Lectures Flashcards
1
Q
How old are the children in CAMHS?
A
4-18
2
Q
Where is CAMHS mainly based?
A
In the community
3
Q
Are there inpatient beds in CAMHS?
A
There are in-patient beds but they are very limited
4
Q
What is the difference between CAMHS and adult psych?
A
[1] less pharmacological treatment; [2] wider range of therapies available (especially creative therapies); [3] more emphasis on involving family, school, college and any system around the child.
5
Q
Which patients might get special transition from CAMHS to adult psychiatry?
A
ADHD; psychoses; anorexia; high risk patients (early intervention teams can take these patients early if needed)
6
Q
What is attachment theory?
A
An infant needs to develop a relationship with at least one primary caregiver for the child’s successful social and emotional development, and in particular for learning how to effectively regulate their feelings.
7
Q
What is the recovery model in psychosocial treatment?
A
People can change their attributes , skills and goals.
8
Q
What is involved in psychosocial treatment?
A
Help with independent living, money, housing, education, employment, meaningful activities (days structured, back to work, volunteering)
9
Q
What is the definition of formulation?
A
Going beyond the diagnosis. Constructing a formulation all focus on the process rather than the finished product.
10
Q
What are the four different things you ask about in the biopsychosocial formulation?
A
Predisposing factors (vulnerability); precipitating factors (triggers); prolonging factors (maintaining); protective factors?
11
Q
What sort of predisposing factors would you ask about?
A
Genetics, developmental disabilities; sensory impairments; temperament; early trauma; core beliefs; formative relationships; school life; security (housing/finance)
12
Q
What sort of precipitating factors would you ask about?
A
Hormones; drug use; physical illness; head injuries; transitions and life stages; life events; bullying; work; relationships
13
Q
What prolonging factors would you ask about?
A
Alcohol and drug misuse; non-adherence; unhelpful coping styles; lack of insight; destructive patterns of behaviour; relationships - anger/dependency
14
Q
What protective factors would you ask about?
A
Intact cognitive function; physical health and mobility; adherence; insight; motivation for change; goals; supportive relationships; engagement with services
15
Q
What is IAPT?
A
Improving access to psychological therapy
16
Q
Where is IAPT bases?
A
In the community and GP practices
17
Q
What conditions does IAPT deal with?
A
Mainly depression and anxiety but it’s remit is widening
18
Q
What are some models of psychotherapy
A
Psychodynamic; CBT; counselling; cognitive analytical therapy; interpersonal therapy; dialectic behavioural therapy; family therapy; marriage therapy
19
Q
What is Freud’s original model based on?
A
Focussed on therapy as a process of uncovering past trauma to resolve present day symptoms
20
Q
How long would you have psychodynamic psychotherapy for?
A
Once a week for about a year
21
Q
What are the waves of CBT?
A
1st wave: behavioural therapy
2nd wave: cognitive behavioural therapy
3rd wave: combines mindfulness and acceptance with the above therapies
22
Q
How many CBT sessions would you normally have?
A
They are generally structured and fairly brief (6-20 sessions) but may be longer in some cases
23
Q
What does CBT focus on?
A
Mainly focuses on the here and now, and on problems in day to day life rather than on the therapeutic relationships
24
Q
What are the aims of counselling?
A
It is fairly short and aims to help patient be clearer about their problems and find answers on their own
25
When is counselling used?
Often used to help someone cope with recent events that are difficult. It does not aim to change you as a person
26
What are the aims of cognitive analytical therapy?
Integrates cognitive and psychotherapy. Patient describes how problems have developed from events in their life and their personal experiences. Focuses on their way of coping and how to improve
27
How often would you have cognitive analytical therapy?
You would have 16-24 sessions over 4-6 months. Each one is about 50 minutes
28
How does interpersonal therapy work?
Aims to help the patient understand how problems may be connected to the way their relationships work. Helps identify how to improve relationships and find better ways of coping
29
What disorders is dialectic behavioural therapy focus on?
Helps with problems associated with borderline personality disorder (repeat self harming)
30
What does dialectic behavioural therapy aim to do?
Goal is to help patients learn to manage difficult emotions by letting them experience, recognise and accept them
31
What are the three different concepts in phenomenology?
Concrete concept (real objects or situations); defined concept (classes of concepts); concepts systems (sets of related concepts)
32
What is an illusion?
Illusions are misperceptions of real external stimuli e.g.if you think a coat rack is a person, the coat rack is real but the interpretation is wrong.
