Psychiatry Flashcards
Typical vs atypical antipsychotics
examples of each
Typical (block dopamine D2 receptors)
- Haloperidol
Atypical (block dopamine D2 receptors AND some serotonin receptors)
- Risperidone
- clozapine
- Quetiapine
- Olanzapine
- aripiprazole
Why would you use a typical vs an atypical antipsychotic
Typical (block dopamine receptors):
- treat positive symptoms of schizophrenia (hallucinations, delusions, disorganized thinking), but less effective at addressing negative symptoms (apathy, lack of motivation)
Atypical: good at both positive and negative symtpoms, also good for mood stabilisation
Antipsychotic SE’s
Typical vs atypical
TYPICAL
Extrapyramidal symptoms (EPS)
Neuroleptic malignant syndrome:
Sedation
antimuscarinic
Haloperidol: prolonged QT
ATYPICAL
Metabolic side effects: Weight gain, increased blood sugar, and increased cholesterol levels, which can lead to diabetes and cardiovascular issues.
Less EPS: as serotonin helps modulate the affect of dopamine
High prolactin levels
reduced seizure threshold
antimuscarinic
Clozapine: agranulocytosis, bowel obstruction/toxic megacolon, myocarditis
Aripiprazole: most tolerable side effect profile, esp w prolactin
Extra pyramidal side effects (EPS)
Akithesia: inner restlessness and an uncontrollable urge to move.
Dystonia: sudden movements
Tardive dyskinesia: involuntary, repetitive movements that usually affect the face, mouth, and tongue
Parkinsonism
What is neuroleptic malignant syndrome
rare but serious condition causing muscle stiffness, fever, and altered mental status.
how does anorexia impact blood results and obs
most things low (potassium, FSH/LH, oestrogen/testosterone, TFTs, HR, BP, BMI)
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Thyroid function tests (T3 reduced with malnutrition)
Creatinine kinase (elevated in excessive exercise).
Bicarbonate (elevated with purging, reduced with laxatives)
Side effects of antidepressant mirtazapine
Fewer side effects compared to other antidepressants
Sedation (worse at lower doses)
Increased appetite
good for elderly with low appetite and insomnia
Alcohol screening test for teens vs adults
Teens: SACs
Adults: AUDIT C
Questions to screen for alcohol misuse or addiction
When you stop drinking, do you develop any withdrawal symptoms, for example tremors, sweating, nausea, or anxiety?
Have you ever had a seizure or delirium tremens (DT)?
Has anyone ever raised concerns about your drinking?
Do you have to have a drink in the morning?
Do you ever have a drink overnight?
What sections of the 1992 mental health act do we need to know about in particular
Section 8a – Application for assessment (anyone)
Section 8b – Certificate supporting an application for assessment (Doctor or nurse)
Section 9 – Notice to attend an assessment examination (Mental health specialist)
Lithium side effects
Dose dependent: Fine tremor and nausea (pass after 1-2 days)
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement/hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
Toxicity: Coarse tremor, general fatigue, vomiting, diarrhoea, a metallic taste in the mouth, and a reduction in the sensitivity of the abdomen (central obtunding)
increased risk of manic relapse if suddenly stopped,
Avoid NSAIDs, ACE/ARBs, diuretics
How to monitor lithium levels, and what do the levels indicate
Serum concentration should be measured five to seven days after dose initiation or dose change,** then every six months**
blood sample should be taken 12 hours after dosing.
0.6 – 0.8 mmol/L - for stable patients
0.8 – 1.0 mmol/L - for acute mania or relapse
> 1.2 mmol/L - toxic
> 2.0 mmol/L - medical emergency
Pharmacologic Treatment for Bipolar disorder
Acute vs chronic
Chronic: anti-depressant + mood stabiliser (lithium, valporate, carbamazapine)
Acute: mood stabiliser is good but takes 5-10 days to take effect, bridge with benzos +/- atypical antipsychotics in the interim
Electroconvulsive therapy can be used for treatment-resistant pts (preg)
other bloods to monitor when on lithium
UES, TFTs: baseline then 6-monthly
Ca, ECG: baseline then yearly
What % of people with depression also have anxiety?
**35 to 50% **of people with major depression also meet the criteria for GAD
Having both depression and anxiety indicates a more severe anxiety disorder with a poorer prognosis
If anxiety symptoms arise as a consequence of depression, effective treatment of the depression will often relieve the anxiety symptoms
