BOF: 2.51
A 26-year-old female has been brought to the clinic by
her parents as her behaviour is causing concern.
She has run up enormous debts, as she has been spending
money lavishly. She says that this is not a problem as she is going to earn
large sums of money by selling her paintings (she is an artist) and soon she
will be world famous.
She has been having many boyfriends and has problems with
relationships as she has
become very promiscuous.
On examination she seems excitable talks very fast and
rapidly moves from one subject to another. She admits to difficulty sleeping
and she has lost some weight.
In this patient which of the following tests would be
useful in predicting an increased risk of complications with first line
treatment.
a)
Thyroid autoantibodies
b)
Serum osmolality
c)
Urine osmolality
d)
ECG
e)
Serum calcium
Answer:
a)
The patient has the clinical features of hypomania. This
condition is usually treated with lithium or antipsychotic (neuroleptic)
drugs.
The common adverse effects of lithium are thyroid
disorders and renal disease. Patients should be screened by checking T4 TSH
and thyroid autoantibodies together with urea, creatinine and 24-hour urinary
volume.
The presence of thyroid autoantibodies increase the risk
of developing thyroid disease (hypothyroidism)
