MENTAL HEALTH DRUGS

Question 1

ATYPICAL ANTIPSYCHOTICS
(Quetiapine, Olanzapine, Risperidone, Clozapine)

Answer 1

I: Urgent treatment of severe psychomotor agitation, Schizophrenia, Bipolar disorder
SE: Sedation, Extrapyramidal effects (movement abnormalities), Metabolic disturbance (weight gain, DM and lipid changes), prolong QT interval and cause arrythmias,
Risperidone (breast symptoms - excess milk production, sexual dysfunction),
Clozapine (agranulocytosis + myocarditis + constipation)
CI: Clozapine in severe heart disease, neutropenia
C: Cardiovascular disease
KI: Not combine with other dopamine blocking antiemetics + drugs that prolong the QT interval (amiodarone, macrolides, SSRIs)
PC: Regular BT monitoring, inform HCP that you are on antipsychotics
M: BT monitoring (FBC, renal and LFTS), monitor SE of metabolic and CVS (weight, lipid profile, fasting BG at baseline and intermittently during treatment) and ECG

Question 2

SSRI
(Citalopram D , Sertaline A - good for the heart, Fluoxetine 1st line in children, Escitalopram)

Answer 2

I: 1st line for moderate to severe depression, panic disorder, OCD
MOA: Inhibit neuronal reuptake of 5-HT from the synaptic cleft, therby increasing its availibility for neurotransmission.
SE: GI upset, changes in appetite and weight (loss/gain), hypersensitivity, hyponatraemia (confusion and low GCS), GI bleeding, serotonergic drugs (antidepressants, tramadol) can cause serotonin syndrome. Sudden withdrawal of SSRI can cause GI upset, neurological and influenza-like symptoms and sleep disturbance, Lower seizure threshold
C: Epilepsy, Peptic ulcer disease, hepatic impairment, drugs that prolong the QT interval such as antipsychotics
CI: Monoamine oxidase inhibitors and serotonergic drugs (tramadol)
PC: improve symptoms (sleep+ appetite), discuss CBT, 6 months treatment, not to stop treatment suddenly, withdrawal symptoms (flu-like), when stopping treatment - they should reduce the dose slowly over at least 4 weeks.

Question 3

LITHIUM

Answer 3

I: Mania, Bipolar disorder, recurrent depression, aggressive or self harming behaviour
SE: Nausea and vomiting, decreased appetite, arrythmias, alopecia, weight gain, diarrhoea, oedema
long term SE: thyroid disorders (hypothyroidism)
CI: Addison’s disease, cardiac disease, dehydration, first trimester pregnancy, breastfeeding, untreated hypothyroidism, FHX/PMHX of brugada syndrome, low sodium diet
C: avoid abrupt withdrawal, renal impairment
M: bloods (LFTS, U+Es, FBC) + serum lithium levels at 1 week after starting then 1 week after every dose change until stable. Then 3 months thereafter

Question 4

VALPROIC ACID (Sodium Valporate)

Answer 4

I: Seizure prophylaxis in epilepsy, established convulsive status epilepticus, bipolar disorder
SE: GI upset, neurological and psychiatric effects (tremor, ataxia), thrombocytopenia, increase in liver enzymes, hair loss
CI: women of childbearing age, conception, first trimester of pregnancy due to fetal abnormalities, hepatic impairment
C: dose reduction in severe renal impairment
KI: Warfarin and lamotrigine increases plasma concentration and risk of toxicity, risk of seizures can be increased by CYP inducers (macrolides)
PC: Reduce frequency of seizures, tablets with food, seek urgent medical advice for unexpected symptoms such as lethargy, loss of appetite, vomiting, abdo pain, bruising, high temp, mouth ulcers.
- Discuss contraception and pregnancy.
M: efficacy, LFTS during the first 6 months, plasma valproate concentration - be measured to check for adherence or toxicity