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psychiatry > psychopharmacology > Flashcards

psychopharmacology Flashcards

1
Q

indications of SSRIs

A
  • moderate/severe depressive episodes (all SSRIs)
  • dysthymia
  • GAD (paroxetine)
  • chronic pain
  • schizoaffective disorder
  • OCD
  • panic disorder (citalopram, escitalporam, paroxetine)
  • social phobia (escitalopram, paroxetine)
  • PTSD (paroxetine, sertraline)
  • impulsivity associated w personality disorders
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2
Q

when do we deem no imporvement w antidepressants

A

at least 2 months

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3
Q

antidepressant classifications

A

TCAs - tricyclic antidepressants
MAOIs - monoamine oxidase inhibitors
SSRIs - selective seotonin
SNRIs

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4
Q

what are TCAs

indications

A

imipramine, amitryptilline

lethal in overdose

QT prolongation and arrhytmias

indications
- depressive illness, nocturnal enuresis in children, neuropathic pain

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5
Q

SEs of TCAs

CIs

A 
sedation, weight gain
- antoihistaminc
- anticholinergic - SLUDGE OPPOSITE
- antiadrenergic - orthostatic hypotension, libido
confusion/delirium
gynaecomastia/galactorrhoea

CIs - recent MI, arryhthmias, mania, sever liver disease, agranulocytosis

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6
Q

MAOIs

indications

A

inhibit monoamine oxidase A and B present at nerve terminals

irreversible - phenelzine, isocarboxide

reversible - moclobemide - good for atypical depression

indications

  • third line for depression or treatment resistant depression
  • social phobia

TYRAMINE CHEESE REACTION
hypertensive crisis - tyramine reaction
avoid certain foods such as peas, wine, processed meats as they contain high amounts of tyramine - high MAOIS inhibitor increase tyramine increase catecholamines leading to HTN crisis - CVS events ie stroke
clinical features
- headache, palpitations, fever, convulsions, coma

serotonin syndrome

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7
Q

SEs of MAOIs

A

CVS - OH, arrhythmias
neuropsychiatric - drowsy/insomnia, headache
GI - increased appetite, weight gain
libido, dry mouth
hepatic - increased LFTs
hypertensive reaction with tyramine containing foods

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8
Q

SSRis

which one is used post MI

in children and adolescents

A

block reuptake of serotonin

sertraline

fluoxetine

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9
Q

SEs of SSRIs

A 
SEs
- GI upset
- GI bleeding - PPI 
libido
anxiety
restlessness
nervousness
insomnia
fatigue
sedation
dizziness
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10
Q

what is discontinuation syndrome and its effects

A

when you stop SSRIs

restlessness
problems sleeping
unsteadiness
sweating
abdominal symptoms
altered sensations (for example electric shock sensations in the head)
altered feelings (for example irritability, anxiety or confusion).

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11
Q

cons of paroxetine

A 
sign CYP2D6 inhibition
sedating 
weight gain
more AntoACH effects
discouraged during pregnancy 
likely to cause discontinuation syndrome
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12
Q

pros of sertraline

A

very weak p45o INTERACTIONS and only slight CYP2D6

short half life w lower build up of metabolites

less sedating

safest in cardiac disease

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13
Q

cons of sertraline

A

max absoprtion requires a full stomach

Increase number of GI adverse drug interactions

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14
Q

pros of fluoxetine

A

long half life. less incidence of discontinuation

activating NOT SEDATION

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15
Q

cons of fluoxetine

A

long half life and active metabolite build up

significant P450 interactions

intiial activation - increase anxiety ad insomnia

more likely to induce mania

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16
Q

pros and cons of citalopram

A

PROS

low inhibition of P450 enzymes so fewer drug-drug interaction

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17
Q

what is SNRIs

A

inhibit both serotonin and noradrenergic reuptake but WO antihistamine

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18
Q

pros fo venlafaxine

A

minimla drug interactions

short half life ad fast renal clearance

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19
Q

cons of venlafaxine

A

can increase diastolic BP

sig nausea

Bad discontinuation syndrome - taper recommeded after 2 weeks of administation DUE TO ITS LONG HALF L

