Mood stabilizers

Question 1

What are the 3 categories of mood stabilisers?

Answer 1

Lithium
Anticonvulsants
Antipsychotics

Question 2

How do anticonvulsants work to stabilise mood?

Answer 2

They calm hyperactivity in the brain.

Question 3

What other diseases are anticonvulsants used for?

Answer 3

Migraine

Epilepsy

Question 4

What type of bipolar disorder reacts well to anticonvulsants?

Answer 4

Those with rapid cycles.

Question 5

What is the 1st line treatment for bipolar?

Answer 5

Lithium

Question 6

What is the prophylaxis for bipolar?

Answer 6

Lithium - for both manic and depressive episodes.

Question 7

What tests must be done before starting lithium?

Answer 7

U&E
TSH
Pregnancy

Question 8

What congenital abnormality is associated with lithium?

Answer 8

Abstains anomaly (heart defect)

Question 9

When is lithium likely to cause a congenital anomaly?

Answer 9

1st trimester

Question 10

When does lithium reach a steady state?

Answer 10

After 5-7 days

Question 11

When most lithium be checked?

Answer 11

5-7 days after starting.

At least 12hrs after the last dose.

Question 12

What is the goal level of lithium?

Answer 12

0.6-1.2

Question 13

when must lithium, TSH and creatinine be checked?

Answer 13

Lithium - every 3 months

TSH and creatinine - every 6 months

Question 14

What is the first line treatment for a manic episode?

Answer 14

Antipsychotics

Lithium can also be used (isn’t 1st line)

Question 15

When is lithium indicated?

Answer 15

1st line bipolar disorder
option in acute manic episode
Unipolar depression when theres no response to antidepressants

Question 16

What are the side effects of lithium?

Answer 16

Nausea
Vomiting
Tremor
ADH blocked - polyuria, polydipsia 
Hypothyroidism (weight gain, cold sensitive, slow HR, mental slowness, hair loss, acne)
Intention tremor
reduced seizure threshold
Renal fibrosis

Question 17

What are the toxic levels of lithium, mild, moderate and severe?

Answer 17

Mild = 1.5-2
Moderate = 2-2.5
Severe = >2.5

Question 18

When should lithium not be used?

Answer 18

For someone with alcohol abuse - causes toxicity if they’re dehydrated

Question 19

What are the 3 main anticonvulsants used as mood stabilisers?

Answer 19

Valproic acid
Carbamazepine
Lamotrigine

Question 20

What condition is valproic acid given as a prophylaxis?

Answer 20

Migraine

Question 21

What are the side effects of valproic acid?

Answer 21

Tremors
GI symptoms
Alopecia
Sedation
Weight gain
Liver toxicity
AV conduction delay

Question 22

What defects can valproic acid cause if used during pregnancy?

Answer 22

Neural tube defects

Question 23

Is valproic acid good as a prophylactic in bipolar?

Answer 23

Good as a manic prophylaxis

Not as good as lithium at depression prophylaxis

Question 24

Why might lithium be given for bipolar prophylaxis rather than lithium?

Answer 24

Better tolerated

Question 25

What tests must be done before using valproic acid?

Answer 25

LFTs Pregnancy test FBC

Question 26

When is a steady state achieved using valproic acid?

Answer 26

4-5 days

Question 27

When must levels of valproic acid be checked?

Answer 27

After 4-5 days | 12 hours after last dose

Question 28

What is the goal for valproic acid levels?

Answer 28

50-125

Question 29

What conditions use carbamazepine as their 1st line treatment?

Answer 29

Trigeminal neuralgia Acute mania Mania prophylaxis

Question 30

Which patients benefit from carbamazepine?

Answer 30

rapid cyclers

Question 31

Which tests must be done before using carbamazepine?

Answer 31

LFT FBC ECG

Question 32

What side effects are seen using carbamazepine?

Answer 32

``` Rash double vision ataxia liver toxicity Teratogenic Av conduction delays Cytochrome P450 induction Water retention (hyponatraemia) ```

Question 33

When is a steady stage achieved using carbamazepine?

Answer 33

after 5 days

Question 34

What are the teratogenic effects of carbamazepine?

Answer 34

Cleft pallet | Spina bifida

Question 35

When must carbamazepine be checked?

Answer 35

after 5 days 12 hours after last dose **Must check again and change dose after 1 month - it induces its own metabolism

Question 36

What is the goal level of carbamazepine?

Answer 36

4-12mcg/ml

Question 37

What is the main thing to remember when using lamotrigine?

Answer 37

If the patient stops their medication for more than 5 days, they need to start at the lowest dose again then titrate up.

Question 38

What is the titration pattern for lamotrigine>

Answer 38

25mg daily - for 2 weeks 50mg daily - for 2 weeks 100mg daily after this

Question 39

What conditions is lamotrigine used most for?

Answer 39

Chronic pain | Neuropathic pain

Question 40

What are the side effects of lamotrigine?

Answer 40

``` Blurred vision GI Nausea Vomiting stevens johnson syndrome ```

Question 41

What is the correlation between anticonvulsants and LFTs?

Answer 41

Can cause an increase in LFTs. | As long as the LFT doesn't triple, its okay.

Question 42

What is the role for lithium?

Answer 42

Its an adjuvant for antidepressants in unipolar depression | It acts as prophylaxis