Bipolar and Related Disorders MCQs

Drugs like Oxcarbazepine, Lamotrigine are safe in pregnancy. Both Lithium and Valproate are teratogenic, but with respect to the risk vs benefit ratio, Lithium is comparatively safer in pregnancy. Adverse effects of Valproate Anorexia, vomiting, loose motions and heartburn are common but mild. Drowsiness, ataxia and tremor occur at high doses. Alopecia, curling of hair, weight gain and increased bleeding tendency have been observed. Rashes and thrombocytopenia are infrequent hypersensitivity phenomena. Administered during pregnancy, it has produced spina bifida and other neural tube defects in the offspring; should be avoided.

Drugs like Oxcarbazepine, Lamotrigine are safe in pregnancy. Both Lithium and Valproate are teratogenic, but with respect to the risk vs benefit ratio, Lithium is comparatively safer in pregnancy. Adverse effects of Valproate Anorexia, vomiting, loose motions and heartburn are common but mild. Drowsiness, ataxia and tremor occur at high doses. Alopecia, curling of hair, weight gain and increased bleeding tendency have been observed. Rashes and thrombocytopenia are infrequent hypersensitivity phenomena. Administered during pregnancy, it has produced spina bifida and other neural tube defects in the offspring; should be avoided.

Fetal exposure to lithium causes: fetal and neonatal cardiac arrhythmia, hypoglycemia, nephrogenic diabetes insipidus, polyhydramnios, reversible changes in thyroid function, premature delivery, floppy infant syndrome. Small increase in congenital cardiac malformation (ebstein's anomaly). Physiological alteration in pregnancy may affect absorption, distribution, metabolism, and elimination of lithium. Women with bipolar disorder who are treated with lithium and plan to conceive: Mild and frequent episodes: treatment with lithium should be gradually tapered More severe episodes with moderate risk of relapse: taper dose of lithium and again reinstituted after organogenesis Severe and frequent episodes: continue same dose throughout pregnancy Fetal assessment with fetal echo considered in female who exposed with lithium in first trimester.

FDA has approved various cannabinoids for medical use, for example: Epidiolex approved for → Lennox-Gestaut syndrome Dronabinol and Nabilone → approved for nausea in patients receiving chemotherapy. Reference: Kaplan and Sadock's Synopsis of Psychiatry, Chapter 20.4, Cannabis-related disorders, Page number 647.

Patient is presented with depression with h/o mania. So better treatment option is antidepressants with mood stabilizers. Reference: Kaplan and Saddocks Synopsis of Psychiaitry, 11th Edition; Clinical Practice Guideline for Bipolar mood Disorder and Major Depressive Disorder, Chapter 8, Page No.: 357

Explanation: Tardive dyskinesia is an extrapyramidal side effect (EPS) associated with antipsychotic drugs , not lithium. Thus, among the given options, tardive dyskinesia is least likely with lithium therapy. Explanation of Other Options: Option A - Hypothyroidism: Recognized adverse effect of lithium. Option B - Tremors: Common neurological side effect of lithium. Option D - Diabetes insipidus: Lithium interferes with renal concentrating ability, leading to nephrogenic DI.

Lithium carbonate is the current agent of choice, particularly during the manic phase. Because the onset of action is slow, concurrent use of antipsychotic agents such as chlorpromazine or haloperidol may be necessary to control mania. Concurrent use of tricyclic antidepressants may be necessary in the depressive phase. Monitoring of lithium levels is necessary because of the serious nature of the adverse effects (neurologic, renal, cardiac). Ref: Ropper A.H., Samuels M.A. (2009). Chapter 57. Depression and Bipolar Disease. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

Maternal use of valproate is associated with an increased risk of foetal neural tube defects such as spina bifida. Increasing folic acid supplements(1-4 mg daily) can help reduce the risk of birth defects. For women in the reproductive age, ensure appropriate contraception if prescribing a medication associated with teratogenicity. Reference : Kaplan and Sadock's Synopsis of Psychiatry, Eleventh Edition, Chapter 29th, Psychopharmacological treatment, Page no. 1047.