Mood stabilisers monitoring

Table A.l Overview of physical health monitoring in Severe Mental illness tSMii Table A.2 Delirium investigations Table A.3 First episode psychosis investigations Table A.4 Baseline checks before starting psychotropics Table A.S Ongoing monitoring - antipsychotics Table A.6 Ongoing monitoring - mood stabilisers Table A. 7 Rapid tranquilisation tRTi cautions and contraindications Table A. 8 Monitoring after RT Appendix B Medications...

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

The most common is augmentation is with the mood stabiliser lithium carbonate. Indeed, lithium may be effective as monotherapy for depression but is not preferred because of its adverse effect profile and need for plasma concentration monitoring. Its prescription in combination with antidepressants that have failed to produce remission is more usual and evidence suggests that up to 50% of patients who have not responded to standard antidepressants can respond after lithium augmentation. Addition of lithium requires careful titration of the plasma concentration up to the therapeutic range, with periodic checks thereafter and monitoring for toxicity (see p. 389). 

Antipsychotics are also used for mood stabilisation in acute mania or BPAD prophylaxis (e.g. aripiprazole, olanzapine, risperidone, quetiapine). They require the usual antipsychotic monitoring. Some offer IM options and none need drug levels, which can help when people are acutely uncooperative or chaotic. 

Olanzapine, aripiprazole, risperidone, quetiapine (p57-9. Appendices B1 2) - effective mood stabilisers, but carry antipsychotic risks and monitoring needs... 

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