Psych stuff you forget Flashcards
What are the 4 dopaminergic tracts in the brain and what is there function?
Mesolimbic pathway – brainstem to nucleus Accumbens – reward centre and salience. Blocking
Mesocortical pathway – VTA to neocortex – emotion control, executive function Nigrostriatal pathway - SN to BG. Used for movement.
Tuberoinfundibular pathway – hypothalamus to pituitary. Dopamine inhibits prolactin release.
What abnormalities are their in the dopaminergic pathways in psychosis/schizophrenia
Underactivity in Mesocortical pathway – decreased emotions/negative symptoms
Overactivity in mesolimbic pathway – increased salience to label stimuli.
Describe SE of typical antipsychotics related to the 4 dopaminergic tracts.
Antipsychotics block D2 receptors.
- By blocking mesolimbic pathway we reduce reward
- By blocking Mesocortical we worsen negative symptoms (neuroleptic dysphoria – feel deadened)
- By blocking nigrostriatal we increase muscle tone – acute dystonia’s, akathisia, long term tardive dyskinesia.
- By blocking tuberoinfundibular pathway can get excess prolactin release (menstrual difficult, gynaecomastia, galactorrhoea).
What can we give to treat acute dystonia’s with if antipsychotic SE?
Procyclidine.
Can give benzos initially.
What can acute dystonia’s lead to if untreated?
Tardive dyskinesia – slow rolling movements of the mouth and tongue. This is irreversible so reduce antipsychotic dose if this is happening.
Name 3 typical antipsychotics
CHaFT P
Chlorpromazine
Haloperidol
Flupentixol
Trifluoperazine
Pipotiazine
Name 3 atypical antipsychotics
QuARC OA
Quetiapine
Aripiprazole
Risperidone Clozapine
Olanzapine
Amisulpride
what do you need to check for clozapine
FBC – agranulocytosis
Constipation (otherwise bowel obstruction and death).
What are indications for clozapine?
Failed treatment from 2 other antipsychotics.
Special about olanzapine and specific SEs
Longest elimination half-life.
Weight gain and T2DM
Special about Risperidone
Most commonly causes hyperprolactinaemia
Some SE of atypical antipsychotics
Wide range due to their blockade on dopamine receptors.
These include metabolic syndrome, dystonia, dyskinesia, hyperprolactinaemia, prolonged QT.
NMS – definition, aetiology, symptoms, treatment
A rare psych emergency.
Initiation of anti-dopaminergic medication (antipsychotics) or withdrawal of dopamine agonists (levodopa).
Fever, sweating/autonomic instability, dysphagia, muscle rigidity and confusion.
Treat with bromocriptine – a dopamine agonist.
How do we treat acute psychosis?
Oral/IM benzodiazepine (Lorazepam) and/or antipsychotics.
If patient aggressive/violent then parenteral RT (BDZs – lorazepam, haloperidol)
What kind of SE’s do typical antipsychotics cause
Extrapyramidal SE
Hyperprolactinaemia
Name 3 mood stabilisers
Lithium, sodium valproate and carbamazepine
Name a monoamine oxidase inhibitor and its indications
These are indicated in treatment resistant major depression.
Examples include phenelzine
How to treat alcohol withdrawal?
Generally, long acting BDZs like chlordiazepoxide or diazepam.
In hepatic failure lorazepam is preferred.
1st line drug in ADHD
Methylphenidate – a dopamine/norepinephrine reuptake inhibitor
Describe SSRI and NSAID interaction
Avoid SSRIs in NSAIDs due to increased risk of GI bleeding. Consider another class of antidepressant or co-prescribe a PPI (be aware of interactions).
Can you give SSRI with sumatriptan?
Triptans are 5HT3 receptor agonists (serotonin) so you cannot due to unacceptable risk of serotonin syndrome.
Can you give SSRI with warfarin/heparin?
