Psychiatry Flashcards
What are major side effects of clozapine?
- DM2
Olanzapine and clozapine lead to weight gain / insulin resistance and therefore accelerate progression to IGT
Antagonism of H1 receptors induced antipsychotic induced weight gain.
these two have highest H1 affinity of antipsychotics and also most strongly associated with DM2
lower risk with risperidone
What are side effects of typical anti-psychotics
Extrapyramidal
- tremors
- rigidity
- resting tremor / chorea
- cogwheeling
- bradykinesia
- shuffling gait
- akinesis
- lead pipe rigidity
Anti-muscarinic
- polydipsia
- xerostoma
- xeropthalmia
- glaucoma
- hyperthermia
- tacchyarrythmia
- confusion
What could be used for refractory depression?
Lithium and fluoxetine
What is relatively safe in overdose used to treat depression?
Valproate
CNS depression can occur with low bp and lactic acidosis
Treat severe OD with ACT charcoal and HD if needed
What are the features of neuroleptic malignant syndrome
RHABDOMYOLSIS especially in older patients
Any dopaminergic antagonist drug
Altered mental state Rigidity Psychosis Pyrexia tachycardia / tachypnoea labile bp lead pipe rigidity in all limbs
Rasied CK (50-100%) myoglobinuria
Supportive management
discontinue all neuroleptics
ICU setting
BROMOCRIPTINE / DANTROLENE - dopa agonists
What is the management of OCD
CBT
SSRI
What is Cotard syndrome
Delusional depression
Believe they have actually died and no longer exist
Mx:
ECT
SSRI / NSRI / tricyclics are less successful and take time
