By Michael Robertson

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Always check for interactions and adjust doses if necessary. Do not use with clozapine due to the risk of neutropenia. 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.

Psychiatric Bulletin. 2000);24:229-231. 63. Wogelius P, Nørgaard M, Munk EM, Mortensen PB, Lipworth L, Sørensen HT. Maternal use of selective serotonin reuptake inhibitors and risk of adverse pregnancy outcome (Abstract). Pharmacoepidem Drug Safety. 2005;14:S72-S73. 64. asp. 65. org HET I AC U T E PS Y C H IATRI C M A N A G E M E N T 41 Effects of untreated psychiatric disorder in pregnancy Any treatment decision must be weighed against the deleterious impact of untreated or suboptimally treated psychiatric disorder.

Echocardiogram is the criterion standard for diagnosis. In M-mode echocardiography the finding is typically paradoxical septal motion and dilated right ventricle. There is delayed closure of tricuspid valve leaflets more than 65 milliseconds after mitral valve closure. On two-dimensional echocardiography there is apical displacement of the septal leaflet of tricuspid leaflet of greater than 8 mm/m2 – considered the most specific sign of the anomaly. Apart from cardiac malformations following first trimester exposure to lithium there are potential dangers towards the end of the third trimester, related to lithium toxicity in the foetus, with case reports of cardiac arrhythmias, cyanosis and hypertonicity.

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Acute Psychiatric Management by Michael Robertson


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