Drugs in psychiatry

Question 1

SSRIs can be used in

Answer 1

Depression and anxiety disorders

Question 2

Clinical features of SSRI discontinuation syndrome

Answer 2

Flu-like symptoms, insomnia, nausea, anxiety, vertigo etc…

Question 3

Which SSRI has the greatest propensity to cause SSRI discontinuation syndrome and why?

Answer 3

Paroxetine, shortest half life

Question 4

Treatment of SSRI discontinuation syndrome

Answer 4

Reassurance and monitoring
Reintroduction of the drug with a tapered withdrawal
Consider alternative antidepressant/anxiolytic

Question 5

Four examples of TCAs

Answer 5

Amitriptyline
Imipramine
Lofepramine
Dothiepin

Question 6

Some adverse effects of TCAs

Answer 6

Anticholinergic effects e.g. dry mouth, constipation, urinary retention

Psychotropic effects - agitation, nightmares

Sexual dysfunction

Akathisia

Cardiac arrhythmias

Question 7

What is Venlafaxine?

Answer 7

An SNRI

Question 8

Side effects of Venlafaxine

Answer 8

Headache, nausea, HTN, discontinuation syndrome

Question 9

Moclebamide

Answer 9

A MAOI - usually reserved for treatment of resistant or atypical depression

Question 10

MAOI interactions

Answer 10

Foods high in tyramine e.g. cheese, red wine
Don’t combine with SSRIs - can lead to serotonin syndrome
Adrenaline, noradrenaline
L-Dopa

Question 11

Mirtazapine

Answer 11

A NaSSA (noradrenergic and specific serotonin antidepressant.)

Acts at alpha 2 receptors (antagonist)

Question 12

Side effects of typical antipsychotics

Answer 12

EPSEs
Tardive dyskinesia
Neuroleptic malignant syndrome

Question 13

Side effects of atypical antipsychotics

Answer 13

Weight gain
Metabolic syndrome (esp. with Olanzapine)
Hyperprolactinaemia

Question 14

2 examples of typical antipsychotics

Answer 14

Haloperidol, Chlorpromazine

Question 15

Four examples of atypical antipsychotics

Answer 15

Risperidone
Quetiapine
Olanzapine
Aripiprazole

Question 16

Treatment for treatment resistant schizophrenia

Answer 16

Clozapine

Question 17

Clozapine

Answer 17

The most effective antipsychotic
Has problems with haematological side effects (agranulocytosis)
Hypersalivation and hypotension may also occur as side effects

Question 18

Four examples of mood stabilisers

Answer 18

Lithium
Carbamazepine
Sodium valproate
Lamotrigine

Question 19

Side effects of Lithium

Answer 19

Short term - fine tremor, polydipsia, polyuria, loose stools, nausea

Long term - hypothyroidism, renal impairment, weight gain, acne

Question 20

Signs of lithium toxicity

Answer 20

Coarse tremor, N+V, ataxia and cerebellar signs, confusion

Question 21

Precipitants of lithium toxicity

Answer 21

Salt depletion, dehydration (e.g. in diarrhoea)
Drug interactions (e.g. thiazides, NSAIDs)
Deteriorating renal function

Question 22

Uses of benzodiazepines in psychiatry

Answer 22

Hypnotics
Anxiolytics
Minor tranquillisers
Management of alcohol withdrawal

Question 23

Benzodiazepine issues

Answer 23

Tolerance

Withdrawal

Question 24

Benzodiazepine withdrawal

Answer 24

Abrupt withdrawal can precipitate acute delirium (also less commonly psychosis, convulsions), nausea, hyperacusis, dizziness

When withdrawing must do a tapered withdrawal using diazepam equivalents

Question 25

Management of alcohol withdrawal

Answer 25

Reducing regimen of oral BZDs
Vitamin supplementation (oral, IV/IM)

Question 26

What additional drugs can be used to maintain alcohol abstinence?

Answer 26

Acamprosate - reduces cravings
Naltrexone - reduces cravings/enjoyment via opioid receptors
Disulfiram - induces severe reaction if alcohol is consumed