MENTAL HEALTH

Question 1

difference between functional and organic conditions

Answer 1

organic = observable and measurable with biomarkers
- can be seen to have a underlying medical reason

functional = psychiatric reasoning for why the patient is having these symptoms

Question 2

Investigations to differentiate between organic and fucntional

Answer 2

bloods - FBC, U+Es, LFTs, TFTs, Bone profile (calcium), Mg&PO4, VitB12 and folate, CRP, Prolactin

urine drug screen
urine MC&S
urine - pregnancy

ECG

CXR
Brain imaging - CT, MRI, PET
CSF analysis
NMDA receptor antibodies

Question 3

ECG monitoring indication in Psychiatry

Answer 3

required if there is a risk of prolonged QT interval - could lead to torsades de points

Question 4

Medications associated with Prolonged QT interval

Answer 4

antidepressants = tricyclic (amitriptyline), citalopram and venlafaxine

antipsychotics = most

antibiotics = erythro/clarithromycin, levofloxacin, ketoconazole, fluconazole

lithium

Question 5

what does antipsychotic monitoring involve?

Answer 5

baseline
fasting glucose, lipid profile, FBC, LFTs, U&e, eGFR, CPK, weight, BMI, pulse, blood pressure and prolactin if indicated, TFTs (with quetiapine only), ECG

3/12 - lipid profile and weight checks

4-6/12 - plasma glucose checks

6/12 - prolactin

annually - repeat baseline bloods

Question 6

what is clozapine?

Answer 6

Clozapine is a 2nd gen (atypical) antipsychotic

Question 7

what are the side effects of clozapine?

Answer 7

hypersalivation 
constipation 
sedation 
reduced epilepsy/seizure threshold 
tachycardia, prolonged QT 
myocarditis (seen with a raised trop)

Question 8

Risk associated with clozapine?

Answer 8

Risk of neutropenia and agranulocytosis

monitored by doing an FBC
baseline FBC checked and then weekly FBCs till 18weeks
- remainder of 1st yr = every 2 weeks
- monthly thereafter

Question 9

Other monitoring for clozapine includes

Answer 9

ECG - risk of myocarditis and also QT prolongation

- myocarditis usually within the first 2/12 (persistent palps/tachy)

Question 10

what should happen in a clozapine induced myocarditis?

Answer 10

stop clozapine and refer to cardiologist

discontinue permanently

Question 11

what baseline tests are done for lithium initiation?

Answer 11

ECG, TFTs, eGFR and calcium

Question 12

after initiation what monitoring is involved in pts using lithium?

Answer 12

lithium levels every month starting a week after initiation or dose changes

when lithium levels are stable - can measure check levels every 3 months

Question 13

what does monitoring for sodium valproate involve?

Answer 13

6/12 - BMI, weight, FBC and LFT, fasting glucose

annually - FBC, LFTs, TFTs, eGFR

valproate levels aren’t routinely checked