Psychopharmacology 3

Question 1

What should be considered in prophylaxis for psychotic diseases

Answer 1

Life long
Complaince issues
Lack of insight
Consider long acting IM injection
May need to use mental health act 

Relapses reduces functionality and IQ. Don’t want to relapse

Question 2

What are the adverse effects of antipsychotics

Answer 2

Tardive dyskinesia- involuntary muscle movements that may not resolve with drug discontinuation.

Neuroleptic malignant syndrome- only psychiatric emergency, svere muscle rigidity, fever, altered mental state, autonomic instability, elevated WBC, CPK and LFT’s. potetnially fatal

Extrapyramidla side effects- Acute dystonia, parkinson syndrome, akathisia

Question 3

What should be started to reduce the chance of extrapyramidla side effects?

Answer 3

Anticholinergics such as benztropine, thexyphendyl, diphenhydramine

Dopamine facilitators such as amantandine

Beta-blockers such as propanolol

Need to watch for anticholinergic SE, particularly if taken with other meds with anticholienbrgic actions e.g. triycylics

Question 4

What bloods would you do before starting someone on an antipsychotic?

Answer 4

Fasting liid profile
Fasting blood sugar
LFT’s
CBC

Question 5

What is akathisia?

Answer 5

Restlessness, can’t sit still patients describe it as feeling uncomfortable in their skin

Associated with higher risk of suicide. Treat it with anxiolytic or propranolol

Question 6

What are anxiolytics

Answer 6

Used to treat panic disorder, generalised anxiety disorder, substance related disorder and their withdrawal,

In anxiety disorders use aniolytics and SSRI’s or SNRI’s

Question 7

What is buspirone?

Answer 7

Anioxyltic

pros- good augmentatiopn strategy
No sedation

CONS- mtakes about 2 weeks to work, no sedation to take the edge off as in benzo’s

Question 8

What are benzodiazepines?

Answer 8

Used to treat insomnia, parasomnias and anxiety disorders

Often used for CNS depressant withdrawl protocols e.g. ethanol withdrawl

Question 9

What are the side effects of benzodiazepines

Answer 9

Somnolence
Cognitive deficits
Amnesia
Disinhibiton
Tolerance
Dependence

Question 10

Should you use benzodiazepines to treat anxiety?

Answer 10

No treat it with SSRI’s

Question 11

What are the take home points?

Answer 11

Be clear on the diagnosis and any co-morbid diagnoses

Try to treat 2 birds with one stone

Select on side effect profile

Monitor efficacy and tolerance

Question 12

What anti psychotic drug would you use to treat schizophrenia with high cholesterol

Answer 12

Risperidone