casue QT prolongation

sex

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20
Q

duloxetine pros and cons

A

helps w physcial Sx of depressionie headaches, pain

CONS
CYPD26 and CYP1A2 inhibitor

cannot break capsule as active ingredient not stable within the stomach

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21
Q

mitrazapine pros

A

atypical antidepressant

noradrenaline and specific serotonin antidepressant receptor

5HT2 and 5HT3 recepetor antagonist

hypnotic at lower dose

CONS
increased appetite and weight gain

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22
Q

SSRIs drug interactions

A

taking NSAIDs increase GI bleeding so if given co-prescribe PPI

warfarin/heparin - consider mitrazapine instead

triptan drugs for migraine - increased risk of serotonin syndrome

MAOIs - increased risk of serotonin syndrome

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23
Q

if taking heprain aspirin warfarin what can be prescribed for depression

A

mitrazapine

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24
Q

inidcations for mood stabilisers

A

bipolar
cyclothymia
schizoaffective
augmentation in treatment resistant depression

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25
Q

classes of

A

lithium
anticonvulsants
antipsychotics

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26
Q

indications of lithium

A
  • first line prophylaxis for bipolar disorder
  • moderate to severe mania
  • augmentation of a n antidepressant

reduces aggression and suicidality

plasma levels

renal toxicity and hypothyroidism

lithium toxicity

interaction w other drugs

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27
Q

Li SEs

A 
GI distress - reduced appetite, N/V, diarrhoea
Leucocytosis
Impaired renal function
Tremor(fine)/ teratogenic/ thirst
Hypothyroidism/ hair loss
Increased weight/ fluid retention
Urine (polyuria)
Metallic taste
TOXICITY
Tremor (coarse)
Oliguric renal failure
ataXia
Increased reflexes
Convulsions/coma/consciousness
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28
Q

Li toxicity

A

mild -> 1.5-2.0 - vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus

moderate -> 2.0-2.6 - NV, anorexia, blurred vision, clinic limb movements, convulsions, delirum, syncope

sever ->
>2.5 generalised convulsions, oliguria, renal failure

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29
Q

drug int w lithium

A

ACE i
AII inhi
diuretics - thiazide
NSAIDs

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30
Q

valproate

indications

SEs

A

mania, hypomania, bipolar depression

SEs
GI disturbances

Very fat
Aggression
LFTs
Platelets low (thrombocytopenia)
Reversible hair loss
Oedema (peripheral
Ataxia
Tremor/Tiredness/Teratogenic
Emesis

CIs
pregnancy - NT defects spina bifida
hepatic dysfunction
porphyria

Before
FBC
LFTs
PT
pregnancy
weight/BMI

LFTs and PT first 6 months

LFTs FBC weight again after 6 months and then annually

continupous monitoring FBC, LFT- 6 months

SEs
NV
weight gain
sedation
tremor
hair loss

teratogen - not to be used in CBAG

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31
Q

carbamzepine

SEs

A

prophylaxis of bipolar disorder 3RD LINE
alcohol withdrawal

U&Es
FBC
LFTs
Baseline weight
monitor 6 monthly
SEs
GI disturbances
rash - dermatits
dizzy
hyponatraemia
blood disorders

monitoring
WCC after a week
LFTs and U&Es

CI
COCP

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32
Q

lamortrigine

A

bipolar depression

before starting
FBC, LFTs, U&Es

titration medication

SEs
GI distubrances
SJS/TEN
headache
tremor
NV
sedation diz ataxia
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33
Q

typical antipsychotic

adverse effects
esp with elderly

examples

administration

A

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways

  • > Extrapyramidal side-effects
  • > hyperprolactinaemia

elderly
increases risk of stroke and VTE

Haloperidol
Chlopromazine

depot
rapid tranquilisationb

low potency - low affinity interact w nondopaminergic
cardiotoxic, anticholinergic - sedation, hypotensionchlorpromazine

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34
Q

atypcial antipsychotics

adverse effects

A

Act on a variety of receptors (D2, D3, D4, 5-HT)

  • Extrapyramidal side-effects
  • hyperprolactinaemia less common
    Metabolic effects

rispieridone, planzapine, clozapine

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35
Q

risperidone

A

tabs, IM depot, rapidly dissolving
less sedating tha olanzapine
high potency

increased extrapyramidal SEs

induce hyperprolactinaemia

weight gain and sedation

DOSE DEPENDENT

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36
Q

olanzapine

A

rabs
IM immediate release

fasting blood glucose

  • after one month’s Mx
  • every 4-6 months

weight gain

hypertriglyceridaemia, hypercholestrolemia, hyperglycaemia

hyperprolcatinaemia
trasaminitis

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37
Q

quetiapine

A

tab

cause transaminitis

good in bipolar

weight gain, hypertriglyceridaemia, hypercholestrolemia, hyperglycaemia

cause orthostatic hypotension

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38
Q

aripiprazole

A

regular tabs, IM formulation, depot form

partial agonist

low extrapyramidal SEs
no QT prolongation
low sedation
CYPD26 (Fluoxetine and paroxetine) and 3A4 (carbamezepine and ketoconazole) interactions - adjust dose POTENTIAL INTOLERABILITY DUE TO AKATHISIA/ACTIVATION

