Question

scenario: a patient with bipolar disorder is experiencing cognitive impairment and tremor while on lithium.
question: what is the most appropriate management strategy?

• discontinue lithium immediately.
• reduce the dose of lithium.
• add an antipsychotic.
• switch to valproate.

Explanation:

When a bipolar patient on lithium has cognitive impairment and tremor (likely lithium - related side effects), switching to an alternative mood stabilizer like valproate is appropriate. Discontinuing lithium immediately can cause mood destabilization. Reducing lithium dose may not fully resolve side effects and could affect efficacy. Adding an antipsychotic doesn't address the lithium - related side effects. Valproate is a valid alternative mood stabilizer for bipolar disorder.

Answer:

D. Switch to valproate.