Mania, at the opposite pole from depression, occurs in individuals with bipolar disorder, who experience a period of depression followed by a period of mania. The cause of mania is not understood, but it is thought to be an overstimulation of certain neurons in the brain. The mainstay for treatment of mania has always been lithium (Lithotabs, Lithobid). Today, many other drugs are used successfully in treating bipolar disorders, including aripiprazole (Abilify), olanzapine (Zyprexa, Zyprexa Zydis), quetiapine (Seroquel), and ziprasidone (Geodon), which are atypical antipsychotics; and lamotrigine (Lamictal). These new approvals were the first advances since the 1970s in the treatment of bipolar disorder.
Lithium salts (Lithane, Lithotabs) are taken orally for the management of manic episodes and prevention of future episodes. These very toxic drugs can cause severe CNS, renal, and pulmonary problems that may lead to death. Despite the potential for serious adverse effects, lithium is used with caution because it is consistently effective in the treatment of mania. The therapeutically effective serum level is 0.6 to 1.2 mEq/L.
Lithium functions in several ways. It alters sodium transport in nerve and muscle cells; inhibits the release of norepinephrine and dopamine, but not serotonin, from stimulated neurons; increases the intraneuronal stores of norepinephrine and dopamine slightly; and decreases intraneuronal content of second messengers. This last mode of action may allow it to selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state. Although the biochemical actions of lithium are known, the exact mechanism of action in decreasing the manifestations of mania are not understood.
lithium – n. 锂
antimanic – a. n. 抗躁狂药(的)
mania – n. 躁狂症
Lithotabs – n. 碳酸锂片剂
Lithobid – n. 碳酸锂缓释片
aripiprazole – n. 阿立哌坐
Abilify – n. 阿立哌唑片剂
quetiapine – n. 喹硫平
Seroquel – n. 思瑞康
lamotrigine – n. 拉莫三嗪
Lamictal – n. 利必通
Lithane – n. 碳酸锂制剂商品名
intraneuronal – a. 神经细胞内的
1. The nurse has provided home-care instructions to a client who is taking lithium carbonate. Which client statement indicates that the client understands the prescribed regimen?
A. “I will restrict my water intake.”
B. “I will make sure that my diet contains salt.”
C. “I will keep my medication in the refrigerator.”
D. “I will be careful to avoid eating foods high in potassium.” 2. A client who is taking an antipsychotic medication is preparing for discharge. To facilitate health promotion for this client, what instruction should the nurse provide?
A. Avoid prolonged exposure to the sun.
B. Adhere to a strict tyramine-restricted diet.
C. Recognize the signs and symptoms of a relapse of depression.
D. Have therapeutic blood levels drawn because the medication has a narrow therapeutic range.
1. B. “I will make sure that my diet contains salt.” Rationale: Lithium is a mood stabilizer used to treat bipolar disorder. It replaces sodium ions in the cells and induces the excretion of sodium and potassium from the body. Client teaching includes the maintenance of sodium intake in the daily diet and increased fluid intake (at least 1 to 1½ L per day) during maintenance therapy. Lithium is stored at room temperature and protected from light and moisture. 2. A. Avoid prolonged exposure to the sun. Rationale: Antipsychotic medications improve the thought processes and behaviors of a client with psychotic symptoms, especially a client with schizophrenia. Photosensitivity is a side effect of antipsychotic medications. Maintaining a strict tyramine-restricted diet is applicable to monoamine oxidase inhibitors (MAOIs). Antipsychotics are not used to treat depression. Lithium is a mood stabilizer that requires monitoring of medication blood levels.
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