4 Flashcards
functional decline associated with dementia
- psychosis
- depression
- altered circadian rhythm
- agitation/ aggression
- anxiety
step 2 management anxiety
for those which active monitoring ineffective:
- CBT
- Individual guided self help
- psychoeducational groups
when assessing anxiety, include
- level of distress
- functional impairment
- substance misuse
- physical health problems
- past experience/ response
- number, severity and duration of symptoms
management of non responders to step 3 of depression in PC
increase level of support \+/- increase dose or switch: 1. different SSRI 2. TCA 3. MAOI (specialist use only)
if combing anti-depressants, psychiatrist should be consulted
what level of lithium do you want
0.6-1.2
lithium side effects
- GI distress
- thyroid abnormalities
- leukocytosis
- polyuria/ polydipsia
- hair loss/ acne
- reduced seizure threshold
- cognitive slowing
- intention tremor
factors predisposing a positive response to lithium
- prior long term response
- family member with good response
- classic pure mania
- mania followed by depression
presentation serotonin syndrome
- abdo pain
- diarrhoea
- sweats
- HTN
- tachycardia
- myoclonus
- irritability
- delirium
- cardio shock
- hyperpyrexia
- death
how do MAOIs work
bind irreversibly to monoamine oxidase preventing inactivation of norepinephrine, dopamine and serotonin
increase in synaptic levels
SNRI examples
- venlafaxine
- duloxetine
how do SNRIs work?
serotonin and norepinephrine reuptake inhibitors
similar to TCA but without side effects
SSRI examples
- sertraline
- paroxetine
- fluoxetine
- citalopram
- ecitalopram
common SSRI side effect
- GI upset
- anxiety
- sexual dysfunction
- insomnia
- might initially feel worse
potential complications TCAs
- lethal in overdose (even 1 week supply)
- QT lengthening
how do secondary TCAs work?
primary block noradrenaline
