Vignette Number GAP 032
Speciality:
General Psychiatry
Date:
10 October 2001
Vignette:
A 52 year old man has been referred to you in the outpatient
clinic by his general practitioner, who is seeking advice with
regard to further management. The GP has been advised by renal
physicians that the patient should stop lithium carbonate because
they believe it has caused renal impairment.
The patient has a long history of manic depressive illness but
has been maintained well on lithium. During his last episode of
illness (about 15 years ago) he jumped off a bridge and broke his
legs in a suicide attempt, while in a depressive episode.
Please tell me how you would assess and manage this
situation.
Suggested Probes:
- What do you believe are the criteria that the renal physicians
have used to give this advice?
- What factors would you take into account when thinking about
his further drug treatment?
- Could the patient sue for medical negligence?
- Evidence base for causing renal impairment
- He may need an alternative mood stabilising drug.
- He could be treated with carbamazepine or sodium
valproate.
- He will need close monitoring if he stops lithium as he may
suffer from a rebound mania. Should the change and medication be on
an in-patient basis?
- Medico-legal issues around medical negligence.