No increased risk of bleeding. Consider Mirtazapine but INR may still increase.
Name 3 special things about the SSRI sertraline
Lowest potential for drug interactions
Only SSRI show dose/response curve
Also recommended 1st line in GAD
Name 2 special things about Fluoxetine
Lowest rate of discontinuation symptoms due to long half-life meaning cannot be used in breastfeeding
Recommended 1st line for patients <18
Name 1 special thing about citalopram
Most associated with dose dependent QTC prolongation
What kind of drug is Mirtazapine and name 2 SE’s
It is a NaSSA used 2nd line for moderate/severe depression
Anti-histamine effects - associated with significant weight gain and day time drowsiness (hence useful in insomnia).
What kind of drug is Venlafaxine?
SNRI
What kind of drug is Paroxetine and state 1 special thing about it
SSRI – most likely to cause discontinuation symptoms
What kind of drug is Bupropion?
Atypical antidepressant (dual inhibition of norepinephrine and dopamine reuptake)
Used in smoking cessation. Contraindicated in AN.
State SSRI discontinuation symptoms
Mood change, restlessness, difficulty sleeping, unsteadiness, sweating, GI symptoms, paraesthesia.
What medication changes if SSRI not worked?
Generally, try a second SSRI. If still doesn’t work then a third is unlikely to.
Instead Venlafaxine (SNRI), Mirtazapine or TCA.
Name 5 indications for BDZs
Sedation (rapid tranqulisation)
Hypnotic – reduce anxiety, pain control, behaviour.
Anxiolytic
Anticonvulsant
Muscle relaxant
Diazepam is used 1st line for seizures/status epileptics. And severe, disabling anxiety.
What is a general difference between anxiolytics and hypnotics?
Hypnotics will sedate during the day
Anxiolytics (sedatives) induce sleep at night
How do BDZs work?
Enhance the effect of GABA receptor, a chloride channel that opens in response to GABA – hyperpolarises the neuron.
Patients commonly develop tolerance and dependence – should only be prescribed for 2-4 weeks.
Name 4 BDZs, their relative duration of action and an indication
Diazepam – long acting, alcohol withdrawal
Lorazepam – intermediate acting, anxiety
Temazepam – intermediate acting, insomnia
Midazolam – short acting, sedation.
Long acting BDZs like lorazepam or Diazepam is preferred for seizures. In sedation, short action is preferred.
What is the problem with long acting BDZs?
Diazepam has an elimination half-life of 72hrs which can cause daytime sedation or the hangover effect
State some symptoms of BDZ withdrawal
Severe – confusion, toxic psychosis, convulsions. Resembles delirium tremens
What is an important SE of BDZs?
Respiratory depression – careful if opioids are co-prescribed.
Name a class of sedative
H1 receptor antagonists – promethazine and cyclizine.
Which drugs are related to impulse control disorder?
Dopamine agonists (bromociptine, cabergoline) – Parkinson’s patient.
How do Z-hypnotics work?
Stimulate the subunit of the GABA receptor to exert effects – binds to a distinct site to BDZs but has a similar effect
Name 2 indications for Z-hypnotics
Zopiclone – used for insomnia and anxiety but prolonged use should be avoided due to tolerance and addiction
What medication do you prescribe for personality disorder?
Medication does not help unless used to treat comorbidities
State 1st and 2nd line pharmacological interventions for GAD
1st – sertraline or alternative SSRI/SNRI. Requires weekly follow-up first month.
If cant tolerate, offer pregabalin.
Can also offer beta blockers for symptoms.
Describe treatment for panic disorder
BDZs not recommended. Sedating antihistamines or antipsychotics are not normally prescribed but may help.
State 3 TCA’s
Imipramine, Clomipramine and amitriptyline
What antipsychotic can be used in acute bipolar disorder?
Quetiapine is good due to its extra sedative effect.
Also, olanzapine/risperidone.
How can we treat heroin addiction?
