A 30 year old female, married since one year, present to the psychiatry clinic with hyperactivity since 2 weeks. A diagnosis of mania is made. She had 3 prior episodes of mania in last 5 years and every time after taking medication she goes to premorbid state. Her urine pregnancy test is positive. Which is the preferred drug for management of this patient?

**Core Concept**
The patient is a pregnant woman with a history of bipolar disorder, presenting with a manic episode. The preferred treatment for bipolar disorder during pregnancy should ideally have a good safety profile for both the mother and the fetus.

**Why the Correct Answer is Right**
Lithium is a mood stabilizer that has been widely used in the treatment of bipolar disorder. It is effective in managing manic episodes and preventing relapses. In pregnancy, lithium is considered relatively safe, especially when used at therapeutic doses. However, it requires close monitoring of serum levels and renal function. The American College of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association (APA) recommend lithium as a first-line treatment for bipolar disorder during pregnancy.

**Why Each Wrong Option is Incorrect**
**Option A:** Valproate is another mood stabilizer used in bipolar disorder but is associated with a higher risk of congenital malformations, particularly neural tube defects, and should be avoided in pregnancy if possible. Its use is generally considered a second-line option.
**Option B:** Carbamazepine is an anticonvulsant that can be used in bipolar disorder but is also associated with a risk of congenital malformations, including spina bifida. Its use in pregnancy is generally considered a second-line option.
**Option C:** Quetiapine is an atypical antipsychotic that can be used in bipolar disorder but is not considered a first-line treatment in pregnancy due to its potential risks, including weight gain and metabolic side effects.

**Clinical Pearl / High-Yield Fact**
Lithium levels should be monitored closely in pregnancy, especially during the first trimester, to ensure that they remain within the therapeutic range (0.6-1.2 mmol/L).

**Correct Answer:** A. Lithium.

✓ Correct Answer: B. Haloperidol