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Abnormal sodium and potassium will predispose patient to lithium toxicity. When there is low sodium or potassium level, the lithium will substitute them and get transported into the cell through the transporter which is usually used to transport the sodium and potassium. However, the pathway to transport the lithium out of the cell is limited. So this will lead to the accumulation of the lithium intracellularly.

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Stop imipramine. Continue lithium and

Lorazepam By intramuscular or slow intravenous injection(into a large vein), acute panic attacks, 25–30 micrograms/kg (usual range 1.5–2.5 mg), repeated every 6 hours if necessary, and

aripiprazole (10-15mg daily initial, then 10-30mg daily)

Monitor patients's psychiatric status and safety, and recognise new mood episodes, minimise adverse reactions and drug interactions.

If patient is not responsive, patient should be reassessed.

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Lithium will concentrated in thyroid gland and may lead to hypothyroidism. Thyroid level need to be monitor before lithium is given. If hypothyroidism is diagnosed, lithium can be given but hypothyroidism should be treated at the same time. Thyroid level should be monitor once when starting lithium and repeat every 6-12 months.

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mood stabilizers : sodium valproate, carbamazepine, olanzapine.

antidepressants: diazepam, clonazepam, alprazolam

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11. On the second day of hospitalisation ED woke up and began yelling at other patients. Which of the following actions would be most appropriate at this time. 

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11. On the second day of hospitalisation ED woke up and began yelling at other patients. Which of the following actions would be most appropriate at this time. 

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Answer: C.Administration haloperidol.

[BNF: This is because it is used to treat schizophrenia, management of psychomotor agitation, excitement or dangerously impulsive behaviour.] [Also, it is available in IV form for the fast on set of action.]

A. Incorrect. Needed to test for lithium plasma concentration and it is narrow therapeutic range.

B. Incorrect. Sudden stop of imipramine will lead to a withdrawal effect.

D. Incorrect.

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1. Drug-drug interaction between imipramine and lithium carbonate: both increase serotonin levels

2. According to BNF, once daily administration is preferred when serum lithium concentration is stabilised within 0.4-1mmol/L. Lithium carbonate 600mg tds change to 300-400mg daily.

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No 8

Abnormal sodium and potassium will predispose the patient with lithium toxicity

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She has been "up all night"

cheerful

aggressive

incoherent speech

elated, anger and irritable

pressure of thoughts, flight of ideas, expansive ideas

grandiose (psychiatry) and persecutory delusion(delusional condition in which the affected person believes they are being persecuted, auditory hallucination

impaired attention and concentration

poor sleep

poor insight (poor mental or emotional condition)

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Hpi - history of patient illness

Heent - physical examination of head, eyes, ears, nose and throat

Perrla - pupil equal, round, react to light, accomadation

Eom - extraocular movement

Drnm - dual rhythm no murmur

Abd - abdomen

Nt,nd - not distended, not tender

Cyanosis - bluish discoloration of skn

Dtr - deep tendon reflex

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Lithium as antimanic drug to treat symptoms like having flight and expansive ideas, cheerful

imipramine is tricyclic antidepressant which is very effective to treat symptoms like anger and irritable.

This combination is needed to treat both mood disorder of manic and depression because she been diagnosed with bipolar disorder

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Q1 : identify the unfamiliar medical terms and abbreviation

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Q1 : identify the unfamiliar medical terms and abbreviation

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HPI- History of Present Illness

PMH- Past Medical History

PE- Physical Examination

VS- vital sign

HEENT-Head, Ears, Eyes, Nose, Throat

PERRLA- Pupils Equal, Round, Reactive to Light and Accommodation

EOMI- Extraocular Movements Intact

GU- Genitourinary

NAD- No Acute Distress

MSE- Medical Screening Exam

Gait - A particular way or manner of moving on foot

Grandiose - extravagantly or pretentiously imposing in appearance or style

Persecutory delusion - A fixed, false, and inflexible belief that others are engaging in a plot or plan to harm an individual.

TPP impaired attention – time, place, person

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Lithium as anti manic

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what is the role of antipsychotics in mood disorder?

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what is the role of antipsychotics in mood disorder?

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Antipsychotics are used in the management of severe mental disorder characteristic such as inappropriate emotional responses, bizarre behaviour, hallucinations and paranoid delusions.

It works by binds to D2 dopamine receptors and block that action of dopamine but positive effects only occur over time.