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39
Q

Clozapine

special monitoring

side effects

A

reserved for Mx resistant pts

ass w granulocytosis - weekly bloods for 18 weeks, fortnightly for one year and then monthly

fasting blood glucose
after one months and then every 4-6 months

weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias
constipation
urinary incintineve
increased seizures
sedation
transaminitis 
dyspepsia

hypertriglyceridaemia, hypercholestrolemia, hyperglycaemia

40
Q

extrapyramidal SEs of

A

PAD-T
-> Parkinsonism -weeks or months

-> Akathisia (severe restlessness) - first months

  • > Dystonia
  • sustained muscle contraction (e.g. torticollis, oculogyric crisis)
  • may be managed with procyclidine - within days

-> Tardive dyskinesia (late onset of choreoathetoid movements, abnormal, most common is chewing and pouting of jaw)
Mx - tetrabenazine
LATE ONSET (years)

41
Q

anxiolytics

A

anxiety disorders

42
Q

benzodiazepines

A

insomina, parasomnias, anxiety

bind to GABA, reduce the excitability of neurones

CNS depressant withdrawal protocols ex. ETOH withdrawal

SEs
somnolence
congitive deficits
ANTEROGRADE AMNESIA - memory recall and creation of new memories is significantly impaired
disinhibition
tolerance
dependence

respiratory deprression - FLUMAZENIL

43
Q

drugs used in ADHD

A

methyphenidate
- inhibit DA and NA reuptake : increasing DA and NA levels in the synaptic cleft

above stimulants

44
Q

drugs used in ADHD

A

methyphenidate
- inhibit DA and NA reuptake : increasing DA and NA levels in the synaptic cleft

above stimulants

DA - abuse potential

45
Q

atomoxetine - NA

A

increase Na LEVELS IN SYNAPITC CLEFT

46
Q

atypical antipsychotics are first line where

A

schizophrenia

47
Q

adverse effects of atypical for antipsychotics

A

weight gain
clozapine is associated with agranulocytosis (see below)
hyperprolactinaemia

48
Q

risks of elderly ppl using antipsychotics

A

increased risk of stroke

increased risk of venous thromboembolism

49
Q

adverse effects of clozapine

A

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation

50
Q

what might increase clozapine

A

smoking

51
Q

SEs of antipsychotics

A 
antimuscarinic
cant see, cant pee, cant spit, cant shit
- blurred vision
- urinary retention
- dry mouth
- constipation
  • tremor
    anithistaminergic
  • sedation
  • weight gain

anti-adrenergic

  • postural hypotension
  • tachycardia
  • ejaculatory failure

endocrine/metabolic

  • raised prolactin - sexual dys, reuced bone mineral, mestrual disturbances, breast enlargement
  • –> may result in galactorrhoea
  • impaired glucose tolerance

neuroleptic malignant syndrome: pyrexia, muscle stiffness

  • reduced seizure threshold (greater with atypicals)

Prolonged QT interval (particularly haloperidol)

52
Q

discontinuation Sx of SSRIs

A 
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
53
Q

SSRIs and pregnancy

A
  • Use during the first trimester gives a small increased risk of congenital heart defects
  • Use during the third trimester can result in persistent pulmonary hypertension of the newborn
  • Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

during breastfeeding - paroxetine and sertraline

54
Q

before starting antipsychotic what is measured

A
  • weight or BMI
  • pulse
  • blood pressure
  • fasting blood glucose or glycosylated haemoglobin (HbA1c)
  • blood lipid profile.
  • ECG - monitoring esp for haloperidol and MANDATORY FOR PIMOZIDE
55
Q

