Bipolar Affective Disorder (BPAD)

Bipolar disorder is characterized by alternating episodes of mania and depression:
Features episodes of mood elevation (mania/hypomania) alternating with depressive episodes.
Treatment: Mood stabilizers such as lithium are the preferred treatment.

Lithium Therapy

Pre-Treatment Checks
i. Kidney Function: An e-GFR blood test to check that the kidneys are in good working order.
ii. Thyroid Function: A thyroid function test (TFT) is essential as lithium can affect thyroid function over time.
iii. Calcium Levels: Regular monitoring is necessary since lithium can impact calcium levels.
iv. Heart Health: An ECG may be necessary if there is a history of heart problems.

Blood Monitoring

i. Lithium Levels: Monitored 1 week after starting treatment, then weekly until stabilized, and every 3-6 months thereafter.
ii. Kidney and Thyroid Function: Monitored every 6 months.
iii. Calcium Levels: Regularly checked with other blood tests.

 

Management of Side Effects and Toxicity

i. Side effects such as nausea, diarrhoea, dry mouth, and fine tremors are common initially and may resolve.
ii. Signs of Lithium Toxicity include severe tremors, vomiting, confusion, muscle weakness, and slurred speech. Immediate medical attention is required.
iii. Causes of Lithium Toxicity: Dehydration, changes in dietary salt intake, and interactions with medications such as NSAIDs like ibuprofen or aspirin.

 

Lithium and Pregnancy

i. Pre-Pregnancy: Women planning to conceive should reduce and discontinue lithium under medical guidance.
ii. During Pregnancy: Consider stopping lithium gradually, monitor levels monthly until 36 weeks, then weekly until birth.
iii. Risk: Lithium is teratogenic, with risks of fetal cardiac malformations, thyroid disease, and floppy baby syndrome.

 

Alcohol and Lithium

Alcohol can increase the risk of dehydration and cause fluctuations in lithium levels, thus it should be consumed with caution.

 

Lithium and Antidepressants (SSRI Interaction):
Risk of Manic Episodes: SSRIs (e.g., Sertraline, Fluoxetine) can worsen manic episodes in patients with bipolar disorder on lithium. If mania worsens, the SSRI should be stopped immediately, as antidepressants may precipitate manic episodes.

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