Psychological Flashcards
What are the treatment options for patients with generalised anxiety disorder?
Sertraline = first-line (SSRI) Alternative = serotonin norepinephrine reuptake inhibitor
What are the treatment options for patients with acute anxiety disorder?
Benzodiazepines - avoid prolonged use
Propranolol
What is the mechanism of action for benzodiazepines?
Propagator of GABA neurotransmission; binds to GABA-A receptors, increases affinity of GABA to its receptor which then increases GABA-A’s opening frequency
How should you prescribe benzodiazepines?
Avoid where possible
Maximum 2-4 weeks use
Anxiety must be severe, disabling or causing the patient unacceptable distress
How should you prescribe SSRIs?
Therapeutic doses are approx the same for anxiety as what you’d prescribe for depression.
Time to onset varies by patient but usually it’s 4 weeks - continue initial therapeutic dose for 4-6 weeks and INCREASE DOSE if no response is shown (don’t switch meds)
What are the side effects of SSRIs?
- Sexual dysfunction
- GI abnormalities (nausea & diarrhoea)
- Insomnia
- Anorexia with weight loss
- Withdrawal on discontinuation
- Serotonin syndrome (tachycardia, agitiation)
What are the features of SSRI toxicity?
Onset: days - week after new SSRI/ increase in current SSRI dose
- Autonomic instability
- Mental status change
- Inducible muscle clonus (via excessive 5-HT1A and 5-HT2A stimulation)
- Hyperreflexia
- Muscle rigidity
- Hyperthermia
Why are SSRIs preferred over TCAs and MAOIs?
SSRIs are significantly less toxic (MAOIs caused most cases historically)
Which SSRIs are most likely to cause serotonin syndrome?
Sertraline
Paroxetine
Fluvoxamine
What pharmacological agents are available for sedation?
Benzodiazepines:
Diazepam (preferred)
Lorazepam
Chlordiazepoxide
What medications can be given as tranquillisers for patients?
Haloperidol
Olanzapine
Lorazepam
How do you manage a benzodiazepine overdose?
Supportive care (ABCDE) Continue management via IV thiamine (Pabrines)
What features would you expect to see in benzodiazepine dependence syndrome?
Tremor Anxiety Perceptual disturbances Dysphoria Psychosis Seizures
How would you manage benzodiazepine withdrawal?
- Benzodiazepine with a prolonged clinical effect (Diazepam = first-line)
- Titrate to effect
- Once symptoms are controlled, gradually taper down dose over several months
N.B. It’s almost impossible to get patients off benzos successfully
Why is lithium used as a mood stabilising drug?
Suspected to be linked to sodium transporters, reduction in suicide risk
What are lithium’s contraindications?
- Significant renal impairment
- Sodium depletion
- Dehydration
- Significant cardiovascular disease
What are the side effects associated with lithium?
- Nausea and diarrhoea
- CNS effects: tremor, ataxis, dysarthria, mild cognitive impairment
- Hypothyroidism
- Diabetes insipidus
- Overdose from its narrow therapeutic window
What are examples of SNRIs?
Duloxetine
Venlafaxine
What is reboxetine’s mechanism of action?
Selective noradrenaline reuptake inhibitor
What are examples of tricyclic antidepressants?
Amitriptyline
Imipramine
Lofepramine
What is mirtazapine’s mechanism of action?
Presynaptic alpha2-adrenoreceptor blocker
What are examples of classic monoamine oxidase inhibitors?
Phenelzine
Tranylcypromine
What is agomelatine’s mechanism of action?
Melatonin receptor agonist and serotonin receptor antagonist
How should a patient be monitored prior to starting antipsychotic medication?
- Weight
- Waist circumference
- Pulse & blood pressure
- ECG if cardiovascular risk factors are identified
- Fasting blood glucose/ HbA1c/ blood lipid profile & prolactin levels
- Assessment of any movement disorders
- Assessment of nutritional status, diet & level of physical activity