Substitute, e.g. methadone.
How can we treat cocaine addiction?
There is NO SUBSTITUE. Advice, safe sex, BBV advice.
Name some drugs used to treat opioid detoxification and maintenance
Detoxification - Lofexidine, Buprenorphine
Maintenance – Methadone, Buprenorphine
Relapse prevention – naltrexone.
What medication is used for somatisation disorders?
No direct pharmacological treatment, only for comorbidities.
Describe 1st, 2nd and 3rd line treatment of OCD (hint not all pharmacological)
1st – BT or ERPT
2nd – fluoxetine or other SSRIs
3rd - try another SSRI
4th line – clomipramine (a serotonergic TCA).
Can also consider phenelzine (MAOIs).
What medication should be prescribed for PTSD?
No direct pharmacological treatment – CBT or EMDR better.
Treat comorbidities with pharmacology.
Which SSRI is used in <18s?
Fluoextine
Which SSRI cannot be used in breastfeeding?
Fluoextine
Sertraline and paroxetine are preferred
What 3 systems do TCAs effect and thus what are their SE’s?
Anti-adrenergic - postural hypotension
Anti-cholinergic - dry eyes, mouth, urine retention, constipation
Anti-histamine - weight gain and sedation
Can also prolong QT interval
SSRI withdrawal Sx
Dizziness, headache, tremor, agitation, GI disturbance
How is lithium metabolised/excreted?
Hence 3 drugs which should be avoided with it
Renally
ACEi, NSAIDs - too greater risk of nephrotoxicity
Diuretics - too much dehydration.
Why may Valproate be preferred to lithium as a mood stabiliser?
If there is renal impairment (lithium renally excreted)
Also there is less need for constant blood monitoring
How do Z drugs and BDZs work?
Both work similar - stimulate GABA receptor.
Z drugs used for sleep.
Are antipsychotics anti-cholinergic?
Yes, hence causes the cant see, wee, spit shit SEs
Which antipsychotics prolong QR interval?
Risperidone and Haloperidol.
What tests to do before starting AChI for AD? (Donepezil)?
ECG and pulse, as it can cause bradycardia.
Describe MHA and MCA
MHA 1983, amended 2007 – civil law which relates to the involuntary admission and treatment of patients with mental disorders.
MCA (including Deprivation of Liberty Safeguarding DOLS 2005) – civil law which concerns consent, capacity and deprivation of liberty.
What is an AMHP, AC, RC, NR, S12 approved doctor?
AMHP - approved mental health professional. Any non-dr who has specialist training in mental health assessment, so can apply for patients to be assessed/treated under sections of MHA
AC - approved clinician. secretary of state can authorise a mental health dr to act as an AC for purposes of the MHA. They responsible for people detained under MHA
RC - responsible clinician. AC with overall responsibility for pts care under MHA. Can be a doctor, social worker, nurse. Usually, the patient’s inpatient consultant.
NR - nearest relative. Family member who has the right to apply for an individual to be assessed under the MHA. Also have right to object to the use of MHA
S12 Dr - recognised under section 12(2) of MHA as having expertise in psych (consultant or SpR) and can file for detaining (2 or 3) with another doctor
Section 2, describe, purpose, duration (renewable)?, who needed to order it, extra.
Assessment
28 days (non-renewable)
AMHP applies but authorised by 2 doctors (one must be S12 approved)
Must have a mental health disorder present
Section 3, describe, purpose, duration (renewable)?, who needed to order it, extra.
Treatment
6months (renewable)
AMHP applies but authorised by 2 doctors (one must be S12 approved)
Reasons for S2 but treatment must be available.
Section 4, describe, purpose, duration (renewable)?, who needed to order it, extra.
Emergency
72hours (non-renewable)
Usually applied for by AMHP or NR, only authorised by 1 doctor
Section 5(2), describe, purpose, duration (renewable)?, who needed to order it, extra.
