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RUHS, Jaipur, PB B.Sc Nursing Entrance-2023
Mental Health Nursing
Easy

First line drug to treat mania is -

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2023

Explanation

  • Lithium is the classic first-line mood stabilizer for treating acute mania and for prophylaxis in bipolar disorder.
  • It is particularly effective in patients with 'classical euphoric grandiose' type of mania.
  • Lithium works to stabilize mood and prevent the recurrence of both manic and depressive episodes, though its onset of action is slower (1-2 weeks) compared to antipsychotics.
  • Unlike antipsychotics or sedatives, it treats the core mood disturbance without causing significant sedation in the long term.

Why Other Options Were Wrong

  • Option A: Benzodiazepines do not treat the underlying mania; they only provide temporary sedation and control of agitation.
  • Option B: Haloperidol is considered a second-line agent for mania due to its side effect profile, including the risk of inducing depression and causing extrapyramidal symptoms.
  • Option D: This option is incorrect because Benzodiazepines are adjunctive and Haloperidol is second-line, while Lithium is a primary first-line treatment. They do not share the same first-line status.

Related Visual

Visual explanation — Related Visual
Clinical Relevance
  • Nursing practice connection: Knowing Pharmacological treatment of acute mania helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
  • A critical nursing responsibility is monitoring for Lithium toxicity. Early signs like coarse tremors, confusion, and severe gastrointestinal distress are a medical emergency requiring immediate intervention.
  • Patient education is key to safety. Nurses must teach patients the importance of maintaining a stable intake of salt and fluids, as dehydration or low sodium levels can quickly lead to toxic lithium accumulation.
  • What if? If a patient on Lithium presents with severe diarrhea and vomiting from a stomach flu, the nurse must recognize this as a high-risk situation for dehydration, leading to increased lithium levels and potential toxicity. The patient should be advised to stop the lithium and contact their prescriber immediately.
How to Approach the Question
  • First, identify the core of the question, which is asking for the 'first-line' drug for 'mania'. This requires knowledge of standard treatment guidelines.
  • Analyze each option based on its pharmacological class and primary use in psychiatry.
  • Evaluate Lithium: Recall that it is a mood stabilizer and the classic treatment for bipolar disorder.
  • Evaluate Benzodiazepine: Recognize this as a sedative/anxiolytic, primarily used for short-term symptom control (like agitation), not as a primary treatment for the mood disorder itself.
  • Evaluate Haloperidol: Identify this as a typical antipsychotic. While used for agitation/psychosis in mania, recall its place as a second-line agent due to its side-effect profile.
  • Conclude that Lithium is the most appropriate 'first-line' answer among the choices, as the others are either adjunctive or second-line.
Concept Tested & Keywords
  • Concept Tested: Pharmacological treatment of acute mania
  • Stem keywords: first line drug, mania
  • Lead-in keywords: is

Question ID

Q9yZPYmAKFlJEDz15w5Jv-

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 5563-5565, 5566-5568

E6 Pharmacology KD Tripathi Essentials 9e Part 2 p. 118-120

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