Which of the following is a mood stabilizer?
Ans: a (Lithium) Ref:Katzung, 10th ed, p 455Lithium carbonate is often referred to as an "antimanic" drug, and is considered a "mood-stabilizing" agent because of its primary action of preventing mood swings in patients with bipolar affective (manic-depressive) disorder. Concentrations considered to be effective and acceptably safe are between 0.6 and 1.25 mEq/L. The range of 0.9-1.1 mEq/L isfavoured for treatment of acutely manic or hypomanic patients. Somewhat lower values (0.6-0.75 mEq/L) are considered adequate and are safer for long-term use for prevention of recurrent manic-depressive illness.Adverse Effects & ComplicationsMany adverse effects associated with lithium treatment occur at varying times after treatment is started.Some are harmless, but it is important to be alert to adverse effects that may signify impending serious toxic reactions.A. NEUROLOGIC AND PSYCHIATRIC ADVERSE EFFECTSTremor is one of the most common adverse effects of lithium treatment, and it occurs with therapeutic doses. Propranolol and atenolol, which have been reported to be effective in essential tremor, also alleviate lithium-induced tremor. Other reported neurologic abnormalities include choreoathetosis, motor hyperactivity, ataxia, dysarthria, and aphasia. Psychiatric disturbances at toxic concentrations are generally marked by mental confusion and withdrawal. Appearance of any new neurologic or psychiatric symptoms or signs is a clear indication for temporarily stopping treatment with lithium and close monitoring of serum levels.B. DECREASED THYROID FUNCTIONLithium probably decreases thyroid function in most patients exposed to the drug, but the effect is reversible or nonprogressive. Few patients develop frank thyroid enlar gement, and fewer still show symptoms of hypothyroidism. Although initial thyroid testing followed by regular- monitoring of thyroid function has been proposed, such procedures are not cost-effective. Obtaining a serum TSH concentration every 6-12 months, however, is prudent.C. NEPHROGENIC DIABETES INSIPIDUS AND OTHER RENAL ADVERSE EFFECTSPolydipsia and polyuria are common but reversible concomitants of lithium treatment, occurring at therapeutic serum concentrations. The principal physiologic lesion involved is loss of responsiveness to antidiuretic hormone (nephrogenic diabetes insipidus). Lithium-induced diabetes insipidus is resistant to vasopressin but responds to amiloride.An extensive literature has accumulated concerning other forms of renal dysfunction during long-term lithium therapy, including chronic interstitial nephritis and minimal-change glomerulopathy with nephritic syndrome. Some instances of decreased glomerular filtration rate have been encountered but no instances of marked azotemia or renal failure.Patients receiving lithium should avoid dehydration and the associated increased concentration of lithium in urine. Periodic tests of renal concentrating ability should be performed to detect changes.D. OEDEMAOedema is a common adverse effect of lithium treatment and may be related to some effect of lithium on sodium retention. Although weight gain may be expected in patients who become edematous, water retention does not account for the weight gain observed in up to 30% of patients taking lithium.E. CARDIAC ADVERSE EFFECTSThe bradycardia-tachycardia ("sick sinus") syndrome is a definite contraindication to the use of lithium because the ion further depresses the sinus node. T-wave flattening is often observed on ECG but is of questionable significance.F. USE DURING PREGNANCYRenal clearance of lithium increases during pregnancy and reverts to lower levels immediately after delivery. A patient whose serum lithium concentration is in a good therapeutic range during pregnancy may develop toxic levels following delivery. Special care in monitoring lithium levels is needed at these times. Lithium is transferred to nursing infants through breast milk, in which it has a concentration about one-third to one-half that of serum. Lithium toxicity in newborns is manifested by lethargy, cyanosis, poor suck and Moro reflexes, and perhaps hepatomegaly.An earlier report suggested an increase in the frequency of cardiac anomalies, especially Ebstein anomaly, in lithium babies. However, more recent data suggest that lithium carries a relatively low risk of teratogenic effects.G MISCELLANEOUS ADVERSE EFFECTSTransient acneiform eruptions have been noted early in lithium treatment. Some of them subside with temporary discontinuance of treatment and do not recur with its resumption. Folliculitis is less dramatic and probably occurs more frequently. Leukocytosis is always present during lithium treatment, probably reflecting a direct effect on leukopoiesis rather than mobilization from the marginal pool. This adverse effect has now become a therapeutic effect in patients with low leukocyte counts.Haloperidol is an antipsychotic and is butyrophenone derivativeThe butyrophenones and congeners tend to be more potent and to have fewer autonomic effects but greater extrapyramidal effects.
Lithium
Haloperidol
Amitriptyline
Diazepam
C.N.S