[ Psychiatric ] Mood disorders 4

Lithium – pharmacokinetics

Narrow therapeutic index (monitor serum levels), primarily renal excretion, contraindicated in renal failure.

Lithium – teratogenic effect

Ebstein anomaly.

Lithium – side effects

Tremor and metallic taste.

Lithium – long-term endocrine effects

Hypothyroidism or hyperthyroidism, and parathyroid elevation with mild hypercalcemia.

Lithium toxicity – drugs that raise levels

Thiazides, NSAIDs, and ACEIs.

Lithium toxicity – GI features

Nausea, vomiting, and diarrhea.

Anticonvulsant mood stabilizers – examples

Carbamazepine, valproic acid, and lamotrigine.

Valproic acid (mood stabilizer) – side effects

Weight gain and thrombocytopenia.

Atypical antipsychotics in bipolar disorder

Can be monotherapy in acute mania, 1st approved drug is olanzapine.

Serotonin syndrome – clinical picture (3 A's)

Increased neuromuscular activity (hyperreflexia), autonomic instability (hyperthermia), and altered mental status.

Serotonin syndrome – antidote

Cyproheptadine (5-HT2 receptor antagonist).

Rapid cycling disorder – definition

4 or more episodes in 12 months