Lithium in Bipolar Disorder Quiz

Mood Stabilizers

• Lithium is the drug of choice for treating acute mania and as prophylaxis for both manic and depressive episodes in bipolar disorder.
• Lithium reduces excitatory neurotransmission (dopamine and glutamate) and increases inhibitory neurotransmission (GABA), having a calming effect.
• Therapeutic range of lithium is 0.4-1.3 mEq/L.
• Side effects of lithium include dry mouth, thirst, increased urination, water and sodium loss, weight gain, and bloatedness.
• Patients taking lithium should monitor blood levels regularly, drink 2-3 liters of fluid a day, and eat well with normal sodium intake.
• Lithium takes about 2-3 weeks to show effectiveness.

Other Mood Stabilizers

• Carbamazepine is used to treat mixed episodes and rapid-cycling bipolar disorder, with an onset of action of 5-7 days.
• Valproic acid is an anticonvulsant that is useful in treating mixed manic episodes and rapid-cycling bipolar disorder.

Antipsychotic Drugs

• Antipsychotic drugs are dopamine receptor blockers, used to treat disorders that involve thought processes.
• Indications for antipsychotic drugs include schizophrenia, bipolar disorder (manic phase), delusional disorders, depressive psychoses, and drug-induced psychoses.
• Initial effects of antipsychotic drugs may be seen in 2 days, but 2-4 weeks are needed for full effect.
• Contraindications for antipsychotic drugs include dementia-related psychoses in the elderly, as they can increase the risk of mortality.

Typical Antipsychotic Drugs

• Typical antipsychotic drugs block dopamine receptors, preventing the stimulation of postsynaptic neurons by dopamine.
• They also have anticholinergic, antihistamine, and alpha-adrenergic blocking effects.

Atypical Antipsychotic Drugs

• Atypical antipsychotic drugs block both dopamine and serotonin receptors.
• Risperidone is used frequently to treat irritability and aggression associated with autistic disorders in children and adolescents.

Extrapyramidal Motor Symptoms

• Extrapyramidal motor symptoms are movement disorders most commonly caused by exposure to dopamine-blocking medications such as antipsychotics.
• Anticholinergic drugs help decrease pseudoparkinsonism symptoms, acute dystonia, and akathisia.

Neuroleptic Malignant Syndrome

• Neuroleptic malignant syndrome is a rare but potentially fatal condition.
• Symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, acute renal failure, respiratory failure, and coma.
• Treatment involves immediately stopping antipsychotic medication, using Dantrolene as a muscle relaxant, and Bromocriptine as a dopamine receptor agonist to relieve CNS toxicity.