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Psychiatry > Treatment Options > Flashcards

Treatment Options Flashcards

1
Q

List the classes of treatment for mental health conditions

A

Psychological
Pharmacological
Social
Physical

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2
Q

List the main neurotransmitter systems in the body .

A

Dopamine
Seratonin
Acetylcholine
Glutamate

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3
Q

Side effects associated with lithium

A 
Leukocytosis 
Insipidius (Nephrogenic Diabetes )
Tremors 
Hydration
Increased GI, skin and memory problems 
Under active thyroid 
Metallic taste
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4
Q

Mr PS presented to A&E with complaints of hearing voices for 6 months, worried that police were following him to his work. On examination he had thought that aliens were controlling his thoughts and his bodily functions.

What is the likely diagnosis?
What are the pharmacological treatment options?

A
  1. Schizophrenia

2.

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5
Q

List the differences in the mechanism of action between atypical and typical antipsychotics and give examples of each

A

Typical: Antagonism of the D2 receptor in the mesolimbinc pathway
Eg: Chlorpromazine, Haloperidol, Prochlorperazine

Atypical: Antagonism of D 3 and 5HT2 receptors
Eg: Olanzapine, Quetiapine, Aripiprazole and Risperidone

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6
Q

List the side effects associated with typical antipsychotics in particular

A

Parkinsons symptoms: Tremor, rigidity

Dystonia: Abnormal face and body movements

Akathisia: Restlessness

Tarditive dyskinesia: Rthymic involuntary movements of the face, jaw and tongue

Drowsiness

Apathy

Agitation

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7
Q

List the side effects associated with atypical antipsychotics

A

Lower likelihood of EPSE

Metabolic syndrome

Rispridone = Increased prolactin

  • sexual dysfunction
  • osteoporosis
  • breast development
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8
Q

List the antimuscarinic side effects of antipsychotics

A

Dry mouth
Constipation
Urinary retention
Blurred vision

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9
Q

List the anti adrenergic effects of antipsychotics

A

Postural hypotension

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10
Q

List the anti histaminergic effects of antipsychotics

A

Sedation

Increase weight gain

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11
Q

List the cardiac effects of antipsychotics

A

Prolongation of the QT interval
Arrthymias
Myocarditis
Sudden death

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12
Q

List the metabolic effects of antipsychotics

A

Metabolic syndrome

  • Obesity
  • Diabetes
  • Hyperlipidaemia
  • HTN
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13
Q

List the different stages of treatment in depression

A
  1. SSRI
    - Fluoxitine
    - Citalopram
    - Sertraline
  2. Try another SSRI
    - Mitazapine
    - Moclobromide
    - Lofepramine
    - Trazadone
    - OR SNRI ( Duloxitine)
  3. Severe depression
    - Clompramine
    - Amitryptyline
    - Venlaflaxine
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14
Q

List the side effects of SSRI’s and the key side effects of

  • Paroxitine
  • Citlopram
  • Serataline
  • Fluoxitine
A 
Headache (*)
GI symptoms 
Insomnia 
Sexual dysfunction 
Hyponatraemia

Paroxitine: Increase weight/ sexual dysfunction
Citlopram: QT prolongation
Seratraline: Diarrhoea
Fluoxitine: long 1/2 life

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15
Q

List examples of TCA’s and list the side effects associated with this type of drug

A

Amitriptyline
Dosulphin
Lofepramine

Side effects

  • Sedation
  • CV EFFECTS ( decrease BP, increase pulse)
  • Increased QT interval
  • Arrhythmias

VERY DANGEROUS IN OVERDOSE

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16
Q

List the side effects associated with Mirtazapine

A

Drowsiness
Weight gain
Oedema
Constipation

17
Q

List the side effects associated with Trazadone

A 
Sedation 
Dizziness 
Headache 
Nausea 
Vomiting 
Tremor
18
Q

List the side effects associated with SNRI’s and give examples

A

Headache
Dry mouth
Constipation
Increased BP

Venlaflaxine
Duloxetine

19
Q

Indications for using lithium

A

Maintenance and mood stabiliser in bipolar affective disorder
Unresponsive severe depression
Actue mania

20
Q

List the levels of treatment for lithium

A

Therapeutic: 0.5-1mmol/L

Toxic: >1.5mmol/L

Dangerously toxic level: >2mmol/L

21
Q

Factors affecting lithium concentration

A
  1. Dehydration
  2. Kidney disease
  3. Diuretics
  4. Alcohol
22
Q

Side effects of lithium

A 
Thirst 
Polydipsia 
Polyuria 
Increased weight gain 
Tremor 
Blurred vision 
Metallic taste 
Hypothyroidism 
Nephrotoxicity
23
Q

Signs of lithium toxicity

A

> 1mmol/L

  • Increased drowsiness
  • Slugishness
  • Ataxia
  • Coarse tremor
  • Profound D&V

> 2mmol/L

  • Toxic psychosis
  • Coma
  • Death
24
Q

Treatment of lithium toxicity

A

Stop lithium
Measure Li after 7 days
Osmotic diuresis
Haematological dialysis

25
Q

What are the guidelines for prescribing clozapine

A

Atypical antipsychotic
Used for treatment resistant schizophrenia
Prescribed if an inadequate response to >2 antipsychotics

26
Q

Side effects of clozapine

A 
Dry mouth 
Constipation 
Postural hypotension 
Sexual dysfunction 
Galactorrhaea 
Increased glucose 
Increased QT interval 
Nause and vomiting
27
Q

What is disassociation

A

Immature ego defence when ones identity is temporarily and drastically modified to avoid the distress of a given situation

28
Q

Outline the components of section II of the mental health act

A 
Admission for assessment 
Up to 28 days 
Cannot be renewed 
Signed by up to x2 dr or 1dr and 1MHP 
Give treatment
29
Q

Outline the components of section III of the mental health act

A 
Admission for treatment 
~6 months 
Can be renewed 
Signed by x2 Dr or x1Dr and 1AMHP
Give treatment and perform Ix
30
Q

Outline the components of section IV of the mental health act

A

Emergency treatment
Only 1 AMHP/1Dr
Hold you in hospital for 72hrs
CANNOT TREAT YOU

31
Q

Outline the components of section V of the mental health act

A

Detention of a patient already in hospital
5.4: Nurses holding power. No treatment (~6hrs)

5.2: Doctors holding power. (~72hrs)

32
Q

Outline the components of section 135 of the mental health act

A

Allows police to remove you from private property if a Dr thinks you could be harmful to yourself and/or others

33
Q

Outline the components of section 136 of the mental health act

A

Allows the police to take you from a public place due to risk to yourself and others .

Psychiatry (4 decks)

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