Misc. - 2 Flashcards
History of Psychotropics and Intervention
Insulin shock therapy
Sakel 1933
History of Psychotropics and Intervention
Frontal leucotomy for psychosiss
Moniz 1935
Metrazol therapy
Meduna1934
cerletti (and bini)
ECT 1938
Cade
Discovered lithium benefit in mania 1949
Chlorpromazine synth
Charpentier 1950
Iproniazid (MAOI) discovery
Kline 1951
Delay and Deniker
Used Chlorpromazine for schizo 1952
Coined ‘Neuroleptic’
Delay and Deniker
Antidepressant of imipramine
Kuhn 1957
Described the cheese effect in MAOI use
Blackwell
Lurie
coined the term antidepressants 1960
Carlsson
Developed the first SSRI 1992 (zimelidine)
Reintroduced clozapine into clinical practice
Kane 1988 (happy birthday)
what was clozapine made from?
imipramine 1958
first antidepressant to be made?
Iproniazid MAOI
First ssri to be made
Zimeldine (CALRSSON 1992)
first antipsychotic
chlorpromazine
who used chlorpromazine for anesthetics before it being used as antipsychotic later?
Laborit and huguenard 1951
what antituberculosis were thought to have antidepressant effects
isoniazid (lurie)
iproniazid
what was imipramine made from
promethazine
what lymphocyte HIV reduces
CD4 T cells
the most prevalent mental health issue in HIV patients?
- first depression 35%
then
Substance misuse
anxiety
psychosis
adjustment disorder
bipolar
which HIV Rx causes depression
efavirenz (mania and suicide)
Rx for efavirenz induced affective disorder?
fluoxetine and paroxetine (RCT -backed)
what is HAND?
HIV-associated NeuroCognitive Disorder
sympotms of HAND
- psychomotor function impairment (slow movement.. impaired coordination…)
-Abnormal attention & concentration - Mental agility
-Mental inflexibility
-Personality change
-Apathy
-social withdrawal
what function is perserved in HANDS
language
suggested Rx in HIV for
psychosis
atypical antipsychotic (less EPSE)
Que (750-800)
Ris 16
Ari (aro30)
when benzodiazepine can be used in delirium in HIV patients
when alcohol or benzodiazepine with drawal is the precipitating factor
suggested Rx in HIV for
Delirium
Atypical preferred (Risperidone [16 max])
Avoid benzodiazepine
suggested Rx in HIV for
Depression
1st line SSRI =Citalopram /Escitalopram
SNRI
Mirtazapine
Bupropion
which antidepressant have to avoided in HIV depression?
MAOIs
suggested Rx in HIV for
Anxiety
SSRI
suggested Rx in HIV for
Bipolar
valproate
lithium with caution
which mood stabilizer should be avoided in bipolar HIV
carbamazepine
is hyperprolactinaemia dose related in antipsychotic use?
yesss
Long term risk fith antipsychotic - induced hyperprolactinaemia?
Osteoporosis
Breast Cancer (theoretical concern)
antipsychotics with high risk of hyperprolactinaemia
Almost all typical antipsychotics
SPAR
Sulpride
Paliperidone
AMulspirde
Risperidone
mnemonic for high risk hyperprolactinaemia antipsychotics
SPAR
prolactive meaurement as per maudsley
before
3 months
1 year
SPAR should be avoided in which patients
- under 25
- with osteoporosis
- hx of hormone-dependent cancer
-Young women
when should prolactine be measured?
1 hr after dose taking or waking
normal range of prolactine
Women 0-25 ng/ml
Men 0-20 ng/ml
abonormality of prolactine range
Elevated= 25-118 ng/ml
Highly elevated= >118 nm/ml
in highly elevated prolactine what should you rule out?
prolactinoma
what if prolactin is raised
if symptomatic = consider to switch (non SPAR)
if non-symptomatic = joint decision after discussion of risk (Breast cancer and Oesteoporosis
what antipsychotic can help if switching is not an option in antipsychotic induced hyperprolactin
add aripirazole (aro30)
other options if swtching is not an option in antipsychotic induced hyperprolactin?
- DA agonist (amantadine or bromocriptine= might worsen psychosis)
- High doses (2.5-3 mg)metformin
if antidepressant induce hyperprolactinemia
switch to mirtazapine
