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As much of this occurs in the context of involuntary psychiatric treatment, the appropriate use of prn medication represents a significant ethical issue. In general terms, prn psychotropic medication is prescribed and administered for either the relief of distress or to reduce the risk of harm to the patient or those around him or her. The decision to use prn medication should only occur once other forms of intervention such as counselling or noninvasive behavioural interventions have been either attempted or at least considered.

Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008;70:2152-2158. 58. Maidment, ID. Gabapentin treatment for bipolar disorder. Ann Pharmacotherapy. 2001;35(10):1264-9. 59. Chengappa, et al. The evolving role of topiramate among other mood stabilisers in the management of bipolar disorder. Bipolar Disorder. 2001;3:215-32. 60. Treatments 2 LEARNING OBJECTIVES • Describe the various iatrogenic risks of psychotropic agents • Identify psychotropic treatment regimes which are comparatively safe in pregnancy • Identify psychotropic agents which are comparatively safe to use in lactating women 39 Psychotropic drugs in pregnancy and breastfeeding Introduction As mental illness frequently affects adults in the child-bearing years, the use of psychotropic medications in pregnancy requires closer consideration.

It is probably more effective than the anticonvulsants in classical bipolar I disorder and in severe mania. It is one of the more effective augmentation strategies in major depression. Around 50% of antidepressant non-responders achieve remission with added lithium. 15% of people with bipolar disorder complete suicide. Only 10% of these deaths occur while the person is taking some form of mood stabiliser. Lithium is the most effective mood stabiliser at preventing suicide37, 38. If a patient is having some breakthrough episodes on an anticonvulsant, a change to lithium is warranted.

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Acute Psychiatric Management by Michael Robertson

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