Psychopharmacology Tips

Lithium may be selected as the mood stabilizer for suicidal bipolar patients and for patients with steroid-induced mania. Carbamazepine may be preferred in patients with comorbid pain syndromes. Gabapentin may be chosen for patients with parkinsonian symptoms and topiramate for those with bulimia.

Ref: - Post, R.M., Frye, M.A., Denicoff, K.D., Speer, A.M., et al. (2001). Preliminary algorithms for treatment-resistant bipolar depression. In: Treatment-resistant mood disorders, (Eds.) Amsterdam, J.D., Hornig, M. & Nierenberg, A.A. pp 350 – 404, Cambridge: Cambridge University Press.

Anticonvulsant therapy is not needed in simple febrile seizures (i.e., generalised tonic clonic convulsions of less than 15 minutes duration, without recurrence within the next 24 hours or within the same febrile illness). However, prophylactic treatment may be desired if a child has one or mainly a combination of -

• Complex febrile seizures (i.e., febrile seizures which last more than 15 minutes, have two or more recurrences within 24 hours, or show focal or unilateral features)
• Neurological abnormalities
• Age less than one year
• Frequent recurrences

Ref: - Panayiotopoulos, C.P. (2002) A clinical guide to epileptic syndromes and their treatment. Oxfordshire: Bladon Medical Publishing.

Episodic nausea occurring only after each dose may be due to local gastric irritation and may be relieved by talking lithium with food. Clinically, any side effect that mainly occurs 1-2 hours after each oral dose of the standard preparation of lithium might be improved by changing to the sustained-release form.

Ref: - Schatzberg, A.F., Cole, J.O. & DeBattista, C. (2003) Manual of Clinical Psychopharmacology. Washington, DC: American Psychiatric Press.

Memory impairment in the Korsakoff syndrome has shown mild response to treatment with clonidine, methysergide, and methylphenidate (McEntee and Crook, 1990), while physostigmine has been found useful in cases with amnestic disorder due to herpes simplex encephalitis (Catsman-Berrevoets et al., 1986, Peters and Levin, 1977).

Ref: -

Catsman-Berrevoets, C.E., Van Harskamp, F. & Applehof, A. (1986) Beneficial effect of physostigmine on clinical amnesic behavior and neuropsychological test results in a patient with a post-encephalitic amnesic syndrome. Journal of Neurology Neurosurgery and Psychiatry, 49, 1088-1090.

McEntee, W.J & Crook, TH. (1990) Age-associated memory impairment: a role for catecholamines. Neurology, 40, 526-530.

Peters, B.H. & Levin, H.S. (1977) Memory enhancement after physostigmine treatment in the amnesic syndrome. Archives of Neurology, 34, 215-219.