33
What is a hallucination?
Hallucinations are perceptions occurring in the absence of an external physical stimulus. Modalities include Auditory, visual, olfactory, gustatory, tactile, somatic. E.g. if you see someone who is not there
34
What is a hypnopompic hallucination?
A hallucination that happens when you're waking up
35
What is a hypnogogic hallucination?
A hallucination that happens when you're falling asleep
36
What is a reflex hallucination?
Experience stimulus in one modality and feel it in another modality. Modality = sense “When you write, I can hear your pen pressing on my heart”
37
What is an extracampine hallucination?
Hallucination that cannot possibly be experienced. ” I can hear people talking to me from Australia.”
38
What are the types of auditory hallucinations?
1st person, 2nd person, 3rd person (running commentary)
39
What is an over-valued idea?
A false or exaggerated belief sustained beyond logic or reason but with less rigidity than a delusion, also often being less patently unbelievable. (eg. I’m the best employee ever, lecture week would fail without me!) not as fixed as a delusion, can be changed with evidence
40
What is a delusion?
Delusion is a false, unshakeable idea or belief which is out of keeping with the patient’s educational, cultural and social background. It is held with extraordinary conviction and subjective certainty. It is a phenomenon that is outside normal experience. They are held without insight
41
What are the types of delusions?
Persecutory – outside agency to cause harm
Grandiose – inflated importance / self-esteem
Self-referential – television, tie, etc
Nihilisitic – bowels rotted, already dead etc
Religious – more refers to the content of a delusion, all can contain religious reference
Hypochondriacal – illness, somatisation
Guilt – responsibility for harm
42
What is the Capgras delusion?
The Capgras delusion is the belief that (usually) a close relative or spouse has been replaced by an identical-looking impostor.
43
What is the Fregoli delusion?
The Fregoli delusion is the belief that various people the believer meets are actually the same person in disguise.
44
What is intermetamorphosis?
Intermetamorphosis is the belief that people in the environment swap identities with each other whilst maintaining the same appearance.
45
What is a delusional perception?
Delusional perception describes a delusional belief resulting from a perception. For example, a perfectly normal event such as the traffic lights turning red may be interpreted by the patient as the defining moment when they realised they were being monitored by the government
46
What are the different thought symptoms?
Thought insertion; thought withdrawal; thought broadcast; thought echo; thought block
47
What is concrete thinking?
Lack of abstract thinking, normal in childhood, and occurring in adults with organic brain disease and schizophrenia . Very literal (would not understand a metaphor e.g. don’t throw stones in a glass house)
48
What is loosening of association?
there is a lack of logical association between succeeding thoughts. It gives rise to incoherent speech (in the absence of brain pathology). It is impossible to follow the patients train of thought (knight’s move thinking/derailment). Not related thoughts at all.
49
What is circumstantiality?
Irrelevant wandering in conversation. Talking at great length around the point. Lots of little stories , like when dad spoke about oskar and started talking about Norway
50
What is perseveration?
Repetition of a word, theme or action beyond that point at which it was relevant and appropriate
51
What is confabulation?
Giving a false account to fill a gap in memory. Severe end of schizophrenia and in alcohol misuse disorder
52
What is somatic passivity?
Delusional belief that one is a passive recipient of bodily sensations from an external agency. Something is brushing on my arm, it’s the devil passing over my arm
53
What is made act/feel/drive?
Made bit – the object in question is experience or carried out by the person, but is considered as alien or imposed. Act – action, feeling – feeling, drive – impulse. “The devil is making me sidestep across the room”
54
What is stupor?
More or less complete loss of activity with no response to stimuli; may mark a progression of motor retardation; found in a wide range of neurological and psychiatric conditions
55
What is psychomotor retardation?
Slowing of thoughts and movements, to a variable degree. Occurs in depression but other causes include psychotropics, Parkinson’s disease etc
56
What is flight of ideas?
Rapid skipping from one thought to distantly related ideas, the relation often being so tentative as for instance the sound (rhyming) of different utterances. Volume of speech is increased (not loudness but amount of it).
57
What is pressure of speech?
Manifest in a very rapid rate of delivery, a wealth of associations which may be quite unusual, (e.g. rhymes and puns) and often wanders off the point of the original conversation. This is highly suggestive of mania. (doesn’t have to be connected)
58
What is anhedonia?
The inability to experience pleasure from activities usually found enjoyable
59
What is apathy?
