By Michael Robertson
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Additional info for Acute Psychiatric Management
Thiazide diuretics (not loop diuretics such as frusemide) can increase lithium levels into toxic range. 5. L ithium toxicity can result in acute or chronic renal failure, seizures, coma, permanent neurotoxicity (especially cerebellar damage) or death. 0mmol/L. Symptoms include worsening tremor, worsening metallic taste in the mouth, nausea and fatigue, confusion, worsening polyuria and dehydration. Patients with mild symptoms should be advised to seek a trough lithium level within a day or so.
A period of post-ictal suppression follows the iatrogenic seizure, evident as low amplitude or flat line reading on the EEG. This latter phase appears to be mediated by the GABA mediated discharge of inhibitory interneurons. The precise therapeutic mechanism of ECT remains uncertain, however ECT is noted to engender down-regulation of beta adrenergic receptors, up-regulation of 5HT2 receptors, and enhanced activity of GABAergic neurones. In line with recent research into antidepressant efficacy, it is noted that ECT increases the transcription of mRNA coding for neurotrophic peptides such as Brain Derived Neurotrophic Factor, which mediates neuronogenesis, arborization and dendritic budding68.
Beware of confounding with mild depression or hypothyroidism. 4. Hair thinning 5. Acne 6. Benign T-wave flattening on ECG 7. 0 X 109 is common) due to increased mobilisation from bone marrow stores. Toxicity Lithium is entirely excreted in the urine. Anything that impedes this excretion may cause blood levels to rise to toxic levels. Your patients will need to be warned to avoid: 1. Excessive lithium intake, for example, some patients take extra tablets on “bad days”. 2. Missing blood tests. Regular tests are vital to detect gradually increasing lithium levels.
Acute Psychiatric Management by Michael Robertson