Mental Health Disorders Flashcards
What are the psychological symptoms of anxiety?
Restlessness Worry Fear Difficulty concentrating Irritability
What are the physical symptoms of anxiety?
Palpitations Muscle aches and tension Trembling or shaking Excessive sweating Shortness of breath Insomnia
What class are benzodiazepines?
CD4 part 1
What are the benzodiazepines?
Alprazolam Clobazam Chlordiazepoxide Diazepam Lorazepam Oxazepam
What benzodiazepines are better for use in elderly?
Short acting
Lorazepam
Oxazepam
Greater risk of withdrawal symptoms
What beta blockers are used for palpitations in anxiety?
Propranolol
Oxprenolol
What is buspirone?
5HT1a agonist
Low potential for abuse and dependence
Takes two weeks to work
What is the mechanism of action of benzodiazepines?
Facilitates and enhances the binding of GABA to the GABAa receptor to cause widespread depressant effect on synaptic neurotransmission
What are benzodiazepines used for?
Short term (2-4 weeks) relief of anxiety that is severe, disabling or causing patient unacceptable distress
What are the side effects of benzodiazepines?
Paradoxical increase in hostility aggression
Overdose - ataxia, drowsiness, dysarthria, nystagmus, respiratory depression, coma
Sedation
Dependence
How do you withdraw benzodiazepines?
Gradually convert to equivalent diazepam dose ON
Reduce diazepam dose by 1-2mg every 2-4 weeks
Reduce further
What are the diazepam drug interactions that increase sedation and CNS depressant effects?
Alcohol Opioids Antihistamines Antidepressants Barbiturates Antipsychotics Z-drugs
What are the diazepam interactions that increase plasma concentrations?
Amiodarone
Diltiazem
Macrolides
Fluconazole
What are the symptoms of ADHD?
Hyperactivity
Impulsivity
Inattention
What is the treatment for ADHD in children 5 years + and young people?
Methylphenidate first line
Lisdexamfetamine second line
Atomoxetine/guanfacine alternative
What is the ADHD treatment in adults?
First line methylphenidate/lisdexamfetamine
Alternative atomoxetine
What is the mechanism of action of methylphenidate?
Potent CNS stimulant
Increases dopamine and noradrenaline levels in the brain
What are the side effects of methylphenidate?
Appetite loss Insomnia Weight loss Increased heart rate and blood pressure Tics and Tourette’s Growth restriction
What needs to be monitored with methylphenidate?
Pulse
BP
Appetite
Weight and height
Psychiatric symptoms
What are the contraindications of methylphenidate?
Cardiovascular disease Hyperthyroidism Hypertension Uncontrolled bipolar Severe depression
Prescribe by brand for MR
What is the mechanism of action of dexamfetamine and lisdexamfetamine?
Potent central nervous system stimulant
Increases dopamine and noradrenaline levels in the brain
What are the side effects of lisdexamfetamine and dexamfetamine?
Appetite loss Anorexia Increased heart rate and blood pressure Tics and Tourette’s Growth restriction in children
What are the signs of lisdexamfetamine overdose?
Wakefulness Hyperactivity Paranoia Exhaustion Convulsions Hyperthermia Coma
What is the monitoring needed for lisdexamfetamine and dexamfetamine?
Pulse BP Appetite Weight and height Psychiatric symptoms
What are the contraindications of lisdexamfetamine and dexamfetamine?
CVD
Hyperthyroidism
Hypertension
Agitated states
What is the mechanism of action of atomoxetine?
Noradrenaline reuptake inhibitor causes increased levels of noradrenaline at synaptic cleft
What are the side effects of atomoxetine?
Suicidal ideation
Hepatotoxicity
QT prolongation
What are the side effect counselling points of atomoxetine?
Report suicidal thoughts, self harming behaviour
Report signs of liver toxicity
What is the monitoring needed for atomoxetine?
Pulse BP Psychiatric symptoms Appetite Weight Height
What is bipolar disorder?
Characterised by extreme mood swings
Bipolar episode can last several weeks or months
What are the two types of bipolar episodes?
Mania
Depression
What do you give for acute mania and hypo mania?
Benzodiazepines - short term use, risk of dependence
Antipsychotics - quetiapine, olanzapine, risperidone
Lithium or valorous acid added if inadequate
Asenapine in moderate-severe manic episodes
What do you use for prophylaxis of bipolar disorder?