Loss of interest in things, loss of energy and motivation
60
What is incongruity of affect?
Emotional responses which seem grossly out of tune with the situation or subject being discussed. They might be genuinely upset and just not presenting it. Wrong expression
61
What is blunting of affect?
An objective absence of normal emotional responses, without evidence of depression or psychomotor retardation. No expression at all
62
What is belle indifference?
Lack of concern and/or feeling of indifference about a disability or symptom. Links to conversion. Patient suffering from domestic abuse, presents with arm that can’t move, arm is physically fine but the patient believes they can’t move their arm, but are indifferent about the fact that they can’t move it.
63
What is depersonalisation?
A feeling of some change in the self, associated with a sense of detachment from one's own body. Perception fails to awaken a feeling of reality, actions seem mechanical and the patient feels like an apathetic spectator of his own activities. Loses the experience of themselves, could be a response to trauma.
64
What is derealisation?
A sense of one's surroundings lacking reality, often appearing dull, grey and lifeless. They believe they are real but the world is not. “the world is made out of paper”.
65
What is dissociation?
An experience where a person may feel disconnected from himself and/or his surroundings. It’s like being locked in a wardrobe in my mind. They know what’s going on but feel they cannot control it
66
What is conversion?
Unconscious mechanism of symptom formation, which operates in conversion hysteria, is the transposition of a psychological conflict into somatic symptoms which may be of a motor or sensory nature
67
What is a mannerism?
A sometimes bizarre elaboration of normal activities on response to stimulation. (twirling hair when speaking in public) Alone, not an example of mental health problem
68
What is stereotyped behaviour?
Uniform, repetitive non goal-directed actions not related to stimulation (may take a variety of forms from simple movement to an utterance)
69
What is an obsession?
A recurrent persistent thought, image, or impulse that enters consciousness unbidden, is recognised as being ones own and often remains despite efforts to resist
70
What is a compulsion?
Repetitive, apparently purposeful behaviour performed in a stereotyped way accompanied by a subjective sense that it must be carried out despite the recognition of its senselessness and often resistance by the patient. Recognised as morbid by the affected individual
71
What is Akathisia?
A condition marked by motor restlessness, ranging from anxiety to inability to lie or sit quietly or to sleep,. Common side effect of treatment.
72
What the affective (mood) disorders?
Depression; bipolar; cyclothymia
73
What are the core symptoms of depression?
Low mood; loss of energy (anergia); loss of pleasure (anhedonia)
74
What are the non-core symptoms of depression?
Change in sleep; change in appetite; change in libido; diurnal mood variation; agitation; loss of confidence; loss of concentration; guilt; hopelessness; suicidal idealation
75
What is mild depression?
Core symptoms and 2-3 others
76
What is moderate depression?
Core symptoms and 4 others and functioning affected
77
What is severe non-psychotic depression?
Several symptoms, suicidal, marked loss of functioning
78
What is severe psychotic depression?
Typically mood congruent (nihilistic and guilty delusions, derogatory voices)
79
What are the two types of bipolar?
Bipolar 1 - both mania and depression
Bipolar 2 - more episodes of depression, very few episodes of mania, only mind hypomania
Rapid cycling - episodes only last a few hours
80
What is cyclothymia?
A milder form of bipolar
81
What are the symptoms of mania?
Extreme elation (uncontrollable); overactivity; pressure of speech; impaired judgement; extreme risk tasking behaviour; social disinhibition; inflated self-esteem; psychotic symptoms; mood congruent
82
What are the conditions that can cause psychosis?
Schizophrenia; delusional disorder; schizotypal disorder; depressive psychosis; manic psychosis; organic psychosis
83
What age is schizophrenia common?
Onset typically in 2nd-3rd decade but 2nd (smaller) peak incidence in late middle age
84
How does schizophrenia differ between women and men?
Men tend to get it earlier than women
85
What is schizophrenia?
Splitting of thoughts or loss of contact with reality
Affects - thoughts, perceptions(sight, smell, taste, touch, sounds), mood, personality, speech, volition, sense of self……
86
What are the first rank symptoms of schizophrenia?
Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception
87
What are the secondary symptoms of schizophrenia?
```
Delusions
2nd person auditory hallucinations
Hallucinations in any other modality
Thought disorder
Catatonic behaviour
Negative symptoms
```
88
What are the positive symptoms of schizophrenia?