Voluntary holding of inpatients (inc. those being held for a physical health problem) - not A&E/community
72hrs (non-renewable)
Authorised by 1 dr or RC
Remember 5(2) for F2’s and 72hrs
Section 5(4), describe, purpose, duration (renewable)?, who needed to order it, extra.
Mental health nurse holding powers
6hrs (non-renewable)
Authorised by approved mental health professional/mental health nurse
Can only be used in hospital inpatient and not community/A&E
Section 136 and 135, describe, purpose, duration (renewable)?, who needed to order it, extra.
Police removing people from public place
24hrs, can be extended to 36hrs
Requires police officer
135 is the same but removal from home - requires court order.
What is section 62(1)?
RC (consultant) can write this for urgent medicines needing consent to treatment (pt cannot consent)
Requires second opinion appointed doctor.
The MHA relates only to Tx of mental disorders, not any physical health co-morbidity that a detained psych patient may have. What are the 2 exceptions?
Enforced refeeding for severe AN
Tx of physical sequelae of attempted suicide attempt which was result of underlying mental disorder
Difference between malingering, Munchausen syndrome and hypochondriasis/illness anxiety disorder?
Malingering – faking symptoms for a secondary benefit, e.g. monetary compensation
Munchausen syndrome – faking symptoms for a direct primary benefit such as medical attention.
Hypochondriasis / illness anxiety disorder – patient reports symptoms and is worried about having a serious disorder, even extensive investigations with no significant findings.
What is De Clerumbault’s syndrome
Delusion of love
Syndromes - describe Capgras, De Fregoli, Othello, Ekbom, Cotard
Capgras - person has been replaced by an imposter
De Fregoli - different people are in fact a single person who changes appearance or is in disguise
Othello - delusion of sexual infidelity on part of a sexual partner
Ekbom - delusion of infestation/parasitosis
Cotard - someone has lost organs/blood or body parts up to the point where someone believes they are dead.
Hallucinations - describe: elementary, lilputian, reflex, autoscopic, haptic, hypnogogic and hypnopompic
Elementary hallucination – simple, unstructured sounds, e.g. buzzing or whistling, or flashes of light.
Lilliputian hallucination is associated with micropsia (objects perceived to be smaller), it is associated with delirium.
Reflex hallucinations are when a normal sensory stimulus, in one modality, precipitates a hallucination in another e.g. the voices are only heard when the lights turn out.
Autoscopic hallucination is a visual hallucination, which describes the experience of seeing oneself in external space.
Haptic is another word for tactile hallucinations. Formication is one type of this, where the patient has a sensation of insects crawling on the skin. This may be associated with long-term cocaine use, or alcohol withdrawal.
Hypnogogic hallucination – occur just as the individual falls asleep. Usually auditory (remember groggy – gogic).
Hypnopompic hallucinations – occur just as the person wakes.
Illusions - describe auditory, affect, completion, pareidolia
Auditory illusion – thinking someone said your name.
Affect illusion – associated with mood states, for e.g. someone who has recently been bereaved may “see” their loved one.
Completion illusion – due to inattention when reading, such as misreading words or completing faded letters.
Pareidolia – when an individual perceives a vivid picture in an otherwise vague or obscure stimulus, such as seeing faces or animals in clouds.
Describe palilalia, echolalia, echopraxia, copropraxia
Palilalia is the automatic repetition of one’s own words, phrases or sentences.
Echolalia – repetition of someone else’s speech including questions being asked. A feature of schizophrenia, typically catatonic schizophrenia which is characterised by negative Sx (blunting of affect, alogia (poverty of speech) and avolition (poor motivation)).
Echopraxia is the meaningless repetition or imitation of the movements of others.
Copropraxia is the involuntary performing of obscene or forbidden gestures or inappropriate touching.
What are the 3 parts to disorders of thought?
