Mental health Flashcards
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Neural pathways involved in psychoses
Mesolimbic (+ve symptoms), mesocortical (-ve symptoms), tubulo-infundibular (prolactin secretion), nigrostriatal (coordination of movement- EPSEs)
Management of acute dystonia
Benztropine (anti-cholinergic) 1-2mg IV or IM (single dose) - then switch to orals and taper
Acute dystonias that are emergencies
Oculogyric crisis
Laryngeal spasm
Opisthotonus
Types of EPSEs
- acute dystonias
- parkinsonism
- tardive dyskinesia
- akathisia
Cardiometabolic R/V of a patient on antipsychotic
BMI + waist circumference, BP, fasting BGL, lipid profile. 3/12 first year, then 6/12 every year on treatment
Tetrad of symptoms of Neuroleptic Malignant Syndrome
- Muscle rigidity (severe ++)
- Hyperthermia
- Autonomic instability (tachycardia, labile BP, tachypnoea, diaphoresis, arrhythmias)
- Changed mental status (confusion, delirium, stupor)
Diagnosis of dysthymic disorder
- Depressed mood for 2 years
- at least 2 of “SGECAS”
sleep disturbance
guilt/hopelessness
energy loss/fatigue
concentration loss
appetite and weight changes
self esteem loss - during this time, the person has not been without symptoms for >2 months and there has been no major depressive episode
Clinical features of antidepressant discontinuation syndrome (withdrawal syndrome)
- Flu-like symptoms (fatigue, lethargy, malaise, headaches, sweating, muscle aches)
- Insomnia
- Nausea
- Imbalance
- Sensory disturbance (paresthesias)
- Hyperarousal
- Dysphoria/psychoses
Clinical features of serotonin syndrome (triad)
- Neuromuscular excitability (hyperreflexia, clonus, shivering, tremor, hypertonia, rigidity)
- Autonomic dysfunction (hyperthermia, diaphoresis, flushing, mydriasis, tachycardia)
- Altered mental status (agitation, anxiety, confusion)
Contraindications to Lithium
Absolute: significant renal impairment, sodium depletion, dehydration, significant CVD
Relative: first trimester pregnancy, psoriasis
Target serum of lithium (for both acute phase and maintenance treatment)
0.8-1.2 mmol/L
Pre-treatment Lithium ix
Bedside - UA, ECG, beta HCG
Lab - FBC, EUC, TFTs, CMP
Serum lithium monitoring regime
- 5-7 days after dose changes
- Weekly measurements until stable therapeutic level for 4 weeks
- Every 6-12 months
Ix regime for lithium monitoring
- Serum lithium 6-12 mthly
- EUC - 2-3mthly first 6 mths, then 6-12 mthly
- TFTs - 2-3mthly first 6 mths, then 6-12 mthly
- CMP yearly
Side effects of lithium (acronym)
LITHIUMS
Lethargy/sedation
Increased urination and thirst (polyuria, polydipsia), increased weight
Tremor, teratogenicity
Hypothyroidism, hair thinning
Impaired cognition
Upset stomach - nausea, diarrhoea, vomiting
Muscle weakness
Skin effects - acne, oedema, psoriasis exacerbation
Clinical features of acute lithium toxicity (early, progressing, late)
Early: marked coarse tremor, poor appetite, N/V, diarrhoea, lethargy, dehydration
Progressing: restlessness, muscle fasciculations, myoclonic jerks, hypertonia
Further: ataxia, dysarthria, drowsiness, confusion
Late: hypotension, arrhythmias, seizures, coma, death
Management of lithium toxicity
- IVF rehydration
- GIT decontamination (if large acute ingestion >50g) - saline whole bowel irrigation via NGT
- Haemodialysis (rarely required for patients with normal kidney function
Indications for haemodialysis in a patient with lithium toxicity
- Serum lithium conc >2.5
- Severe clinical manifestations (delirium, coma, seizures, hypotension)
- Serum lithium conc >1.5 with a) persistent clinical effects, b) little response to IVF c) persistent kidney impairment despite IVF
Diagnostic criteria of a manic episode
A period of abnormally or persistently elevated, expansile or irritable mood, lasting at least one week and including 3 of: Distractability Insomnia Grandiosity Flight of ideas Activity - goal directed Speech pressure Thoughtlessness - high risk activity involvement
Differences between mania and hypomania
Time: M >7 days, HM >4 days
Functioning: M impairs social/occupation funcitoning, HM does not
Hospital: M may require hospitalisation for safety of self or others, HM does not
Psychosis: M may have psychotic features, HM does not
Diagnosis of Bipolar 1 disorder
The only criteria is the occurrence of one manic episode or one mixed episode
Management of acute manic episode
- olanzapine 5mg PO nocte
Risperidone 0.5mg PO nocte
Options for maintenance therapy in Bipolar 1
- Lithium
- Carbamazepine
- Sodium valproate
- Lamotrigine
Diagnosis of Bipolar 2
the occurrence of at least one major depressive episode and at least one hypomanic episode
*** if they’ve ever had a full manic episode its B1 not B2