Monitoring antipsychotic drug Mx

A

FBC, U&Es and LFTs - annually
- pulse and blood pressure after each dose change

  • weight or BMI weekly repeat at 3, 6 months and then yearly

HbA1c, lipid profile, Glucose - repeat at 3, 6 months and yearly

  • prolactin - at 6 months then yearly
  • ECG - drug/dose change and yearly
  • response to treatment, including changes in symptoms and behaviour
  • side effects and their impact on physical health and functioning
  • the emergence of movement disorders
  • adherence
56
Q

clinical features

Ix

Mx

of NMS

A
  • hyperthermia
  • muscle rigidity
  • confusion
  • fluctuating consciousness
  • autonomic instability
  • tachycardia
  • fluctuating BP

Ix

  • increase in CK
  • FBC
  • LFTs deranged

Mx

  • stop antipsychotic
  • IV fluids for renal failure
  • cooling
  • dantrolene (muscle relaxant)
  • bromocriptine - dopamine agonist

complications

  • PE
  • renal failure
  • shock
57
Q

what is depot antipsychotic

A
  • long acting, slow release given IM every 1-4 weeks
  • typical antipscychotic - flupentixol, fluphenazine

atypical - aripiprazole

58
Q

why should chlorpromazine be avoided in the elderly

A

increases death

59
Q

what are anxiolytics and hypnotics

A

licensed for anxiety disorders

hypnotics induce sleep

60
Q

examples of anxiolytics

A 
benzodiazepines
barbituates
buspirone
beta-blockers
antipsychotics
61
Q

examples of hypnotics

A

benzodiazepines
low dose amitriptyline
Z drugs - zopiclone, zolpidem, zaleplon

62
Q

examples of benzos

Which of the following benzodiazepines do you think would present the largest problem in terms of withdrawal?

MOA

A

long acting (>24 hours) - diazepam, chlordiazepoxide

short acting (<12 hours) - lorazepam, midazolam

lorazepam 0 short half life

increase GAB

63
Q

indications of benzodiazepines

what is the usual recommended maximum duration of treatment?

how to discontinue long term use benzodiazepines

A
  • insomnia
  • anxiety disorders - panic/phobia
  • delirium terens adn alcohol detoxicification
  • acute psychosis
  • violent behaviour

2-4 weeks

Reduce the dose in steps of 1/8th of the daily dose every fortnight

64
Q

SEs of benzodiazepines

A
  • drowsiness/light headed
  • confusion + ataxia
  • amnesia
  • dependence
  • paradoxical increase in aggression
  • muscle weakness
  • respiratory depression
65
Q

aim of cbt

A

initially to help individuals to identify and challenge their automatic negative thoughts and then to modify any abnormal underlying core beliefs.

66
Q

what is operant conditioning

A

states that behaviour is reinforced if it has positive consequences for the individual, and it prevents any negative consequences.

67
Q

what is relaxation training

A

This is particularly useful for those with stress-related and anxiety disorders. Here, the patient is asked to use techniques causing muscle relaxation during times of stress or anxiety. The patient also learns to put themselves in situations that they find relaxing, such as walking in the fields.

68
Q

Systemic desensitization

A

This is often used for phobic anxiety disorders. In this therapy, an individual is gradually exposed to a hierarchy of anxiety-producing situations

69
Q

flooding

A

Unlike systemic desensitization, flooding therapy involves the patient rapidly being exposed to the phobic object without any attempt to reduce anxiety beforehand. They are required to continue exposure until the associated anxiety diminishes. It is not a technique commonly used.

70
Q

ERP

A

his therapy can be used for a variety of anxiety disorders but is particularly useful for OCD and phobias. Patients are repeatedly exposed to the situation which causes them anxiety (e.g. exposure to dirt) and are prevented from performing the compulsive actions which lessens that anxiety (e.g. washing their hands). After initial anxiety on exposure, the levels of anxiety gradually habituate and decline

71
Q

behavioural activation

A

This therapy is used for depressive illness. The rationale behind it is that patients avoid doing certain things as they feel they will not enjoy them or fear failure in completing them. Behavioural activation involves making realistic and achievable plans to carry out activities and then gradually increasing the amount of activity.

72
Q

indications

rationale

aim

mode of delivery

of psychodynamic

A

Dissociative disorders, somatoform disorders, psychosexual disorders, certain
personality disorders, chronic dysthymia, recurrent depression.

It is based upon the idea that childhood experiences, past unresolved conflicts and previous relationships significantly influence an individual’s current situation. It is based on psychoanalytic principles.

he unconscious is explored using free association (the client says whatever comes
to their mind) and the therapist then interprets these statements. Conflicts and defence mechanisms (e.g. denial, projection) are explored and the client subsequently develops insight in order to change their maladaptive behaviour.

