Download Psychiatric treatment of children and adolescents with Lithium

Psychiatric treatment of children and
adolescents with Lithium Carbonate
1. Identification and description of the procedure
Use of lithium salts, in the form of lithium carbonate tablets (Plenur ) as mood stabilisers. Lithium is
the most widely-studied stabiliser and its benefits for this condition have not yet been surpassed. It has
also been observed to have an anti-aggressive effect. This is a long-term treatment. When the treatment
is discontinued, lithium is eliminated quickly from the system. 20 to 30% of patients do not respond to
treatment. Its use is authorised for children of 12 or older.
2. Purpose of the treatment and benefits that are expected.
Control symptoms in the manic episodes of bipolar disorder (BD) (Lithium is the drug of first choice in
acute mania - patient with excessive euphoria, persistently elevated or expansive mood, irritable, very
talkative, distractible, including flight of ideas, aggressive, reduced need for sleep, sexual disinhibition,
increased risk of accidents and excessive spending, potential frequent and significant fluctuations in
mood) and prevent the occurrence of relapse of symptoms of mania and depression (including suicidal
thoughts and behaviours) . The improvement of symptoms facilitates the effectiveness of psychological
treatment and intervention in the family and school environment.
The expected benefits are: control of the symptoms or reduction of their intensity.
3. Reasonable alternatives to this procedure
As a pharmacotherapeutic alternative there are a number of antiepileptic drugs that are also used as mood
stabilisers [such as sodium valproate (Depakine ®), carbamazepine (Tegretol ®), oxcarbazepine (Trileptal ®),
topiramate (Topamax ®) lamotrigine (Lamictal ®)] or atypical antipsychotics [such as risperidone (Risperdal
®), olanzapine (Zyprexa ®), quetiapine (Seroquel ®)] to help control altered behavior and enhance the
action of the stabilisers.
4. Foreseeable consequences of its performance
Control or improvement of bipolar disorder symptoms.
5. Foreseeable consequences of not using it.
Persistence of the symptoms of BD and the risks derived from them, including serious problems of
relationship and adaptation, particularly at home, school or work.
6. Risks.
Common: At the beginning of the treatment any of the following may occur: diarrhoea, fine tremor of
the hands (most typical side effect, which worsens with fatigue, anxiety or caffeine), thirst, increased
amount and frequency of urination and stomach pain; and in subsequent weeks drowsiness and sensation
of fatigue.
In prolonged therapy: fine tremor of hands, nausea, weight gain, increased amount and frequency of
urination, acne, symptoms of hypothyroidism (from simple reduction of thyroid hormones, subclinical
hypothyroidism, to the appearance of goiter, leukocytosis, impaired memory, oedema).
Rarely:
Patient may require urgent medical attention due to possible poisoning symptoms: persistent vomiting
and diarrhoea, severe hand tremor, drowsiness, apathy, dizziness, blurred vision, poor articulation of
words, uncoordinated movements,
PSICHIATRY
abnormal perception of sounds or noises (which only the patient perceives) accompanied by headache.
Cardiac arrhythmias were observed at toxic levels.
Precautions:
The use of lithium requires a prior medical evaluation and regular monitoring of blood levels (to avoid
toxic or subtherapeutic levels). Monitoring of the renal and thyroid function is also required. Consult your
doctor, pharmacist or dentist before taking other medication. Do not change or discontinue treatment
without your doctor’s authorisation. Do not mix with alcohol. It may affect or impair the ability to drive
vehicles or operate heavy machinery. Caution in pregnancy and breastfeeding, high-risk or violent sport;
keep out of reach of children.
7. Risks and consequences depending on the clinical condition of the patient.
Risk of malformations in the first trimester of pregnancy. Diets low in sodium or dehydration can cause
lithium intoxication. Intense sweating (eg. caused by prolonged exercise) may reduce the levels in the
blood by eliminating more lithium than sodium in sweat.
……………………………………………………………………………………………………………………..
Contraindications: Lithium treatment is contraindicated in cases of renal disease (acute renal failure)
alterations in the cardiac conduction (sinus node disease), epilepsy, pregnancy (risk of malformations) or
myasthenia; a special assessment should be made for the possible use in Type I diabetes (juvenile).
Psychiatric treatment of children and
adolescents with Lithium Carbonate
Declaration of consent
Mr./Mrs./Miss........................................................................................, aged ............................., with home address
at .......................................................................,................., National Identity No. ..................................... and SIP
number ................................................................ .
Mr./Mrs./Miss................................................................................................., aged ......................., with home address
at........................................................................................................, acting in the capacity of (the patient’s
legal representative, relative or close friend) ..................................................... , with National Identity
No .............................................................
Hereby declare:
That the Doctor ............................................................................................................ has explained to me that it is
advisable/necessary in my situation to perform a .....................................................................................................,
and that I have adequately understood the information he/she has given me.
In ......................................... on ...................................................., 2.........................
Signed: Mr./Mrs./Miss. ............................................ With National Identity Card No ................................................
Signed: Dr. ............................................................... With National Identity Card No .......................................
Associate number .................................................
Revocation of the consent
I hereby revoke the consent granted on the date of ..........................................................., 2................... and I do
not wish to carry on with the treatment that I hereby terminate on this date.
In ......................................... on ...................................................., 2.........................
Signed: The Doctor ....................................................
Signed: The patient .....................................................
Associate number: .................................................................
PSICHIATRY