What is the difference between formal through disorder and disorders of thought
Thought form - processing/organising of thoughts.
Thought content - delusions, obsessions, compulsions
Thought posession - insertion, withdrawal, broadcasting etc.
Disorders of thought can be any of the 3 things above and the many things in each of those categories.
Formal thought disorder – when patients speech indicates that the links between consecutive thoughts are not meaningful. Includes loosening of association, alogia, blocking, circumstantiality, clang association etc.
Abnormalities of thought form include the following - describe them:
Loose associations - clang associations, word salad, knight’s move
Flight of ideas
Circumstantial/tangenital thoughts
Thought blocking
Perserveration
Neologisms
Loose associations
- Clang associations are when ideas are related to each other only by the fact they sound similar or rhyme.
- Word salad is completely incoherent speech where real words are strung together into nonsense sentences.
- Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.
Flight of ideas, a feature of mania, is thought disorder where there are leaps from one topic to another but with discernible links between them.
Circumstantial thoughts - Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return the original point.
Thought blocking - inability to finish a sentence or thought.
Perseveration is the repetition of ideas or words despite an attempt to change the topic.
Neologisms - are new word formations, which might include the combining of two words.
Some abnormalities of thought possession are alienation experiences. Describe these and their significance
Thought insertion, broadcasting, withdrawal.
These are thought alienation experiences, first rank symptoms of schizophrenia
Which physical conditions can precipitate anxiety?
• Hyperthyroidism
• Phaeochromocytoma
• Lung disease – excessive use of salbutamol (adrenaline agonist)
• CHF – heart medications can lead to anxiety
• Hypoglycaemia
Key Sx for diagnosis of GAD
excessive worry about many events (not just one thing), difficulty controlling the worry for at least 3 weeks (some say 6m).
Describe NICE stepwise approach to GAD management
- Education about GAD (bodily responses related to anxiety) + active monitoring. Self-care – sleep hygiene, exercise.
- Low intensity psychological interventions (individual, non-facilitated self-help or individual guided self-help, or psychoeducational groups). Less evidence than in other anxiety disorders as lack of triggers to target.
- High intensity psychological interventions (CBT or applied relaxation) or drug treatment, drug treatment includes:
- Sertraline is first line SSRI. If ineffective offer alternative SSRI (fluoxetine) or SNRI (duloxetine/ venlafaxine). Weekly follow-up for 1st month - suicidal thinking risk.
- If cannot tolerate SSRI or SNRI then offer pregabalin. - Highly specialist input, e.g. multi-agency teams
What characterises Panic disorder?
Characterised by repeated unpredictable attacks of severe anxiety that occur without warning. Autonomic symptoms predominate, peaking in severity within 10minutes.
For a diagnosis of PD, there must have been several attacks in a month or a single attack must be followed by 4 weeks of persistent fear of another attack. Not 2o to substance misuse/medical conditions or other psych disorder.
NICE stepwise Mx of Panic disorder
Step 1 – recognition and diagnosis
Step 2 – treatment in primary care:
o CBT or drug treatment.
o SSRIs are first-line, contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered (TCAs not actually licenced).
Step 3 – review and consideration of alternative treatments
Step 4 – review and referral to specialist mental health services
Step 5 – care in specialist and mental health services.
BDZs can be used for 2wks if incapacitating Sx
Mx of agoraphobia or social phobia
Pharmacological - antidepressants as for PD. BDZs short term
Psych - behavioural or cognitive methods.
Describe bipolar type 1 and 2
Type 1 is mania (>1week +/- psychosis) and depression
Type 2 is hypomania (4+ days, no effect on function) and depression
Describe cyclothymia
Chronic, fluctuating course of mood disturbance characterised by numerous periods of hypomanic symptoms and numerous periods of depressive symptoms; the symptomatic periods are of insufficient severity, pervasiveness, or duration to meet full criteria for a manic episode or for a major depressive episode. For at least 2 years.