Psychoanalysis is an intense therapy that usually involves between one and five 50-minute sessions per week, possibly for a number of years. This is a much longer duration than in CBT.

73
Q

what is transference

A

The patient re-experiences the strong emotions from early important relationships, in their relationship with the therapist. When the current emotions are positive it is said to be positive transference and vice versa for negative emotions.

74
Q

what is counter transference

A

The therapist is affected by powerful emotions felt by the patient during therapy and reflects what the patient is feeling.

75
Q

what is psyhcoeducatoin

A

delivery of information to people in order to help them understand and cope with their mental illness.

1) the name and nature of their illness; 2) likely causes of the illness, in their particular case; 3) what the health services can do to help them; and 4) what they can do to help themselves (self-help)

76
Q

counselling

A

form of relieving distress and is undertaken by means of active dialogue between the counsellor and the client.

Behaviour and emotional life are shaped by previous experience, the current environment, and the relationships that individuals have.

77
Q

what is Interpersonal therapy (IPT)

A

depression and eating disorders.

deals with four interpersonal problems (grief at the loss of relationships, role disputes within relationships, managing changes in relationships and interpersonal deficits) which may be causing difficulty in initiating or maintaining relationships.

78
Q

what is EMDR

A

access and process traumatic memories with the goal of emotionally resolving them.

PTSD

client recalling emotionally traumatic material while focusing on an external stimulus

79
Q 
Antidotes to 
paracetamol
opiates
benzodiazepines
warfarin
beta-blockers
TCAs
organophosphates
A 
paracetamol - N-acetylcysteine
opiates - naloxone
benzodiazepines - flumazenil
warfarin - vitamin K
beta-blockers - Glucagon
TCAs - sodium carbonate
organophosphates - atropine

Activated charcoal: for the majority of drugs taken in overdose, early
use of activated charcoal (within one hour of ingestion) can prevent or reduce absorption of the drug.
􏰀 TOXBASE can be viewed for information on rarer poisons.

80
Q

define suicide
attempted suicide
risk assessment

A

􏰀 Suicide: A fatal act of self-harm initiated with the intention of ending one’s own life.

􏰀 Attempted suicide: The act of intentionally trying to take one’s own life with the primary aim of
dying, but failing to succeed in this endeavour.

􏰀 Risk assessment: In a psychiatric context, it is assessing the risk of self-harm, suicide and/or risk to others.

81
Q

clinical RFs for suicide

A

History of DSH or attempted suicide
􏰀 The rate of suicide in people who have self-harmed increases and is 50–100 times greater than in the general population.

Psychiatric illness
􏰀 Including depression, schizophrenia, substance misuse, alcohol abuse and personality disorder.

Childhood abuse
􏰀 History of childhood sexual or physical abuse.

Family history
􏰀 Family history of suicide or suicide attempt in first-degree relatives increases the risk.

Medical illness
􏰀 Physically disabling, painful or terminal illness.

82
Q

socio-demographic RFs of suicide

A

Male gender
􏰀 Males are 3x more likely than females. Male suicide attempts are more likely to be violent and therefore successful.

Age
􏰀 Highest in the age group 40 to 44 in men.

Employment and financial status
􏰀 Those unemployed and who have low socioeconomic status are at higher risk.

Occupation
􏰀 Vets, doctors, nurses and farmers are at higher risk of suicide.

Access to lethal means
􏰀 The most lethal means of suicide are firearms, followed by hanging, strangling, and suffocation.

Social support
􏰀 Low social support, living alone, institutionalized, e.g. prisons, soldiers.

Marital status
􏰀 Those that are single, widowed, seperated or divorced.

Recent life crisis
􏰀 e.g. Bereavement, family breakdown.

83
Q

clinical features of a suicidal pt

A

Preoccupation with death

􏰀 Sense of isolation and withdrawal from society.

􏰀 Emotional distance from others.

􏰀 Distraction and lack of pleasure: Often are ‘in their own world’ and suffer from anhedonia.

􏰀 Focus on the past: They dwell on past losses and defeats and anticipate no future; they voice the notion of Beck’s cognitive triad that the world would be better off without them.

􏰀 Feelings of hopelessness and helplessness.

84
Q

Ix for suicide

A

Questionnaires - Tool for Assessment of Suicide Risk (TASR), Beck Suicide Intent Scale.

