Psyxhoatry Flashcards
Psychotic symptoms
Hallucinations
Delusions
Disorganised speech
Disorganised behaviour
What receptors do AP work on
Dopamine 2
Different pathways
- Mesolimbic - postive symptoms
meso cortical - negative
nigrostriatal- extraoyrimidal symptoms
Toubro infundibular- increase prolactin
Typical Ap divided into
Low potency - more sedative in nature, bind to histamine alpha 1 and muscarinic receptors, have a weak AP effect and would need higher doses
Cause orthostatic hypotension, sleep and anticholergic effects
High potency - just have an affinity for the dopamine
Examples of atypical ap
Clozapine
Risperidone
ADR of typical ap
EPS
Hyperprolactinemia
Example of low potency
Chlorpromazine
Example of high potency
Haloperidol
Indications for AP
Schizophrenia Schizo-affective disorder Bipolar and depressive disorders Substance induced psychotic disorder Somatic disease induced psychotic disorder
Which non psychotic states can we use AP for
Anxiety
Autism
Ticks
Personality disorders
Also used in non mental states like Nassau and vomiting
Here we rely on not the main properties of the drug but the other affects such anti- impulsive , anti suicide, anxiolytics
Clozapine
It is more of a last resort for example in treatment resistant schizophrenia
BecUse or secere side effves
Used in very aggresive patients - strong effect
Used in very suicidal patients 
CI AP
Absolutely Coma Delirium Neuroleptic malignant Syndrome Hypersensitive
Caution.
Parkinson
Epilepsy
Heart, hepatic renal dysfunction
Akathisia
Usually occurs after starting a new antipsychotic or increasing the dose these patients have an unpleasant sensation of restlessness they can’t sit still to treat it you reduce the dose and we can give them beta-blockers a benzodiazepines
Tranquillisers
Like benzos
When can we use b’z
Alcohol withdrawal
Anxiety disorders -GAD, social anxiety , substance induced anxiety
Acute stress disorder but use in PTSD is debatable
Adjustment disorders
Hypnotics
CI of b’z
MG
Severe resp problems
Sleep apnea
How long are b’z usually used for
Less than a month due to dependence and side effects
AdR
- Benign physical dependable
- BD use disorder
- Antegrase amsnesia
The gradual accumulation in the case of long acting b’z that can put you at risk in important tasks that require focus like driving
Paradoxical activation of self harm or aggression
Drowsiness during the day
If you are dependant then if you wirhdraw too quickly problemss can occur
Alternatives to b’z
SsRi’s
Low dose AP and TCA- bht many sidedfevts
Hydroxizine- First-generation antihistamines pregabalin
When do you start to see the effect of AD
After 2 to 3 weeks
TCA Moa
Work on seratonin and noradrenalin
Side effects of TCA’s
Also bind to h1, muscarinjc and alpha 1 so risk is sedation, anticholernwegix and risk of orthostatic hypotension
In attempt to overdose, arrhythmia and epileptic seizures
Ssri example
Fluoxetine
SNRI advantages and example
Don’t bind to other receptors like histamine and alpha 1 like TCA and at higher doses they can also affect dopamine too bringing additional benifit and treatment resistant depression
Velnafaxine
Seratoninergic AD indicatoons
- Panic disorders
- OCD
- Bulenia - fluoxetine
- Premature ejaculation
- Prime status dyshopric disorder
SSRI’s
Side effects
Short term : Nausea diarrhoea sweating loss of appetite weight gain sexual dysfunction such as reduce libido delayed ejaculator shin anorgasmia
Alternatives for depression
Mood stabilises and low-dose antipsychotics
ECT- induce a seizure
St. John’s wort for mild moderate 
So a psychotic disorder due to a somatic disease
Focal brain injury
Epilepsy
mS
Tx of psychotic disorder
Atypical AP but if not work we can switch to typical
