Psych CASC / OSCE · Psychopharmacology — mood stabilisers
Explaining lithium versus valproate and pregnancy-safe planning (CASC)
CASC-style station: explain mood-stabiliser choice using BALANCE evidence, lithium monitoring in plain language, and why valproate is not appropriate given pregnancy plans.
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FRANZCPMRCPsychABPNMD-DNB
Prompt
A 31-year-old woman with bipolar I, recently manic, attends with her partner. She was told in ED that valproate is a 'strong mood stabiliser'. She wants to start a family in a year. She is anxious about lithium blood tests and 'kidney damage'.
Station instructions (candidate)
You have 7 minutes. Explain recommended long-term mood stabilisation after mania, address the valproate comment from ED, outline lithium monitoring in plain language, and incorporate her pregnancy plans. Do not frighten, do not minimise teratogenicity, and do not guarantee zero risk from any option. Anchor in evidence (BALANCE, lithium suicide signal, valproate pregnancy data) and shared decision-making.[1][2][4]
References6ShowHide
- [1]Geddes JR, Goodwin GM, Rendell J, et al. Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial Lancet, 2010.PMID 20092882
- [2]Cipriani A, Hawton K, Stockton S, et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis BMJ, 2013.PMID 23814104
- [3]Nolen WA, Licht RW, Young AH, et al. What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium Bipolar Disord, 2019.PMID 31112628
- [4]Tomson T, Battino D, Bonizzoni E, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry Lancet Neurol, 2011.PMID 21652013
- [5]Meador KJ, Baker GA, Browning N, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs N Engl J Med, 2009.PMID 19369666
- [6]Gitlin M Lithium side effects and toxicity: prevalence and management strategies Int J Bipolar Disord, 2016.PMID 27900734