85
Q

individual suicide prevention strategies

A

􏰀 Detect and treat psychiatric disorders.
􏰀 Urgent hospitilization under the Mental Health Act.
􏰀 Involvement of the Crisis Resolution and home treatment team.

86
Q

population level suicide prevention strategies

A

Public education and discussion.
􏰀 Reducing access to means of suicide, e.g. encouraging patients to dispose of unwanted tablets, safer prescribing, safety rails at high places.
􏰀 Easy, rapid access to psychiatric care or support groups, e.g. Samaritans (who provide emergency 24 hour support).
􏰀 Decreasing societal stressors, e.g. unemployment and domestic violence.
- reducing substance misuse

87
Q

what is ECT

A

small electrical current through the brain with a view to inducing a modified epileptic seizure which is therapeutic.

88
Q

Indications of ECT

A

ECT’ (Euphoric Catatonic Tearful):
1. Prolonged or severe mania (Euphoric).
2. Catatonia(Catatonic).
3. Severe depression (Tearful):
􏰀 Treatment-resistant depression.
􏰀 Suicidal ideation or serious risk to others.
􏰀 Life-threatening depression, e.g. when the patient refuses to eat or drink.
NOTE: (1) Severe depression is the most common indication for the use of ECT.

89
Q

consent for ECT

A

􏰀 ECT is a procedure where written, informed consent is vital.
􏰀 For patients detained under the Mental Health Act, an independent second opinion must be obtained to determine suitability for ECT.

90
Q

Short term side effects of ECT

A

PC DAMS
Peripheral Nerve palsies
Cardiac arrhythmias, Confusion
Dental and oral trauma
Anaesthetic risks 􏰅 laryngospasm, sore throat, N+V
Muscular aches and headaches
Short-term memory impairment, Status epilepticus

NOTE: ECT may precipitate a manic episode in patients with bipolar affective disorder.

91
Q

long term side effects OF ECT

A

Anterograde and retrograde amnesia – the deficit is greater in those who receive bilateral ECT versus unilateral ECT.

92
Q

Contraindications of ECT

A

􏰀 MI (<3 months ago), Major unstable fracture.
􏰀 Aneurysm (cerebral).
􏰀 Raised ICP, e.g. intracranial bleed, space-occupying lesion (the only absolute contraindication).
􏰀 Stroke <1 month ago, a history of Status epilepticus, Severe anaesthetic risk (e.g. severe cardiovascular or respiratory disease).
NOTE: The risks associated with ECT may be enhanced during pregnancy, in older people, and in children. Therefore clinicians should exercise particular caution in these groups.

93
Q

which antipsychotic does not cause weight gain and safe in cardiac pts

A

aripiprazole

94
Q

what is community treatment order

A

This can be used to specify conditions to which the patient is subject to on discharge, and the patient may be recalled to hospital if the conditions are not met. For example, if the patient does not comply with their medication in the community, they can be recalled to hospital regardless of whether they would otherwise currently meet the required criteria for detention under a Section of the Mental Health Act – This means clinicians needn’t wait for the patient to relapse and become risky before re-admitting them to hospital, thus avoiding relapses and possible consequences of relapses.

95
Q

advantage of a depot

A

Paliperidone is a depot version of Risperidone. This is not a medication which Mr S has previously tried or had adverse reactions to.

  • Paliperidone does not require oral medication (Risperidone) to be taken during initiation, so is a good choice in a patient who is currently refusing all oral medications. It is initiated through loading doses of IM injections (Day 1 and Day 8 of treatment, then monthly thereafter).
  • If a patient remains stable for at least four months on the monthly dose of IM Paliperidone, they can instead be given a formulation which only requires administration every 3 months.
96
Q

role of pregablin

A

• Binds to voltage gated calcium channels in neurones
• Increases extra-cellular amounts of the enzyme responsible for
synthesis of GABA and therefore increases GABA concentrations in
the brain
• Reduces neuronal activity (i.e. is a CNS depressant)
• Used in anxiety, neuropathic pain and epilepsy
• Less potential for misuse and dependence (and tolerance) than
benzodiazepines – but still misused – nickname “Budweisers”
• BNF says short term use – often used indefinitely
• Causes sedation and can cause weight gain

97
Q

what do you do when with SSRI before commencing ECT

A

reduce the dose of SSRI and maybe increase it at the end of ECT

psychiatry (14 decks)

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