Case 3
Case 3
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33 yo woman hospitalized with her first episode of mania. She has no previous history of a depressive episode. She has no drug or ETOH history and has no medical issues. What medication would you like to start?
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Given her first presentation was a manic episode statistically she will do better on lithium.
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Make sure to check a pregnancy test, serum creatinine and TSH prior to initiation of treatment.
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Discuss with her what she will use for birth control and document this discussion.
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You start her at 300mg BID (average starting dose) and when she comes to see you in one week she is complaining about stomach irritation and some diarrhea. What do you think is going on and what should you do?
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GI irritation including diarrhea is common particularly early in treatment. Encourage pt to drink adequate fluid, leave at current dose and see if side effects resolve.
Case 4
Case 4
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27 yo male is admitted secondary to a manic episode. In reviewing his history you find he has 5 to 6 manic or depressive episodes a year. He has also struggled on and off with ETOH abuse. What medication would you like to start?
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Depakote would be a good choice because pt is a rapid cycler (4 or more depressive or manic episodes/year) and because of comorbid ETOH abuse.
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You start 250mg BID and titrate to 500mg BID. His depakote level is 70. You check his lfts and compared to baseline they have increased as follows:
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ALT 48 → 115
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AST 62 → 140
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ALK PHOS 32 → 80
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What happened and what do you want to do??