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Treatment of Psychological Disorders
Published in Mohamed Ahmed Abd El-Hay, Understanding Psychology for Medicine and Nursing, 2019
Mood stabilizers are those drugs that are effective in the treatment and prophylaxis of mania and bipolar depression. The most commonly used mood stabilizers include lithium, valproate, carbamazepine, and lamotrigine. Recently, several atypical antipsychotics, such as olanzapine, quetiapine, and aripiprazole have been added to the list of drugs used in maintenance treatment of bipolar disorder.
Psychiatric Emergencies in Women
Published in R. Thara, Lakshmi Vijayakumar, Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
Because of the high risk of teratogenicity associated with many mood stabilizers, women may abruptly discontinue their medications or be advised to do so during or in preparation for pregnancy. The dose of some medications may actually need to be increased during pregnancy to maintain stability of mood. Affective symptoms may recur because of inadequate treatment, since health providers and mothers often try to minimize fetal exposure to the medication. Emergency physicians often come across women presenting with depression, mania, or a mixed episode of abrupt onset owing to such medication-related issues. Decisions regarding whether to increase or restart medications are complicated, and a comprehensive risk–benefit analysis is of critical importance. Generally for a pregnant woman with untreated mania, the risk of a poor obstetric outcome is great. It is recommended to start or restart treatment immediately. An antipsychotic such as haloperidol or olanzapine is preferable. However, after the first trimester, mood stabilizers such as lithium carbonate or sodium valproate may be restarted if these previously kept the woman well.
Agitation and Psychosis
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
Mood stabilizers have been used to treat bipolar disorder, recurrent depression, impulse control disorders, and aggression associated with brain impairment. Lithium was the first mood stabilizer, and it has been a staple of psychiatric care for more than four decades. Several anticonvulsants, in addition to being used to treat seizure disorders, neuropathic pain, and migraine headaches, are used as mood stabilizers. Mood stabilizers have also been used to treat agitation in dementia but with significant data establishing their efficacy. Several case studies and randomly controlled trials using valproic acid have shown limited to no benefit (Gauthier, et al., 2010) while two small randomly controlled trials with carbamazepine suggest modest efficacy for aggression and hostility (Olin et al., 2001; Tariot et al., 1998). The data for gabapentin (Sommer, Fenn, & Ketter, 2007; Kim, Wilkins, & Tampi, 2008), lamotrigine (Ng et al., 2009), oxcarbazepine (Sommer et al., 2007), and topiramate (Sommer et al., 2007) is not strong enough to support their use. All mood stabilizers take weeks to have an effect, have limited data on dosing, and require monitoring for critical side effects including sedation, confusion, ataxia, and increased risk of falls, as well as hepatic, hematologic, and dermatologic toxicity.
Evaluating lumateperone for its use in treating depressive episodes associated with bipolar I or II disorder in adults
Published in Expert Review of Neurotherapeutics, 2023
Hagar Abuelazm, Omar H. Elsayed, Rif S. El-Mallakh
There is increasing recognition that the foundational pharmacotherapy of bipolar disorder necessitates the use of a mood stabilizer [42]. However, the weak antidepressant effect of mood stabilizers combined with the predominant existence of depressive symptoms in bipolar disorder [43] has resulted in an unprecedented decline in the use of mood stabilizers and concomitant fivefold increase in the use of antipsychotics over the past 20 years [44]. Furthermore, antidepressant use in bipolar illness continues to increase despite the lack of any evidence of benefit and documented evidence of harm in type I bipolar illness [43,45,46]. These bizarre trends are simply a reflection of the unmet need for adequate antidepressant treatment for patients with bipolar disorder. There is a clear need for an effective and safe agent with adjunctive (to a mood stabilizer) antidepressant actions. The need is even greater for type II bipolar illness, which is extremely understudied [8].
Updated perspectives on how and when lithium should be used in the treatment of mood disorders
Published in Expert Review of Neurotherapeutics, 2023
Janusz K. Rybakowski, Ewa Ferensztajn-Rochowiak
Lithium can be regarded as a drug of first choice for prophylaxis of bipolar mood disorder and the best option for the majority of patients. The optimal indications would be a classic form of the illness, moderate number of episodes, euthymic remission periods, no other psychiatric co-morbidity, episodic clinical course with the sequence mania-depression-remission, later onset of the illness, non-rapid cycling, and the absence of psychotic episodes. However, lithium can be successfully used in a wide variety of patients with bipolar disorder. In some of them, a possibility of a prospective combination with another mood stabilizer may be considered if suboptimal efficacy is ascertained after 1–2 years of administration. Due to anti-suicidal activity, thinking about longitudinal lithium use in mood disorder subjects in whom a suicidal risk is high seems reasonable. If possible, lithium should be started early in the course of the illness, preferably within the first three years. Beginning lithium prophylaxis can be made after the successful treatment of a manic state or the augmentation of antidepressants. Lithium can also be introduced during a remission period.
An overview of the pharmacological options for pediatric obsessive-compulsive disorder
Published in Expert Opinion on Pharmacotherapy, 2022
Donatella Marazziti, Andrea Pozza
Mood stabilizers are generally used in adult OCD when it is comorbid with bipolar disorders, or with anxiety symptoms or with neurological signs and the same in pediatric OCD, although not mentioned in the current guidelines [17,44]. Amerio et al. [54] carried out a systematic review of 14 studies where patients with OCD and comorbid bipolar disorder received mood stabilizers. In the largest study [55], 42.1% of comorbid patients required a combination of multiple mood stabilizers and 10.5% a combination of mood stabilizers with atypical antipsychotics. Addition of antidepressants to mood stabilizers led to clinical remission of both conditions in only one study. Some patients on mood stabilizers benefitted from adjunctive psychotherapy [55]. The key shortcoming of this review, however, concerns the fact that the studies had mostly single-case or cross-sectional designs based on retrospective assessments. In a more recent review, Amerio and colleagues [56] added a new study and found that in 40% of the studies Aripiprazole augmentation demonstrated to be effective as maintenance therapy and for treating OCD symptoms during manic episodes.