Mental Health Flashcards
DDx for new-onset psychosis
Primary/Psychiatry
- Schizophrenia spectrum
Secondary/Organic
Ix to differentiate between organic & functional cause
- 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
Purpose of Ix in pyschiatry
- To determine DDx/ co-morboities
2. To determine base- line results before starting ANY psychotrophics + drug monitoring.
DDx for depression
- Infections ( post viral infections)
- Thyroid disorder
- Adrenal dysfunction
- Autoimmune disorder
- Early dementia
- Brain tumour (neurological issue)
Medication
DDx for mania
- Thyroid disorder
- Infections
- Intoxication
- Drug SE e.g. steroids
- Agitated delirium
- ?brain tumour
DDx for psychosis
- Autoimmune
- Brain tumour
- Encephalopathy
- Dementia
- Endocrine
Causes of delirium
D - drugs E- epilepsy, electrolyte imbalance L- liver failure, low O2 I - Infection R - Retention I - Intracranial U - Uraemia M - metabolism
Why do you monitor antipsychotics?
- General health measures
- Metabolic side effects of drugs ( weight gain, glucose intolerance, altered lipids)
- Risk of neuroleptic malignant syndrome ( a rare but LIFE THREATINING reaction to neuroleptic medications)
- Other potential side effects ( hyperprolactinemia, altered thyroid function, cardiac abnormalities)
Why is ECG monitoring essential in psychiatry?
querying prolonged QT interval —> Torsade de points
What medications can cause pronlonged QT interval?
Amitriptylne, citolopram, MOST antipsychotics, lithium antibitoics
How often do you monitor when prescribing antipsychotics?
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 monthly: lipid profile and weight checks
4-6 monthly: plasma glucose checks
6 monthly: prolactin
Annually - repeat baseline bloods
Examples of antipsychotics
risperidone
quetiapine
olanzapine
clozapine
What is clozapine?
2nd generation (atypical) antipsychotic
What is a risk of cloazapine?
How do monitor this?
Risk of neutropenia and agranulocytosis
Monitoring:
• Check FBC at baseline
• Weekly FBC for 18 weeks
• Fortnightly FBC for remainder of 1st year
• Monthly FBC thereafter
• In addition to monitoring for metabolic side effects
Side effects of clozapine
Hypersalivation Constipation Sedation More prone to getting epilepsy Tachycardia (in first 2 months --> further assessment) Prolonged QT myocarditis
If myocarditis/cardiomyopathy suspected clozapine, what should you do?
Clozapine should be stopped and patient referred urgently by cardiologist
What is lithium?
Mood stabiliser
Baseline monitoring for lithium - tests
ECG, TFTs, eGFR & calcium.
When do you monitor lithium levels and what other tests do you monitor after initiation?
6 monthly: ECG, TFT, eGFR
3 monthly: Lithium levels (1 week after initiation or dose change, 3 monthly when dose
stable)
What is sodium valproate?
Antiepileptic medication, used as a mood stabiliser and for acute mania
When & What do you monitor in sodium valproate?
6 months: BMI, weight, FBC & LFT, fasting
Annual: FBC, LFTs, eGFR, TFTs
Levels not routinely checked
Side effect of sodium valproate
teratogenic