MOOD-STABILIZERS

“BB’s music is sort of cathartic, for me. It’s quite negative sometimes, but somehow it takes all the negativity from inside me and leaves me purified. I always feel much better, much calmer, after listening to breaking benjamin… it’s the feeling of calm after the storm has passed.”

I don't smoke to get stoned.

I smoke as much as I do because I have BPD.

If I didn’t medicate as much as I did. I would be one rude ass mean cunt with racing thoughts followed by crying about being a rude mean cunt then laughing about all of it as the other person just looks at me in disbelief that one person could experience all those moods in less than 30 minutes.

So yes I do need to eat 150mg-250mg and yes I do need to dab a few times. Don’t judge unless you know wtf you speak of 😊

Anti-epileptics/Anti-convulsants Made Incredibly Easy

TREATMENT STRATEGIES:

  • Start therapy after the second seizure; first ONLY if recurrence is high = MRI abnormal, EEG abnormal, or status epilepticus.
  • Monotherapy until seizures are controlled.
  • If failed: titrate up to maximum tolerated dose –> shift to alternative drug –> use drug combination –> VNS, DBS.
  • Full drug therapy for 2 – 3 years after the last fit.
  • Gradual withdrawal over at least 6 months.

Rx Profile:

(Drawings are courtesy of @mynotes4usmle​)

Carbamazepine

  • Mainly for generalized tonic-clonic seizures
  • Trigeminal neuralgia
  • Bipolar disorders (with depressive predomince) - mood stabelizier
  • NEVER in abscence seizures
  • SE:

Lamotrigine

  • Safer profile, with minimal interactions.
  • Bipolar disorders (with depressive predominance) - mood stabilizer  
  • SE: maculopapular rash; SJS

Topiramate

  • Broad spectrum anti-seizure; used in migraine.
  • SE of TopIRamate: enzyme Inhibitor + Renal stones.

TREATMENT PROTOCOL:

Green: first line; Yellow: second line; Orange: third line; Red: contraindications. (Graph reproduced from Oxford Handbook of Clinical Medicine)

Epilepsy & Pregnancy:

  • Non-enzyme-inducing AEDS have no effect on the pill. Enzyme inhibitors prolong the half life of OCP (=Valproate) so better for birth control , and vice versa.
  • Most of AEDs are teratogenic; Category D
  • Therapy not stopped; uncontrolled seizure is risky to fetus & mother. Give lowest effective dose.
  • Avoid phenytoin, valproate and barbiturates (use Lamotrigine)
  • Most AEDs cause folate deficiency …. Folic acid (prior to or early in conception)
  • Most AEDs are competitive inhibitors of vit. K-dependent clotting factor: Vit. K to mother 10 days before labor & to newborn.
  • Most except carbamazepine and valproate are present in breast milk. Lamotrigine is safe on infants.

Status Epilepticus:

  • WHAT? Seizures lasting for >30min, OR repeated seizures without intervening consciousness.
  • Things to be done:
  1. Bedside glucose, the following tests can be done once Rx has started: lab glucose, ABG, U&E, Ca2+, FBC, ECG.
  2. Consider anticonvulsant levels, toxicology screen, LP, cultures, EEG, CT, CO level.
  3. Pulse oximetry, cardiac monitor.
  • How to treat?

THE END

Originally posted by disneypixar

Discharge day!!!!!!

This feels so weird, and honestly I never thought it would happen, but today I will see my psychiatrist for the last time and be officially discharged from all psychiatric services. It’s be almost two years since things got bad, two years since I was admitted to the provinces children’s psychiatric ward and diagnosed with cyclothymic disorder. Cyclothymia is a relatively unknown illness, it is a more chronic sub-threshold of bipolar disorder. After years on anti-depressants, mood stabilizers and atypical antipsychotics I am officially free!!!!! I never thought this day would ever come!!!!