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By Michael Robertson

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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. 3. D  ehydration, especially in summer. Some patients try to control the polyuria by reducing water intake, with disastrous results.

This is described as the ‘recruitment phase’ (Fig. 1). As these discharges summate and become synchronous, the EEG assumes a more uniform appearance, as the seizure occurs and seizure complexes appear (Fig. 2). The seizure leads to the discharge of inhibitory interneurones, which results in a flattened EEG appearance in a phase described as ‘post-ictal suppression’ (Fig. 3). Note that in all three traces, there is little activity on the EMG, reflecting the administration of muscle relaxants to modify Fig 1.

Lamotrigine Studies suggest effectiveness in bipolar depression, either as monotherapy or with an antidepressant, but a relative lack of efficacy in treating or preventing mania. It is therefore often combined with another mood stabiliser to target both mood poles57. If rash does not occur, it is generally very well tolerated. Patients find the lack of weight gain or sedation particularly welcome. As is true for the other anticonvulsants, there is little evidence of efficacy in unipolar depression.

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Acute Psychiatric Management by Michael Robertson

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