Management Flashcards
What are the indications for ECT?
- catatonia
- a prolonged or severe manic episode
- severe depression that is life-threatening
Side effects of antipsychotics in elderly?
Stroke
VTE
Common side effect of atypical side effect especially olanzapine?
weight gain
Side effects of clozapine?
weight gain excessive salivation agranulocytosis neutropenia myocarditis arrhythmias
Following MI, preferred AD?
Sertraline
What would you give for acute dystonia due to atypical antipsychotics?
benztropine IM/IV
procyclidine
What is NMS? How does it present?
Neuroleptic malignant syndrome - condition caused by antipsychotics
more common in young male patients onset usually in first 10 days of treatment or after increasing dose pyrexia rigidity tachycardia
How would you manage NMS?
stop antipsychotic
IV fluids to prevent renal failure
dantrolene* may be useful in selected cases
bromocriptine, dopamine agonist, may also be used
How could you diagnose NMS?
Rised creatine kinase
leukocytosis
What is section 2?
admission for assessment
AMHP and two doctors
28 days
appeal within 14 days
What is section 3?
admission for treatment
AMHP and two doctors
6 months
if renewed within second 6 months, then every year
What is section 4?
emergency assessment
AMHP + any doctor
72 hrs
What is section 5(2)?
Urgent detention of a voluntary inpatient
doctor in charge
72 hrs
What is section 5(4)?
Nurses holding of voluntary inpatient
registered mental health nurse
6 hrs
What is a 135?
magistrates
entry of home and removal of patient to safety
72 hrs
What is a 136?
police officer
allows patient in public to be removed to a place of safety
72 hrs
What class of drugs are anti-psychotics?
Block dopamine D2 receptors
side effects of antipsychotics?
parkinsonism
akathisia
dystonias
tardive dyskinesia
hyperprolactinaemia (gynaecomastia, menstrual disturbance, decreased libido, reduced sperm count)
What are the symptoms of neuroleptic malignant syndrome?
autonomic : hyperthermia, tachycardia, pallor, sweating
fluctuating level of consciousness
muscular rigidity
urinary incontinence
What is a way to give antipsychotics to improve compliance?
depots
What patients should quetiapine not be used on?
ones with cardiac pathology - as it may cause long qt syndrome
What can be given to patients who have the parkinsonism side effects of anti-psychotics? What considerations should be taken before this?
(procyclidine, orphenadrine)anti-muscarinics/cholinergic
can cause anti-musc side effects
can worsen tardive dyskinesia
What tests should be done before prescribing Lithium?
renal function - plasma urea, electrolytes and creatinine
tfts
How often should plasma lithium levels be checked? What is the optimal range?
twice weekly when drug first started
then up to 3 months when in maintenance
