Psych- Tx Flashcards
Bipolar gold standard tx
and second line
Lithium- monitoring required can fuck kidneys and cause hyperparathyroidisn
sodium valproate second line
management of mania/hypomania in bipolar
consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
management of depression in bipolar
talking therapies; fluoxetine is the antidepressant of choice
Ed tx
Halt weight loss, if weight gain required then aim for 0.5-1.0kg inc per week
Medical stabilisation etc.
Schizophrenia tx guidelines
1st line: 2nd generation (atypical) 6-8 weeks + cbt
2: 1/2nd generation 6-8 weeks
3: check diagnosis, consider psychological input, optimise social support, check compliance
monitor CVD risks
First time pharmacological treatment for depression
how long should it be prescribed minimum
SSRIs- fluoxetine
at least 6 months post remission
Depression management
1:Watchful waiting 2 weeks
2: Group cbt/digital CBT, non directive supportive tx for 2-3months
3: Individual cbt, …
4th: fluxetine
5th: Sertraline or citalopram (SSRI)
still resistant?- ECT
Ptsd tx
1st: CBT
2nd: EMDR (eye therapy thing)
Exposure is key ingredient of successful psychological therapy
Complex ptsd tx
Phased treatment;
Stabilisation and safety (resourcing): enhance coping etc
Trauma tx (reprocessing): working through traumatic experience, cptsd
Rehabilitation
Medication for ptsd
if used: venlafaxine or SSRI eg. sertraline
severe - risperidone
drug tx should not be a routine first line tx for adults
Ocd mild tx
CBT including Exposure and Response Prevention (ERP)
2nd: SSRI or more intense CBT
moderate OCD tx (1st and second line drug)
1st: SSRI/ more intensive CBT (including ERP)
2nd line drug- clomipramine
severe OCD tx
refer to secondary care mental health team for assessment
whilst awaiting assessment offer combined treatment with an SSRI/clomiparine and CBT (including Exposure Response Prevention)
first line tx for parkinsons with quality of life affected by motor symptoms
levodopa
first line tx for parkinsons if motor symptoms are not affecting patients quality of life
dopamine agonist
or
levodopa
or
monoamine oxidase
give an example of a short acting benzodiazapene
lorazepam
give 2 examples of long acting benzodiazepines
chlordiazepoxide and diazepam
alcohol withdrawal tx
first second line
1st line: . chlordiazepoxide or diazepam
2nd: carbamezapine (anti-convulsant)
how long should antidepressants be continued
at least 6 months after remission of symptoms to decrease risk of relapse
generalised anxiety disorder drug treatment
1st line: sertraline
2nd: alternative ssri or SNRI
3rd: if neither SSRI or SNRI tolerated offer pregabalin
generalised anxiety disorder step wise approach
step 1: education about GAD + active monitoring
step 2: eg. guided self help
step 3: eg cbt or drug treatment.
step 4: highly specialist input e.g. Multi agency teams
SSRIs are associated with inc risk of suicide in the under… agr group. therefore a review must be done within …. of commencing SSRI
under 30
review within 1 week of commencing
if OCD tx with ssri is effective, how long must it be continued
at least 12 months to avoid relapse
what type of drug is clomipramine
tricyclic antidepressant
how do tricyclic antidepressants work and SE
inhibit re-uptake of noradrenaline and toa lesser extent serotonin
antagonism of :
histamine receptors (drowsiness),
muscarinic receptors (dry mouth, blurred vision, constipation etc),
adrenergic receptors (postural hypotension)
lengthen QT interval
which antipsychotic reduces seizure threshold
clozapine
which atypical antipsychotic has the most tolerable side effect profile
apiprazole- particularly for prolactin elevation
give 2 examples of SNRIs
duloxetine and venlafaxine
what are the risks of SSRI use in pregnancy
first trimester -congenital defect (paroxetine inc risk)
use during third trimester can cause persistent pulmonary hypertension of the newborn
how often are lithium levels checked
lithium levels checked weekly until levels stable, includes after dose change, after stable, check every 3 months
panic disorder tx
1st line: CBT
2nd: SSRIs
3rd: clomipramine- (tricyclic)
escitalopram drug- what is it
SSRI
what is clomipramine
tricyclic antidepressant
antipsychotics:
avoidance of EPSE (extrapyramidal side effects)
give atypical
antipsychotics: less sedating
give haloperidol, risperidone
antipsychotics: more sedating
give Olanzipine, Chlorpromazine.
antipsychotics:
Avoidance of weight gain
give Haloperidol, Aripiprazole.
antipsychotics: treatment resistant
give clozapine
antipsychotics: depot
give risperidone
SSRIs se
hyponatraemia
sexual dysfunction
worsening symptoms
what substances have anti-convulsant properties and therefore can cause…. when suddenly stopped
(non epileptic drugs)
benzodiazipines
alcohol
heroin overdose tx
naloxones
paracetamol overdose tx
<1 hour - activated charcoal
>1 hour- acetylcysteine
absolute contraindication to ECT
raised ICP
benzos act on what receptor
gaba A agonists (increase nurone inhibition)
benzodiazapines reversal drug
flumazenil
what antidepressant has a self harm risk
SSRI
monamine oxidase inhibitor mechanism of action
se
prevents removal of monamines froms ynaptic cleft
can cause hypertensxive crisis if taken with substances contining tyramine eg cheese alcohol
serotonin syndrome tx
benzo for agitation
sever: ventilation and sedation
opiod detox tx
methadone full agonist, oral solution
buprenorphine- partial agonist, oral tablet
delirium tremens tx
long acting benzo eg. chloropioxide
