Mental health Flashcards
I cause the following:
1-month period of active symptoms such as hallucinations, lack of mobility, erratic and extreme movement, Tangentiality Inability to stay on topic. Negative symptoms: flattened effect, reduced speech, lack of inititive and Positive symptoms: Delusions, hallucinations & disorganised speech. What is this condition?
Schizophrenia
What drugs are used to treat an acute manic epidsode?
Antipsycotics first generation
- Urgent treatment of severe psychomotor agitation that is causing dangerous or violent behaviour, or to calm patients to permit assessment.
- haloperidol, chlorpromazine, prochlorperazine
What drugs are used to treat an acute manic epidsode?
Antipsycotics first generation
- Urgent treatment of severe psychomotor agitation that is causing dangerous or violent behaviour, or to calm patients to permit assessment.
- haloperidol, chlorpromazine, prochlorperazine
DISCUSS ANTIPSYCHOTICS CLINICAL PHARM
Drug names: Quetiapine, olanzapine, risperidone, clozapine
Indications:
- Urgent treatment of severe psychomotor agitation leading to dangerous or violent behaviour, or to calm such patients to permit assessment.
- Schizophrenia
- Bipolar disorder
Adverse effects:
- degree of sedation
- extrapyramidal effects
- Metabolic disturbance
- prolong the QT interval
- Arrhythmias
- breast symptoms
- sexual dysfunction
- agranulocytosis
- myocarditis
Warnings/cautions:
- ▴cardiovascular disease
Contraindications:
- ✗severe heart disease
- ✗neutropenia
Interactions:
- ▴dopamine-blocking antiemetics
- ▴drugs that prolong the QT interval (e.g. amiodarone
Monitoring:
- Assessment of symptoms and signs is the best form of monitoring for treatment efficacy. For most antipsychotics, blood tests (typically FBC, renal and liver profiles) are required at the start of treatment and periodically thereafter
A patient is experiencing the following: - Disturbed sleep - Decreased or increased appetite and/or weight - Fatigue/loss of energy - Agitation or slowing of movements - Feelings of worthlessness or excessive or inappropriate guilt. - Suicidal thoughts or acts. - For at least 2 weeks WHAT AM I?
Depression
scored by the DSM- 5
DISCUSS SSRI CLINICAL PHARM
Drugs: Citalopram, fluoxetine, sertraline, escitalopram
MOA: Selective serotonin reuptake inhibitors (SSRIs) preferentially inhibit neuronal reuptake of 5-HT from the synaptic cleft, thereby increasing its availability for neurotransmission
Indications:
- moderate-to-severe depression, and in mild depression
- Panic disorder
- Obsessive compulsive disorder
Adverse effects:
- GI upset
- Changes in appetite and weight
- hypersensitivity reactions
- Hyponatraemia (elderly)
- Suicidal thoughts and behaviour may be increased in patients on SSRIs
- Lower the seizure threshold
- Prolong the QT interval
- Risk of bleeding
- serotonin syndrome (triad of autonomic hyperactivity, altered mental state and neuromuscular excitation)
- sudden withdrawl can cause GI upset, neurological and influenza-like symptoms.
Warnings/cautions:
- ▴epilepsy
- ▴peptic ulcer disease
- ▴young people (poor efficacy as heightens self harm/suicidal thoughts)
- ▴hepatic impairment
Contraindications:
- In a manic phase of bipolar disorder.
- With poorly controlled epilepsy.
- With known QT interval prolongation
Interactions:
- ✗monoamine oxidase inhibitors
- ▴serotonergic drugs (e.g. tramadol)
- Gastroprotection for NSAIDs
- Bleeding risk is also increased where SSRIs are co-prescribed with anticoagulants
- ▴drugs that prolong the QT interval
Monitoring:
- improve symptoms
- psychological therapy
- Explain that they should carry on with drug treatment for at least 6 months
- Not to stop treatment suddenly as this may cause a tummy upset, flu-like withdrawal symptoms
- Symptoms should be reviewed 1–2 weeks after starting treatment and regularly thereafter. If no effect has been seen at 4 weeks, you should consider changing the dose
I cause the following:
- Anhedonia, the inability to feel pleasure
- Low mood, which is present most of the day, almost everyday
- Sleep disturbance (insomnia or hypersomnia)
- Lack of concentration
- Change in appetite which has resulted in change of weight
- Suicidal ideation
Mania: Increased goal-directed activity – sexually, at work, socially etc or psychomotor agitation
Pressure of speech of increased talkativeness
Flight of ideas
WHAT AM I?
BIPOLAR DISORDER
DISCUSS LITHIUM CLINICAL PHARM
Indications: - Treatment and prophylaxis of mania, Treatment and prophylaxis of bipolar disorder, Treatment and prophylaxis of recurrent depression, Treatment and prophylaxis of aggressive or self-harming behaviour Drug names: Lithum carbonate Adverse effects: - Abdominal discomfort - Alopecia - Dizziness - Arrhythmias - Dry mouth - Hypotension
Warnings/caution:
- cardiac disease
- diuretic treatment (risk of toxicity)
- elderly (reduce dose)
- epilepsy
- psoriasis (risk of exacerbation)
Contraindications:
- Addison’s disease
- dehydration; family history of Brugada syndrome
- untreated hypothyrodism
Interactions:
- Amiodarone
- Amitriptyline
- Beclometasone (hypokalaemia)
- Bendroflumethiazide (hypokalaemia)
Monitoring:
- Samples should be taken 12 hours after the dose to achieve a serum-lithium concentration of 0.4–1 mmol/litre
- A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania
- Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter
DISCUSS SODIUM VALPORATRE CLINICAL PHARM
Indications:
- Seizure prophylaxis in epilepsy management
- First-line choice for prophylaxis of generalised tonic–clonic seizures, absence seizures, focal seizures
- established convulsive status epilepticus
- Bipolar disorder
Adverse effects:
- GI upset (such as nausea, gastric irritation and diarrhoea
- neurological and psychiatric effects
- thrombocytopenia
- increase in liver enzymes
- hair loss
- severe liver injury, pancreatitis, bone marrow failure, antiepileptic hypersensitivity syndrome
Warnings/cautions:
- ▴hepatic impairment
- ▴severe renal impairment
Contraindications:
- ✗women of child-bearing age
- ✗conception and in the ✗first trimester of pregnancy
- risk of fetal abnormalities
Interactions:
- Risk of toxicity with ▴lamotrigine
- ▴drugs metabolised by cytochrome P450 (CYP) enzymes, such as warfarin
- Adverse effects are increased by ▴CYP inhibitors (e.g. macrolides
- efficacy of antiepileptic drugs is reduced by ▴drugs that lower the seizure threshold
Monitoring
- Warn patients that they may have some indigestion or tummy upset when starting valproate, but that these will settle in a few days and can be reduced by taking tablets with food.
- comparing seizure frequency before and after starting treatment or dose adjustment and toxicity
