DUMS Flashcards
What are some of the things we are monitoring for in patients taking antipsychotics
Fasting blood glucose, prolactin, ECG, FBC
Why do you get raised prolactin when using an antipsychotic?
Due to inhibition of the dopaminergic tuberoinfundibular pathway
Do patients on clozapine need to let doctors know when they cut down or begin smoking?
Yes – smoking increases the levels of clozapine in the body so if a patient starts smoking increased levels of the drug may be harmful
Which anti-psychotic has the best side effect profile
Aripiprazole
A pateint is being started on anti-psychotics and wants to avoid weight gain and T2DM risk – which should be avoided
Olanzapine associated with the most weight gain and highest T2DM risk
Which anti-psychotic do you give patients with parkinsons
None!!!!!!!
Give lorazepam
Ideas of reference
Innocuous or coincidental events will be ascribed significant meaning
Seeing objects arranged in a particular way and thinking someone is sending you a message
Self-referential experience
The sense than external events are connected to oneself in some way
TV/Radio are transmitting signals aimed at me
Passivity phenomenon
Disconnection between performing an action and having ownership of that action
Delusion
A fixed falsely held belief with unshakeable conviction
Impervious to logical argument
Knights move thinking
Aka looseing of associations
Unexpected illogical connections between ideas
Flight of ideas
Quick erratic speech in which the person jumps between ideas
No apparent association between ideas
Neologisms
Made up words
side effects of ECT
headache, nausea, short term memory impairment, cardiac arrhythmia
the amygdala processes sensory data and passes information to the?
hypothalamus
periaqueductal gray
hippocampus
cingulate cortex
what does the hypothalamus do
mediates bodily stress response by releasing cortisol
what does the periaqueductal gray do
mediates flight or fight response
what does the hippocampus do
responsible for memory and learning
what does the cingulate cortex do
mediates emotions of anxiety
short acting benzodiazepine
lorazepam
long acting benzodiazepine
diazepine
when would you use benzo to treat anxiety
only used for rapid relief of severe symptoms
avoid long term use
withdrawal side effects of benzo
anxiety, insomnia, depression, perceptual sensitivity
first line antidepressant for anxiety
SSRI
why is pregabalin used in anxiety
its a calcium channel blocker (indirectly enhances GABA)
consider if unresponsive to others
generalised anxiety disorder
6 months of disproportionate anxiety about everything
management: CBT + SSRI
what is the appetitive system
promotes seeking behaviours
mediated by dopamine
what is the aversive system
promotes survival in event of stress
- loss event= depression
- threat event= anxiety
mediated by serotonin
what is atypical depression
reactive mood with anxiety/rejection hypersensitivity
increased appetite/sleep
what is cortisol dysregulation
stress releases cortisol
chronic stress can cause cortisol dysregulation
excess cortisol may cause depression through
- neuronal damage (low hippocampal volume)
- release of pro-inflammatory cytokines
two main mechanisms to increase monamine activity
reuptake inhibition: keep monoamine in synaptic cleft
monamine oxidase inhibitor: prevent removal of monoamine from presynaptic neuron
what type of antidepressants work through reuptake inhibition
tricyclics
SSRI
SNRI
how does tricyclics work
inhibit reuptake of serotonin + noradrenaline (also 5-HT antagonists, membrane stabilisers)
how do SSRIs work
inhibit reuptake of serotonin
how do SNRIs work
inhibit reuptake of serotonin and noradrenaline
big side effect of MAO
cause hypertensive crisis if taken with substance containing tyramine (cheese, wine, beer)
examples of MAOI
phenylzine
moblecamide
atypical antidepressant
mirtazapine
side effect of mirtazapine
massive weight gain
sedation
when to use an atypical antidepressant
after trial of SSRIs
especially useful if they have had trouble sleeping
what is serotonin syndrome
caused by an excess of serotonin in the synaptic cleft
most often caused by taking combination of SSRI and MAOI
presentation of serotonin syndrome
neuromuscular excitation- hyperflexia, clonus, myoclonus
altered mental status- agitation, insomnia, delirium
autonomic dysregulation- tachycardia, high temperature, shivering, sweating, diarrhoea
what can a prolonged fever from serotonin syndrome lead to
rhabdomyolysis
metabolic acidosis
renal failure
DIC
treatment of serotonin syndrome
benzodiazepine for agitation
if severe ventilation and sedation
cyproheptadine may be used- serotonin receptor antagonist
when to use ECT in depression
if life threating or rapid response needed
management if psychotic depression
SSRI and augment with antipsychotic
how long to continue antidepressant treatment
6 months after symptoms stop
definition of mania
7 days of manic symptoms- not going to list them all
what is hypomania
4 days of less severe symptoms which don’t impact on function
bipolar 1
one episode of mania
bipolar 2
depression with episode of hypomania
acute management of mania
antipsychotic + benzodiazepine
- antipsychotic- olanzapine, quetiapine or risperidone
acute bipolar depression management
antipsychotic- quetiapine, olanzapine or lurasidone
signs of toxic lithium levels
D&V
ataxia
course tremor
drowsiness/altered conscious level
coma
what is the mesolimbic pathway
circuit where dopaminergic inputs from the ventral tegmental area innervate brain regions involved in executive, affective and motivational function
recommended amount of alcohol per week
<14 units
wernicke’s encephalopathy
acute thiamine deficiency
- ataxia
- nystagmus
- confusion
korsakoff syndrome
chronic thiamine deficiency
- dementia
- confabulation
detoxification of alcohol
benzodiazepine (gradually withdraw) + vitamin supplementation
- choose: chlordiazepoxide or diazepam
- lorazepam may be preferable in patients with hepatic failure
- carbamazepine also effective
mechanism of alcohol addiction
chronic alcohol consumption enhances GABA mediated inhibition in the CNS and inhibits NMDA-type glutamate receptors
withdrawal of alcohol causes the opposite
how many hours after last drink do symptoms start of alcohol withdrawals
6-12 hours
when is the peak incidence of seizure in alcohol withdrawal
36 hours
when is the peak incidence of delirium tremens in alcohol withdrawal
48-72 hours
presentation of alcohol withdrawal
tremor
sweating
tachycardia
anxiety
presentation of delirium tremens
coarse tremor
confusion
delusions
auditory and visual hallucination
fever
tachycardia
disulfram
acetaldehyde dehydrogenase inhibitor
causes alcohol intolerance
acromprosate
acts centrally (GABA/glutamate)
reduces cravings
detoxification of opioids
methadone: full agonist
buprenorphine: partial
opioid reversal
IV naloxone
cluster A personality disorders
odd and eccentric
- paranoid
- schizoid
- schizotypal
cluster B personality disorders
dramatic and emotional
- borderline
- histrionic
- antisocial
cluster C personality disorders
anxious and avoidant
- avoidant
- dependent
- anakastic
