A 30-year-old pregnant woman comes to your clinic with decreased sleep, increased appetite and hyperactivity for last 2 weeks. A diagnosis of mania is made. Fuher probing reveals four episodes of major depression in the past two years. What drug will you prescribe to this patient?
Haloperidol
Lithium
Promethazine
Clonazepam
Bipolar disorder - Bipolar disorder is characterized by marked mood swings between mania (mood elevation) and bipolar depression that cause significant personal distress or social dysfunction Bipolar I - mania + depression Bipolar II - depression + hypomania Mania: Decrease need for sleep Over talkativeness Abnormally increase activity levels Distractibility Increase self-esteem or grandiosity Flight of ideas Excessive involvement in pleasurable activities that have a high potential for painful consequences Duration - 7 days Hypomania - Less severe symptoms than mania Duration - 4 days Treatment:- Acute mania - mood stabilizer + antipsychotic >only antipsychotic In pregnancy antipsychotic is preferred because most of mood stabilizer are teratogenic Mood stabilizer - lithium (D/O/C for acute mania, causes ebstein's anomaly), valproate (most teratogenic), carbamazepine
Mood Disorders