A 23-year-old woman with bipolar I disorder has had two manic episodes in 18 months and stopped lithium becaus…

Question

A 23-year-old woman with bipolar I disorder has had two manic episodes in 18 months and stopped lithium because of intolerable tremor and polyuria. The psychiatrist proposes sodium valproate and asks the intern to counsel her before the first dose. She has a regular partner and they use condoms only. She says she has no plans to have children for at least five years and that she will simply stop the tablets if she ever becomes pregnant. Which one of the following is the most important point for…

Accepted Answer

Effective contraception is needed throughout treatment

Answer

Folic acid 5 mg daily removes the malformation risk

Answer

The drug can be stopped once pregnancy is confirmed

Answer

The malformation risk applies only in late pregnancy

Answer

Valproate is safer in pregnancy than lithium

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