pysch

Question 1

drugs that cause acute dystonia reaction.
treatment (the atpicals)

Answer 1

sustained muscle contraction (e.g. torticollis, oculogyric crisis)
may be managed with procyclidine

Clozapine
Risperidone
Olanzapine

Question 2

what type tend to cause the tardive dyskinesia

Answer 2

the typicals - Haloperidol
Chlopromazine

may be irresversible

Question 3

Management of GAD

Answer 3

NICE suggest a step-wise approach:
step 1: education about GAD + active monitoring
step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment. See drug treatment below for more information
step 4: highly specialist input e.g. Multi agency teams

Question 4

Management of less severe depression

Answer 4

Treatment options, listed in order of preference by NICE
guided self-help
group cognitive behavioural therapy (CBT)
group behavioural activation (BA)
individual CBT
individual BA
group exercise
group mindfulness and meditation
interpersonal psychotherapy (IPT)
selective serotonin reuptake inhibitors (SSRIs)
counselling
short-term psychodynamic psychotherapy (STPP)

Question 5

Mix of more severe depression

Answer 5

a combination of individual cognitive behavioural therapy (CBT) and an antidepressant
individual CBT
individual behavioural activation (BA)
antidepressant medication
selective serotonin reuptake inhibitor (SSRI), or
serotonin-norepinephrine reuptake inhibitor (SNRI), or
another antidepressant if indicated based on previous clinical and treatment history
individual problem-solving
counselling
short-term psychodynamic psychotherapy (STPP)
interpersonal psychotherapy (IPT)
guided self-help
group exercise

Question 6

Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

Answer 6

the first SSRI should be withdrawn* before the alternative SSRI is started

Question 7

Switching from fluoxetine to another SSRI

Answer 7

withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI

Question 8

Switching from a SSRI to a tricyclic antidepressant (TCA)

Answer 8

cross-tapering is recommend (the current drug dose is reduced slowly, whilst the dose of the new drug is increased slowly)
Expect fluoxetine - which should be stopped prior

Question 9

Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine

Answer 9

cross-taper cautiously. Start venlafaxine 37.5 mg daily and increase very slowly
Fluoxetine stop then start