Lithium salts
Valproate
Olanzapine
Carbamazepine
What are the contraindications in bipolar disorder?
Do not give antidepressants in - rapid cycling bipolar disorder, recent history of hypo mania, manic episode, rapid mood fluctuations
What are the lithium salts used for?
Prophylaxis and treatment of mania, hypo mania and depression in bipolar disorder, resistant depression and aggressive or self harming behaviour
What is the therapeutic range for lithium?
- 4 - 1 mmol/L - lower end for prophylactic/elderly
0. 8 - 1 mmol/L - acute manic episodes
What is the monitoring needed for lithium?
12 hours post dose
Monitored every 3 months
Additional monitoring if significant inter current illness or significant changes to diet or water intake
Why should you avoid abrupt withdrawal of lithium?
Warn patients of higher risk of relapse
What are the signs and symptoms of lithium toxicity?
Revenge
Renal disturbances Extra pyramidal symptoms Visual disturbances Nervous system disturbances GI effects
> 2 mmol/L - renal failure, arrhythmias, seizures, BP changes, circulatory failure, coma, death
What are the side effects of lithium?
Thyroid disorders Renal impairment Benign intracranial hypertension QT prolongation Lowers seizure threshold
What are the counselling points for the side effects of lithium?
Report hypothyroidism symptoms
Report renal dysfunction
Report persistent headaches, visual disturbance
Does hyper or hyponatraemia predispose lithium toxicity?
Hyponatraemia
What are the counselling points for lithium?
Report signs and symptoms of lithium toxicity
Maintain salt and water intake
Lithium treatment pack
Can cause drowsiness avoid alcohol
OTC interactions - ibuprofen, soluble analgesics, antacids
Is lithium teratogenic?
Yes
Need effective contraception
Toxicity can occur in breast fed infants
What are the lithium interactions that increase risk of seizures?
Ciprofloxacin
SSRIs
Epilepsy
What are the lithium interactions that increase risk of arrhythmias due to QT prolongation?
Quinolones Citalopram Clarithromycin Amiodarone Antipsychotics Imipramine Theophylline Corticosteroids B2 agonists Loop/thiazide
What are the lithium interactions that increase risk of lithium toxicity due to reduced renal excretion?
ACEi
ARB
NSAIDs
What are the lithium interactions that increase risk of hyponatraemia and so predispose lithium toxicity?
Diuretics
Antidepressants
What are the lithium interactions that increase risk of extrapyramidal symptoms?
Haloperidol Clozapine Phenothiazines Parkinson’s disease Metoclopramide
What drugs used with lithium affect the salt balance?
Soluble analgesics
Sodium containing antacids
What are the lithium interactions that increase risk of neurotoxicity?
Phenytoin
Carbamazepine
Antipsychotics
Amitriptyline
What are the lithium interactions that increase risk of serotonin syndrome?
Sumatriptan Citalopram Granisetron MAOIs Amfetamines St Johns Wort Tramadol
What are the psychological symptoms of depression?
Low self esteem
Worry and anxiety
Suicidal thoughts
What are the physical symptoms of depression?
Lack of energy
Changes in weight/appetite
Insomnia
How do antidepressants work?
Depression is thought to be caused by under activity of monoamine neurotransmitters
Antidepressants increase monoamine levels at synapse
What are the tricyclic antidepressants?
Raises 5HT, NA
Amitriptyline Clomipramine Dosulepin Imipramine Nortriptyline
What are the tricyclic related antidepressants?
Mianserin
Trazodone
What are the selective serotonin reuptake inhibitors?
Raises 5HT
Citalopram (QT prolongation) Escitalopram (QT prolongation) Fluoxetine (only antidepressant given in children) Fluvoxamine Paroxetine Sertraline - safe to use after MI
What are the irreversible monoamine oxidase inhibitors?
Raise 5HT, NA, DA
Phenelzine
Isocarboxazid
Tranylcypromine
What are the reversible monoamine oxidase inhibitors?
Moclobemide
What are antidepressants used for?
Moderate to severe depression
What are the first line antidepressants?
SSRIs
Better tolerated and safer in overdose
Less sedating, antimuscarinic, epileptogenic, cardiotoxicity than TCAs
MAOIs rarely used
How long does it take for antidepressants to work?
At least two weeks
Initially feel worse, increased agitation, anxiety, suicidal ideation
Review every 1-2 weeks
Wait at least 4 weeks