Iechyd Meddwl Flashcards
What is the treatment for mild depression?
Offer low-intensity psychosocial intervention e.g. Guided self-help bases on principles of CBT, structured group physical activity programme
What is the treatment for moderate or severe depression?
Combination of antidepressants and a high-intensity psychological intervention e.g. CBT
What are higher risk factors for suicide?
> 45yrs, male, unemployed, psychiatric/ physical illness, previous attempt, single, FH of mental health issues
What are lower risk factors for suicide
Female, <45yrs, employed and in a couple
What type of anti-depressant is most commonly first line treatment for depression?
Selective serotonin reuptake inhibitor (SSRIs)
What is the most common side effect of lithium?
Tremor
What is the most common side effect of clozapine?
Postural hypotension
What SSRI can cause QT prolongation?
Citalopram. It is therefore contraindicated with other medications that can also cause a prolonged QT. e.g. antipsychotics
How long does it take for the SSRIs to begin to work?
4 weeks (6weeks in elderly) They except some effect immediately however this is cancelled out by side effects
What are the side effects of SSRIs?
Nausea, dry mouth, drowsiness, anxiety, agitation (short term)
Sexual dysfunction
Increased risk of G.I. bleeding
Increased risk of hyponatraemia in the elderly
When are SNRIs commonly used?
After two SSRIs have failed.
What is a contraindication for use of the SNRI Venlafaxine?
Hypertension
What needs to be done when starting a patient on lithium?
Monitor renal and thyroid function before treatment and every 6 months after (more often if there is evidence of renal impairment)
ECG monitoring if at high risk of CVD
monitor serum lithium 1 week after treatment starts, at every dose change, and every 3 months.
What is mirtazapine?
A presynaptic alpha2 adrenoreceptor antagonist
What other antidepressants have similar MOA to SNRIs?
Tricyclics e.g. amitriptyline, nortriptyline
What foods can’t you eat when taking monoamine oxidase inhibitors?
Cheese and wine. They cause a hypertensive crisis as you are unable to breakdown tyrosine
What makes tricyclics antidepressants particularly dangerous?
Overdose. They increase risk levels of noradrenaline activating beta receptors and increase HR whilst simultaneously blocking the effects of muscarinic receptors which are cardiotoxic
What needs to be taken into account when stopping antipsychotics?
Must be stopped slowly. They are not addictive but taking them away can cause anxiety, sleep disturbances and headaches.
Monitor for signs of relapse
For how long are antidepressants prescribed?
Fist episode is 9 months
Several episodes / severe / risk of relapse is 2 years
What are the side effects of typical antipsychotics?
Extra pyramidal (Parkinsonism, dyskinesia), sedation, raised prolactin and QT prolongation
How do you manage the extra pyramidal side effects of antipsychotics?
Give them an anti-muscarinic drug
Name some atypical antipsychotics
Risperidone, clozapine, olanzopine, quatriapine, aripirizol
What is first line antipsychotic and what is second line?
First line is whichever antipsychotic the patient can handle best
Second line is clozapine