By Michael Robertson

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Lithium also commonly causes a concentrating defect at therapeutic levels, resulting in polyuria, which may progress to diabetes insipidus. Warn patients to drink water for resulting thirst, rather than soft drinks or fruit juice, as these worsen weight gain. Abnormalities in renal function should be referred to a renal physician for investigation, as there are many possible causes. Thyroid: Lithium suppresses the action of the thyroid, including the release of thyroid hormone from the gland. Clinical hypothyroidism occurs in up to 20% of people (especially women) taking lithium for ten years.

Most recently preliminary information about the results of a new study examining data from a Swedish Medical Birth Registry have been made available65. 55)). This study also suggests that the other SSRIs examined (citalopram, fluoxetine and sertraline) are not associated with an increased risk of congenital malformations. The results of these studies suggest that women should not take paroxetine in the first trimester, and that this does not appear to be an SSRI class effect. Anticonvulsants Sodium Valproate There is a twenty fold increase in neural tube defects following fetal exposure to valproic acid compounds.

Indications for ECT ECT is most commonly administered for severe melancholic or psychotic depression, either when antidepressant treatment has been ineffective, or there are severe complications such as refusal to eat or catatonia. ECT is effective in terminating refractory episodes of severe mania and psychotic symptoms in schizophrenia. ECT rapidly reverses catatonic symptoms and may terminate an episode of neuroleptic malignant syndrome or protracted delirium. ECT appears to temporarily alleviate movement disorder in Parkinson’s disease and may be used in refractory cases of status epilepticus.

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Acute Psychiatric Management by Michael Robertson

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