For BAD, how is acute manic and acute depressive episode managed?
Antipsychotic for mania, quetiapine preferred due to sedative effect. Haloperidol can make mania worse. ween SSRI.
Acute depression - not antidepressants. Quetiapine, lamotrigine, olanzapine used.
Stop antidepressants/ween down as can precipitated mania. Can have SSRI as long as mood stabiliser as well.
Monitoring of lithium and SE of lithium
Weekly until levels stable, 3m for first year, then every 6months (BMI, U&Es, TFTs)
Weight gain, nephrotoxic, tremor, DI, hypothyroidism
Signs of lithium toxicity and treatment
Like a drunk person - slurred speech, ataxia, coarse tremor, sleepy, confusion. Also extreme thirst, diarrhoea, N/V
Stop lithium and rehydrate.
NMS Px quadrad and treatment?
Hyperthermia, muscular rigidity, confusion/delirium/altered level of conscious, autonomic lability (diaphoresis, tachycardia)
BDZs for acute behavioural disturbance
Supportive measures - cooling to reduce temperature, oxygen, fluids.
Monitor rhabdomyolysis (CK, AKE - U&E’s) - Tx w/ hydration and alkalinsation of urine w/ IV sodium bicarb
Pharmacotherapy to reduce rigidity
- Dantrolene - muscle relaxant that blocks ryanodine receptors (Ca2+). Also used for spasticity after strokes and hyperthermia
- Lorazepam
- 2nd line - Bromocriptine (DA agonist)
- 3rd line - Nifedipine
Triad of serotonin syndrome Px and Mx
Neuromuscular excitability (myoclonic jerks, hypertonia, clonus)
Altered mental state - agitation, anxiety, confusion
Autonomic dysfunction (high/low BP, tachycardia)
If mild, reduce dose, cardiac monitoring, observe for at least 6hrs. Symptoms usually resolve within 24hrs
Moderate/severe - diazepam to settle hyperadrenergic Sx. Alternatively a serotonin antagonist (Cyprohepatine) and intensive care.
4 signs of bulimia nervosa
Enamel erosion - cavities/tooth sensitivities
Swollen salivary glands
Russell’s sign (calluses on knuckles)
Hoarse voice
Normal body weight
8 indications for hospital admission in eating disorders
Low weight (<85% expected or <1/3 centile for BMI)
Lack of weight gain
Significant oedema
Physiological decompensation (electrolyte imbalance, cardiac disturbance, altered mental status, orthostatic differential >30)
Temperature <36C
Pulse <40bpm
Psychosis or high suicide risk
Mx of eating disorder
Short-term: NG tube, stabilise, avoid refeeding
Longterm: CBT first line. Fluoxetine at high dose is an option but not licensed. Remember low dose for drugs if low BMI.
Difference between AN and food avoidant disorder
Food avoidant disorder - low food intake without any disturbances in body image.
What do antipsychotics do to seizure potential?
Reduce it - Clozapine the worst, Haloperidol does it the least.
What are SCAM SE of clozapine
Seziures (reduced seizure threshold)
Constipation
Agranulocytosis
Myocarditis
What is catatonia and what is it a feature of?
Catatonia is stopping of voluntary movement or staying still in an unusual position. Not speaking/making any movements.
It is believed to be due to abnormalities in dopamine levels. Commonly described to be associated w/ certain types of schizophrenia.
Can be managed w/ BDZs or ECT
Signs (toxidrome) of TCA overdose
Tachycardia
Dilated pupils
Decreased conscious
ECG - wide QRS and prolonged QT
When do you initially need to monitor lithium levels?
Weekly, until levels are stable. It is usually checked 12hrs after the dose is taken.
Once levels are stable 3monthly for a year, then 6monthly in low risk patients.
Alcohol withdrawal timings
6-12hrs - symptoms
36hrs - seizures
72hrs - delirium tremens
Which antipsychotic has the lowest SE profile
Aripiprazole - particularly for prolactin elevation.
