Counselling a patient on treatment with lithium 1. Explain indications - Used as a mood stabiliser - Used for bipolar to help reduce the severity and frequency of mood swings 2. Explain mechanism of actions - Link to patient’s symptoms e.g. for those struggling with mood swings 3. Taken at the same time each day 4. If missed can take it as soon as you remember, but don’t take more than 2 in 1 day 5. Can take a few weeks to have a full effect 6. Requires regular blood tests to monitor for lithium concentration blood levels, LFTs, thyroid 7. Explain side effects - Severe tremors or ataxia - Confusion - Vomit - Slurred speech - Change in vision - Seizures/coma - Nausea - Diarrhoea - Abdo pain - Tremors - Polydipsia - Weight gain - Fatigue - Brain fog 8. Explain monitoring and safety netting - Initially weekly for lithium and kidney function -> to be done every 6 months or earlier if clinically indicated - Importance of good hydration - Avoid alcohol due to interaction - Avoid using NSAIDS e.g. ibuprofen and some diuretics - Avoid driving when feeling drowsy 9. Explain need for continuity - It is a chronic disease so most likely yes 10. Won’t eliminate the mood swings completely -> but should reduce the frequency and severity 11. Diet adjustment - Limit salt intake - Hydration -> lithium causes dehydration -> increasing toxicity Balanced diet to help with weight gain management Limit alcohol as it can make lithium side effects worse