Mood disorders: mood stabiliser in renal impairment: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Mood disorders: mood stabiliser in renal impairment

Sample item

A 48-year-old man with bipolar I disorder has stage 4 chronic kidney disease with a markedly reduced glomerular filtration rate. He needs a mood stabiliser for long-term prophylaxis. Which drug is generally avoided?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Lithium

Lithium is renally excreted and is nephrotoxic, so it is avoided in significant renal impairment because of the risk of toxicity. Valproate and some atypical antipsychotics are alternatives that do not depend on the kidney for clearance.

Option by option

  • A. Lithium (correct)

    Correct. Lithium depends entirely on renal clearance and is generally avoided in significant renal impairment.

  • B. Sodium valproate

    Valproate is hepatically metabolised and is a reasonable alternative.

  • C. Quetiapine

    Quetiapine is hepatically metabolised and can be used with careful dosing.

  • D. Lamotrigine

    Lamotrigine is mainly hepatically metabolised and does not rely on renal clearance.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, Lithium. Lithium is renally excreted and is nephrotoxic, so it is avoided in significant renal impairment because of the risk of toxicity.

Why is "Sodium valproate" not the answer?

Valproate is hepatically metabolised and is a reasonable alternative.

Why is "Quetiapine" not the answer?

Quetiapine is hepatically metabolised and can be used with careful dosing.

Why is "Lamotrigine" not the answer?

Lamotrigine is mainly hepatically metabolised and does not rely on renal clearance.

What concept does this question test?

It tests Mood disorders: mood stabiliser in renal impairment in Psychiatry. Valproate and some atypical antipsychotics are alternatives that do not depend on the kidney for clearance.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Mood disorders: mood stabiliser in renal impairment?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.