mania
Mania followed by depression

Question 5

What tests need to be done before prescribing lithium?

Answer 5

Baseline U+Es
TSH
Pregnancy test

Question 6

What is lithium associated with causing in a foetus?

Answer 6

Ebsteins anomaly

Question 7

What is ebsteins anomaly?

Answer 7

Tricuspid valve does not close properly

Question 8

When is a steady state achieved in lithium therapy?

Answer 8

5 days

Question 9

When are tests done after starting lithium therapy?

Answer 9

12 hours after last dose at 5 days

Question 10

How often are tests once stable in lithium therapy?

Answer 10

3 monthly

Question 11

What is tested at the 3 monthly checks?

Answer 11

TSH

Creatinine

Question 12

What is the blood lithium level target?

Answer 12

Between 0.6 - 1.2

Question 13

What are the SE of lithium?

Answer 13

GI

• Reduced appetite
• Diarrhoea
• Nausea/vomiting

Thyroid problems

Reduced seizure threshold
Cognitive slowing
Tremor

Question 14

What hormone does lithium antagonise?

Answer 14

ADH

- leads to polyuria and polydipsia

Question 15

What may be seen on FBC in lithium?

Answer 15

Nonsignificant leukocytosis

Question 16

What are signs of mild lithium toxicity and what blood lithium levels define it?

Answer 16

Blood lithium 1.5 - 2.0

• Vomiting
• Ataxia
• Dizziness
• Nystagmus
• Slurring speech

Question 17

What are signs of moderate lithium toxicity and what blood lithium levels define it?

Answer 17

Blood lithium 2.0 - 2.5

• Vomiting
• Anorexia
• Blurred vision
• Clonus
• Convulsions
• Syncope

Question 18

What are signs of severe lithium toxicity and what levels define it?

Answer 18

Blood lithium >2.5

• Generalised seizures
• Oliguria
• Renal failure

Question 19

What anti-convulsants are good in psych?

Answer 19

Valproate
Carbamezapine
Lamotrigine

Question 20

When is valproate used?

Answer 20

Mania

Question 21

What predicts good response to valproate?

Answer 21

Rapid cycling
Substance issues
Anxiety disorders

Question 22

SE valproate?

Answer 22

Thrombocytopenia and platelet dysfunction
Weight gain
Sedation
Tremor 
Risk of neural tube defect in pregnancy

Question 23

What is carbamezapine used for?

Answer 23

first line acute mania and prophylaxis

Good for rapid cyclers in bipolar disorder

Question 24

What bloods should be done before prescribing carbamezapine?

Answer 24

LFTs
FBC
ECG

Question 25

When should carbamezapine levels be re-tested and why?

Answer 25

At 1 month | There is a metabolic adjustment

Question 26

SE carbamezapine?

Answer 26

Rash very common Nausea/vomiting Sedation AV conduction delat Agranulocytosis Urinary retention

Question 27

What type of anaemia may be caused by carbamezapine?

Answer 27

Aplastic

Question 28

What are side effects of lamotrigine?

Answer 28

``` Sedation Dizzines Ataxia Confusion TEN/SJS ```

Question 29

What drugs may increase levels of lamotrigine?

Answer 29

Sertraline | Valproate

Question 30

Antipsychotic for manic, mixed and maintainance bipolar?

Answer 30

Aripiprazole | Olanzapine

Question 31

Antipsychotic for manic and mixed but not for mainainence of bipolar?

Answer 31

Risperidone

Question 32

Antipsychotic for manic and mainanence but not mixed?

Answer 32

Quitiapine

Question 33

Antidepressent for manic, mainainance and depressive bipolar?

Answer 33

Quitiapine XR

Question 34

How do typical antipsychotics work?

Answer 34

D2 dopamine receptor antagonists

Question 35

What is the big SE of typicals?

Answer 35

Extrapyramidal side effects

Question 36

What are extrapyramidal se?

Answer 36

Tardive dyskinesia Restlessness Akithisia

Question 37

What are examples of typicals?

Answer 37

Haloperidol | Fluphenazine

Question 38

What are other types of typicals?

Answer 38

Low potency typicals

Question 39

How do low potency typicals work?

Answer 39

Have a lower D2 affinity but can interact with other non-dopaminergic receptors

Question 40

What are the SE of low potency atypicals?

Answer 40

Cardiotoxicity Anticholinergic - Sedation - Hypotension

Question 41

How do atypical antipsychotics work?

Answer 41

Serotonin-dopamine 2 antagonists

Question 42

What pathways are said to be worked on by atypical antipsychotics?

Answer 42

The 4 major dopamine pathways of the brain