Psychiatry Flashcards
Side effects of lithium
short term - NVD, polyuria, polydipsia, fine tremor
Long term - weight gain, hypothyroidism, impaired kidney function
Lithium toxicity
Coarse tremor, hyperreflexia, ataxia, nystagmus, renal impairment - oliguria, dysarthria, seizures convulsions
Advice when starting lithium
-Its a mood stabiliser drug, advise you to stay on this for at least 3 yrs - before that the rate of relapse with bi-polar is high.
- Shouldn’t rapidly change the amount of salt in your diet.
- Should use contraception and have a discussion with doctors before trying to become pregnant
- Take the lithium at the same time every evening - allows accurate blood tests when we measure the levels so we can make sure they’re in the right range.
- If you miss a dose don’t double your dose, just leave the missed tablet ad continue as normal the next day. but if you regularly miss your dose then it won’t be as effective and there is risk of recurrence.
- regular blood tests to maintain the levels of lithium in your blood at the correct level.
some things interact with lithium so you shouldn’t use NSAIDs over the counter, other drugs to be avoided include diuretics, ace inhibitors ( a type of BP med), SSRIs + haloperidol.
Life threatening adverse effects of clozapine
- Blood dyscrasia
- Seizures
- PE
- Myocarditis
Workup before starting clozapine
FBC Weight + BMI blood glucose fasting lipid profile ECG
non life threatening side effects of clozapine
Sedation hyper salivation weight gain HTN tachycardia constipation fever
what is the starting dose of clozapine?
12.5mg OD take at night b/c of hypotension. then 12.5mg BD, work up to a total of 300-450mg/day with plasma level of 350mcg/L
How often are bloods done on a patient on clozapine?
Weekly for first 18 wks, then bi-weekly until end of first yr, monthly after that first yr.
Bloods to be done before starting lithium
renal function
TFTs
Alternatives to lithium
sodium valproate, carbamazepine, lamotrigine
Treatment of acute mania
Stop anti-depressant
consider anti-psychotic = olanzapine for behaviour short term
consider short acting Benzo or sodium valproate
long term Goal will be to start lithium therapy,
Side effects of SSRI
nausea, vomiting, sleep disturbance, Dizziness, increased suicide risk.
Serotonin syndrome - tremor, hyperthermia, CV collapse
Example of SSRIs
Sertaline, citalopram, fluoxetine
What type of drug is venlafaxine
SNRI
Side effects of Amitryptyline
Atropine like effects
- constipation, blurred vision, dry mouth, postural hypotension.
Side effects of ECT
short term - headaches, muscles aches, nausea, confusion,
- possible that Short term memory + executive functioning would be impaired - should improve but there is some evidence to suggest that this can be long term.
- less likely with unilateral electrode use ( done now vs the bilateral which was the old way)
Indications for ECT
Catatonia
Severe treatment resistant depression or when a rapid response is needed,
Refractory psychosis
Refreactory or life threatening mania
Side effects of anti-psychotics
Postural hypotension, sedation, weight gain, dry mouth, increased QTc
Major side effects include extra-pyramidal SE’s, Tardive dyskinesia, endocrine se - hyperprolactinemia, metabolic syndrome.
What are the extra-pyramidal side effects and when do they occur?
Dystonic reactions ( hrs) - e.g. oculogyric crisis
Akathasia (1-2wks)= restlessness
Parkinsonism (1-6wks) - pill rolling tremor
What is tardive dyskinesia
A long term side effect of anti-psychotic medication ( but is less common with the newer medications). A movement disorder that is often irreversible, tremor, writhing?, oro-facial dyskinesia.
Symptoms of delirium tremens
Confusion
Vivid hallucinations
Marked tremor
Symptoms of Wernicke’s encephalopathy
Confusion, ataxia, ophthalmoplegia
Risk factors for neuroleptic malignant syndrome
- rapid dose increase
- rapid withdrawal
- anti-psychotic polypharmacy
- male
- younger age
- dehydration
- parkinson’s
- alcoholism
- hyperthyroidism
S+S of neuroleptic malignant syndrome
Fever, diaphoresis, rigidity confusion tachycardia, fluctuating BP, elevated CK, altered LFTs, leukocytosis
List the causes of delirium
Infections Withdrawal - benzo, alcohol Acute metabolic syndrome Trauma Cns pathology - SOL Hypoxia Deficiency B12, B1, folate, Endocrine Acute vascular - stroke, TIA Toxins - drugs Heavy metals - lead
Key features of delirium
- Acute onset + fluctuating course
- Inattention
+ Disorganised thinking / altered LOC
What are the somatic symptoms of depression?
sleep distubance apetite diurnal mood variation flattened affect psychomotor agitation poor concentration anhedonia
What are the first rank symptoms of schizophrenia?
Auditory hallucinations
Thought interference - TI,TW,TB
Passivity phenomena
Delusional perception.
What are the +ve symptoms of schizophrenia?
Delusions
hallucinations
thought disorder
What are the negative symptoms of schizophrenia?
flattened affect
social withdrawal
loss of volition - passivity
