Mood Stabilizers Module 4

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Questions and Answers

What is the mechanism of action of lithium?

Alters sodium transport across membranes of nerve and muscle cells

What are some side effects of lithium?

Weight gain (correct)

Ataxia (correct)

Dysarthria (correct)

Nausea (correct)

What is the therapeutic range for lithium?

0.6-1.2 mEq/L

Which anticonvulsant is effective for mood stabilization and prevention of mania and depression?

Lamotrigine Signup and view all the answers

What baseline tests must be conducted before starting lithium treatment?

Kidney and thyroid function tests and EKG Signup and view all the answers

Lithium is prescribed more frequently than other mood stabilizers due to its lack of side effects.

False Signup and view all the answers

What is Valproate's mechanism of action?

Blocks voltage-sensitive sodium channels and increases GABA Signup and view all the answers

What are the potential monitoring parameters for patients taking Valproate?

All of the above Signup and view all the answers

Which of the following are symptoms of Major Depressive Disorder? (Select all that apply)

Markedly diminished interest or pleasure Signup and view all the answers

Recurrent thoughts of death are a symptom of Major Depressive Disorder.

True Signup and view all the answers

What is required for a diagnosis of Persistent Depressive Disorder (Dysthymia)?

Depressed mood for most of the day for at least 2 years. Signup and view all the answers

What characterizes a manic episode in Bipolar I Disorder?

Abnormally elevated mood and increased goal-directed activity. Signup and view all the answers

Which symptoms are indicative of a hypomanic episode in Bipolar II Disorder? (Select all that apply)

Excessive involvement in activities with painful consequences Signup and view all the answers

In Bipolar I Disorder, there has to be at least one ______ episode.

manic Signup and view all the answers

How long must mood disturbance last to classify a hypomanic episode?

4 consecutive days. Signup and view all the answers

The symptoms of Persistent Depressive Disorder can never last more than 2 months at a time.

False Signup and view all the answers

Study Notes

Student Learning Outcomes

Differentiate between pathophysiology of mania and bipolar disorders.
Understand mechanisms of action, adverse effects, and monitoring for drugs treating mania and bipolar disorder.
Justify mood stabilizer choices for patients.
Create care management plans for bipolar disorder patients.
Collaborate on genetic, ethnic, cultural, or gender issues impacting psychiatric prescribing practices.

Mood Stabilizers Overview

Mood stabilizers treat acute mania and stabilize both mania and depression.
Combining mood stabilizers may enhance treatment effectiveness.
Understanding individual therapeutic actions is crucial for treatment selection.

Lithium

Lithium has been used for over 50 years to treat mania.
Its mechanism of action is not fully understood; may involve:
- Inhibition of enzymes affecting signal conduction.
- Modulation of G proteins and gene expression related to growth factors.
Proven to prevent suicide in mood disorder patients.
Comparable or superior efficacy to valproate for mood episodes.
Prescribing is limited due to:
- Need for monitoring.
- Narrow therapeutic index.
- Side effects and potential long-term adverse effects.

Lithium Mechanism, Side Effects, and Monitoring

Alters sodium transport across nerve and muscle cell membranes.
Side effects include:
- Ataxia, dysarthria, tremor, memory problems, polyuria, polydipsia, weight gain, sedation, possible goiter, and cardiac arrhythmias.
- Gastrointestinal symptoms like nausea and abdominal cramps may resolve, but persistent vomiting and diarrhea indicate toxicity.
Therapeutic range is 0.6-1.2 mEq/L.
Initial plasma level monitoring every 1-2 weeks, then every 2-3 months for 6 months.
Assess dehydration signs and obtain baseline kidney, thyroid function, and EKG before starting treatment.
Caution advised with diuretics due to potential lithium concentration increase.

Anticonvulsants

Effective in treating acute mania and stabilizing mood.
Key agents include:
- Valproate: Blocks sodium channels and increases GABA.
- Carbamazepine: Not detailed but also recognized as effective.
- Lamotrigine: Known for mood stabilization and preventing mania/depression.

Valproate

Mechanism involves blocking voltage-sensitive sodium channels and enhancing GABA activity.
Side effects include:
- Sedation, gastrointestinal disturbances, weight gain, tremors, dizziness, ataxia, and headaches.
Monitoring requirements:
- Baseline liver function and coagulation tests.
- Track weight and BMI.
- Plasma levels monitored after each dose increase, with targets of 50-125 mcg/mL.
Be mindful of the rare but serious risks of liver failure and pancreatitis.
Most patients may need combination therapy for optimal results.

Major Depressive Disorder (MDD)

Requires five or more symptoms in a 2-week period, representing a change from previous functioning.
At least one symptom must be depressed mood or loss of interest/pleasure.
Symptoms include:
- Persistent depressed mood most of the day, nearly every day.
- Marked reduction in interest or pleasure in almost all activities.
- Significant weight change or appetite fluctuations nearly daily.
- Insomnia or excessive sleeping (hypersomnia) nearly every day.
- Psychomotor agitation or retardation nearly every day.
- Fatigue or energy loss nearly every day.
- Feelings of worthlessness or inappropriate guilt nearly every day.
- Diminished concentration or indecisiveness nearly every day.
- Recurring thoughts of death or suicidal ideation without a plan, or previous attempts.
Symptoms must cause clinically significant distress or impair functioning in areas like social and occupational aspects.
Excludes physiological effects of substances or other medical conditions.
Cannot be better explained by psychotic disorders.
No history of manic or hypomanic episodes.

Persistent Depressive Disorder (Dysthymia)

Characterized by depressed mood for most of the day, more days than not, lasting at least 2 years (1 year for children/adolescents).
Requires at least two additional symptoms during depressive periods:
- Poor appetite or overeating.
- Insomnia or hypersomnia.
- Low energy or fatigue.
- Low self-esteem.
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness.
Symptoms must not be absent for over 2 months during the 2-year period.
Major depressive disorder criteria may be continuously present for the duration.
No manic or hypomanic episodes, nor criteria met for cyclothymic disorder.
Disturbance not better explained by persistent psychotic disorders.
Symptoms must not result from substances or other medical conditions.
Causes clinically significant distress or functional impairment.

Bipolar I Disorder

Defined by the presence of at least one manic episode.
Manic episodes feature:
- Abnormally elevated, expansive, or irritable mood lasting at least one week or requiring hospitalization.
- Three or more symptoms during mood disturbance, including:
  - Inflated self-esteem or grandiosity.
  - Decreased need for sleep (feeling rested after 3 hours).
  - Increased talkativeness or pressure to keep talking.
  - Racing thoughts or flight of ideas.
  - Distractibility.
  - Increased goal-directed activities or psychomotor agitation.
  - Engaging in activities with high potential for painful consequences.
Mood disturbance must cause significant social or occupational impairments or necessitate hospitalization.
Not attributable to substance effects or other medical conditions.

Bipolar II Disorder

Requires at least one hypomanic episode and one major depressive episode.
Hypomanic episodes involve:
- Persistently elevated mood and increased activity lasting at least 4 consecutive days.
- Symptoms include similar features as in manic episodes but are less severe, not causing marked impairments or requiring hospitalization.

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Description

This quiz covers the key concepts from Module 4 on Mood Stabilizers, focusing on the pathophysiology of mania and bipolar disorders. You'll learn about the mechanisms of action, adverse effects, and monitoring parameters essential for effective treatment. Enhance your understanding and prepare for clinical applications in psychiatric nursing.