Hyperprolactinaemia - ED, gynaecomastia, loss of libido.
What do you do if clozapine doses are missed for >48hrs?
Need to restart/re-titrate the clozapine dose up again slowly.
This is because when you start Clozapine after a break of >48 hours, it can make side effects worse, such as blood pressure changes, drowsiness and dizziness. If there is a gap in treatment of 3 days (72 hours) then you may also require more frequent blood tests for a short period.
4 key Sx of PTSD
Re-experiencing/intrusion Sx
Avoidance
Hyperarousal - sleep problems, anger
Emotional numbing
Within 1-6m after the thing
What are DSM-5 3 degrees of severity of depression?
For all, Sx must be present every day for 2 weeks.
Mild depression - 2 core symptoms and 2 other sympotms. Minor functional impairment
Moderate depression - 2 core symptoms and 3 other symptoms.
Severe depression - all 3 core symptoms and 4+ other symptoms. Seriously distressing and unmanageable sx.
Describe PHQ-9 output for depression
0-4 - none
5-9 mild (watchful waiting, repeat at follow-up)
10-14 moderate, treatment plan, counselling or pharmacotherapy
15-19 - moderately severe - active Tx w/ pharmacotherapy and/or psychotherapy
20-27 - severe. Immediate.
Depression Tx if pregnant?
SSRI (sertraline)
ECT
Psychotherapy
Depression Tx if SSRI fails
Try another SSRI
If fails, try SNRI or Mirtazapine (can cause weight gain)
If fails, can try TCAs or MOAs (phenelzine)
1st rank Sx of schizophrenia (TP3D)
- Thought alienation
- Passivity phenomena
- 3rd person auditory hallucinations
- Delusion of perception
Duration of BDZs (D LTM (limited time event))
Duration of BDZs from longest to shortest:
- Diazepam
- Lorazepam
- Temazepam
- Midazolam
How do you remember how to treat acute dystonia’s and tardive dyskinesia?
Procyclidine for acute dystonia (anticholinergic for acute)
Tetrabenazine for tardive dystonia (inhibits Moa breakdown or something)
So for both, match the first letters.
What do alcohol drugs do?
Acamprosate
Naltrexone
Disulfiram
Naloxone
A = anti-craving
Naltrexone is longer than naloxone indicating it is used for both alcohol and opioid withdrawal. Naloxone is therefore the opioid OD antidote
Disulfiram inhibits aDh enzyme so not metabolised causing immediate hangover.
What are 3 cluster’s of personality disorders?
Cluster A (Odd or Eccentric - “weird”) - Paranoid, Schizoid, Schizotypal
Cluster B (Dramatic, Erratic - “wild”) - Antisocial, EUPD, Histrionic, Narcissistic
Cluster C (Anxious, Fearful - “worried”) - avoidant, dependent, obsessive-compulsive/Anankastic
Describe Schizoid and schizotypal PD
Schizoid like a void. Cold, detached, indifferent, few interests, no friends
Schizotypal is kind of like classic schizophrenia - delusions, distorted perceptions, unusual words or phrases.
Describe histrionic and narcissistic PD
Histrionic - need to have attention on themselves, act in dramatic/narcissistic way to achieve this. Inappropriate sexual advances.
Narcissistic - grandiosity, lack of empathy, need for admiration.
Describe avoidant and paranoid PD
Paranoid - find it hard to trust and confide in others. Interpret innocuous remarks and situations as dangerous/threatening.
Avoidant - painfully shy, insecure, fearful of criticism, unliked, rejection.
What are some SE of SSRI’s in pregnancy:
- First Trimester
- Third Trimester
What does paroxetine do in pregnancy?
Use during first trimester gives increased risk of congenital heart defects
Use during third trimester can result in persistent pulmonary hypertension of the newborn
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
