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Psychotherapy: 107b - Mood Stabilizers

Psychology13 CardsCreated about 2 months ago

This flashcard set outlines lithium’s uncertain but intracellular mechanism of action affecting neurotransmission, and its primary use in the treatment and maintenance of bipolar disorder, particularly in preventing manic episodes and reducing suicide risk.

What is the MOA of Li?

Acts via intracellular signal transduction to alter the activity of several neurotransmitters

Not well understood

No synaptic action

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Key Terms

Term
Definition

What is the MOA of Li?

Acts via intracellular signal transduction to alter the activity of several neurotransmitters

What are the indications for lithium?

  • Mania

    • But can take 1-3 weks to see full affect

What fetal malformatio is associated with lithium?


Ebstein’s anomaly

(Dysplastic tricuspid valve)

In general, what is the mechanism of AEDs?

Increased inactivation of voltage-gated Na+ channels

Results in increased GABA, decreas...

Which drugs can be used to treat acute mania?

  • Valproic acid

    • Works quickly

  • Which medications can be used to treat manic episodes AND for Bipolar disorder maintenence therapy?

    • Lithium

    • Valproic acid

    • Carbam...

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TermDefinition

What is the MOA of Li?

Acts via intracellular signal transduction to alter the activity of several neurotransmitters

Not well understood

No synaptic action

What are the indications for lithium?

  • Mania

    • But can take 1-3 weks to see full affect

    • Not used alone for acute episodes

  • Maintenence treatment for bipolar disorder

    • More effective at preventing manic vs. depressive episodes

  • Bipolar depression

    • Better for bipolar depression than most other mood stabilizers

    • Decreases risk of suicide

What fetal malformatio is associated with lithium?


Ebstein’s anomaly

(Dysplastic tricuspid valve)

In general, what is the mechanism of AEDs?

Increased inactivation of voltage-gated Na+ channels

Results in increased GABA, decreased glutamate activity

Which drugs can be used to treat acute mania?

  • Valproic acid

    • Works quickly

  • Carbamazepine

  • Lithium

    • Does not act quickly; not used as monotherapy

  • Antipsychotics

    • Especially 2nd generation

Which medications can be used to treat manic episodes AND for Bipolar disorder maintenence therapy?

  • Lithium

  • Valproic acid

  • Carbamazepine

Which AED can be used as maintenance therapy for bipolar disorder, but not to treat acute manic episodes?

Lamotrigine

Which mood stabilizers are most effective in the treatment of bipolar depression?

  • Lithium

  • Lamotrigine

  • 2nd generation antipsychotics

Valproic acid, carbamazepine can be used in acute mania and maintenance, but are not as effective for bipolar depression

Which AED carries the lowest risk of sedation and weight gain?

What side effect IS associated with this agent?

Lamotrigine

10% get benign rash, 1% get SJS

What are the symptoms of Lithium toxicity?

  • Acutely:

    • GI symptoms

  • Chronically

    • Neurologic: tremor, ataxia

    • Renal

    • Cardiac

How is lithium toxicity managed?

  • Stop lithium

  • Rehydrate w/ normal saline (mild)

  • Dialysis if severe

What might cause a patient previously doing well on Lithium to develop lithium toxicity?

  • Dehydration

  • Decreased Na+ intake

    • Results in increased Li absorption

  • Decreased renal blood flow

    • Intrinsic renal disease, heart failure, cirrhosis

What are the key differences between antidepressants and mood stabilizers?

Both work to treat and prevent depressive episodes

  • Mood stabilizers also treat and prevent manic episodes

    • And treat depressive episodes without precipating mania

  • Antidepressants can precipitate manic episodes

    • And do not work to treat manic episodes