WK1 Mental health Flashcards
first line medicaiton for GAD
SSRI -Sertraline
why are SSRIs and SNRIs used
best combination of efficacy and safety -less serious SE
escitalopram=
SSRI
paroxetine=
SSRI
SNRI=
serotonin and noradrenaline reuptake inhibitor
depression treatment with SSRIs initiation –>
start low go slow
average clinically meaniful action for SSRI
4 weeks
how long should the initial therapeutic SSRI/SNRI dose be continued for
4 - 6 weeks
how should an SSRI be increased
in 1-2 week increments until sufficient improvement or maximum dose tolerated
how do SSRIs work
inhibit neuronal reuptake of serotonin from synpatic cleft increasing its avalibility for neurotransmission
common SSRI side effects (4)
- GI upset
- appetite and weight change
- hypersensitivity reactions incl skin rash
- sexual dysfunction
other important SE of SSRIs (6)
- suicidal thoughts
- hyponatraemia
- lower seizure threshold
- prolong OT interval
- serotonin syndrome
- GI bleed
how long should a patient experiencing a good clinical response stay on antidepressants for GAD
12 months
SSRIs overdose risk compared to TCA and MAOIs
much less
venlafaxine=
SNRI
SNRI vs SSRI for overdose
SNRI have a greater risk of significant toxicity in overdose
symptoms of SSRI overdose
- CNS features (tremor, agitation, fatigue, coma)
- CVS features (tachycardia, hypotension, HTN, prolonged QT etc)
- Rhabdomyolysis
- serotonin syndrome
serotonin syndrome=
clinical combination of;
- autonomic instability
- mental status change
- increased neuromuscular tone
what typically causes serotonin syndrome
combining two or more serotonergic medications
when does serotonin syndrome occur
several days to one week after addition of new agent / dose increase
3 most likely to cause serotonin syndrome
sertraline
paroxetine
fluvoamine
clinical findings of serotonin syndrome (8)
muscle clonus ocular clonus agitation diaphoresis tremor hyperreflexia muscle rigidity hyperthermia
severe serotonin syndrome can present with (5)
acute hyperthermia HTN tachycardia agitated delirium muscle rigidity
without intervention serotonin syndrome can result in (7)
rhabdomyolysis metabolic acidocis, renal failure ' seizures disseminated intravascular coagulation shock
treatment of seizures from overdose
benzodiazepines
serotonin antagonist (can be used in severe serotonin syndrome)
cyproheptadine
prolonged OT interval after SSRI ingestion management
serial ECGs
treatment of acute stress disorder
BDZ
when does acute stress disorder become PTSD
> 4 weeks
mirtazapine=
TCA
antidepressant treatment for PTSD if
- preference for drug treatment
- refusal of specialist psychological therapies
- delayed referral
main treatment for PTSD
specialist mental health services for trauma focused psychological treatment
antidepressants used in PTSD = (2)
paroxetine
mirtazapine
prevalence of alcohol dependancy in UK
3.6%
% of admitted patients with alcohol use problems
40%
pharmacological support for alcoholics
IV thiamine
Chlordiazepoxide
which BDZ are preferred in alcohol withdrawal
long-acting BDZ (e.g Diazepam)
BDZ effect on GABA-A
increasing opening frequency of GABA-A receptor potentiating neurotransmission
what ion does GABA increase the influx of into the neuron
Cl-
useful effect of BDZ (6)
sedation sleep induction anterograde amnesia anticonvulsant anxiolytic reduces muscle tone
indication for BDZ
short term relief (2-4 weeks) of anxiety that is disabling or causing unacceptable distress
when can BDZ be used to treat insomnia
when its severe, disabling, or causing extreme distress
rapid withdrawal of BDZ can be
life threatening
symptoms of BDZ withdrawal (6)
tremors anxiety perceptual disturbances dysphoria psychosis seizures
onset of withdrawal from BDZ
24-28 hrs –> 3 weeks (depending on half-life)
how long do the symptoms of BDZ withdrawal last
1-2 weeks
treatment of BDZ withdrawal
IV diazepam titrated to effect tapered gradually over months once symptoms controlled
symptoms of alcohol withdrawal start how long after stopping drinking
6-12 hours
peak incidence of seizures after stopping drinking
36 hours
peak incidence of delirium tremens after stopping alcohol
48-72