```
Hallucinations
Delusions
Passivity phenomena
Thought alienation
Lack of insight
Disturbance in mood
```
89
What are the negative symptoms of schizophrenia?
```
Blunting of affect (not very expressive)
Amotivation
poverty of speech
Poverty of thought
Poor non-verbal communication
Clear deterioration in functioning
self neglect
Lack of insight
```
90
What are the symptoms of generalised anxiety?
Excessive anxiety across different situations
>6 months
Tiredness
Poor concentration
Irritability
Muscle tension
Disturbed sleep (usually initial insomnia rather than EMW)
91
What are the physical symptoms of panic disorder?
```
Palpitations
chest pain
choking
Tachypnoea
Dry mouth
Urgency of micturition
Dizziness
Blurred visions
Parasthesiae
```
92
What are the psychological symptoms of panic disorder?
```
Feeling of impending doom
Fear of dying
Fear of losing control
Depersonalisation
Derealisation
```
93
What are the characteristics of the obsessions in OCD?
```
Often unpleasant – death/ sexual/ blasphemous
Repetitive
Intrusive
Irrational
Recognised as patient’s own thoughts
```
94
What are some examples of compulsions in OCD?
Checking, washing, counting, symmetry, repeating certain words or phrases
95
What are the subtypes of dementia?
```
Alzheimer's
Fronto temporal (Pick’s Disease)
Vascular
Lewy Body
Parkinson’s
Normal pressure Hydrocephalus
```
96
What are the clinical features of Alzheimer's disease?
Insidious changes – missing appointments, lack of self-care, wandering
Cognitive Fx - 4As
Amnesia – recent memory, disorientation for time>place
Apraxia – clothes, using appropriate cutlery
Agnosia – recognise parts of the body
Aphasia – late, mixture of receptive & expressive speech
97
What are the neuroradiological signs of Alzheimers ?
Cerebral and hippocampus atrophy, enlarged ventricles
98
What are the clinical features of vascular dementia?
```
Onset and progression
Acute
Stepwise decline
Focal neurology
CVA
Expressive dysphasia
```
99
What are the neuroradiological signs of vascular dementia?
Cortical and subcortical lesions, seen as white dots of MRI
100
What are the clinical features of fronto-temporal lobe dementia?
Onset 50-60 years (a lot younger than Alzheimers)
Personality change
Apathy, disinhibition, emotional blunting (no reactivity to things that are happening around them), coarsening of sociability (undress inappropriately in public)
Language Changes (not being able to name things as well)
Intellectual functioning (can’t manage the bills)
Progressive
Memory imp may occur later (quite good preserved memory)
101
What are the clinical features of Lewy body dementia?
Onset and progression
Fluctuating onset and progression with a more rapid decline (quicker decline than Alzheimers)
Visual Hallucinations
Small children, animals, complex scenes
Parkinsonian signs
REM sleep behaviour disorders
Frequent falls (postural hypertension from the dementia)
102
What should you look at in the mental state examination?
```
Appearance
Behaviour
Mood
Speech
Thoughts
Perception
Insight
```
103
What does the Addenbrookes Cognitive Examination look at?
```
Attention/Orientation 18/18
Memory 26/26
Language 26/26
Visuospatial 16/16
Fluency 14/14
```
104
How would you treat Alzheimers?
NMDA antagonist - Memantine
| Acetyl-cholinisterase inhibitors - Rivastigmine
105
How would you treat vascular dementia?
```
Statin
Antihypertensive medication
Aspirin
Treat diabetes
No benefits of acetylcholinesterase inhibitors, but still get all the side effects
```
106
What is BPSD?
```
Behavioural and psychological symptoms of dementia: Anxiety
Depression (more in early dementia)
Agitation
Psychosis
Disinhibition
```
107
What causes BPSD?
Pain (they can’t tell you they’re in pain, so if they’re aggressive they may be showing distress)
Infection
Nutrition
Constipation
Hydration
Medication (may be having side effects such as hallucinations, look to see if any new drugs)
Environment
108
What are the non-pharmacological treatments of dementia?
```
INFORMATION
Carer Support
Life story
Psychological
Target symptoms Mood etc
Occupational therapy
Physiotherapy
Social Inclusion
Social activity
```
109
What psychotic disorders occur in the elderly?
```
Late onset Schizophrenia
Persistent Delusional disorder
Psychotic depression
Dementia
- Delusions
- Hallucinations eg Lewy Body Dementia
```
110
What is late onset schizophrenia?
Onset after 45 years old
111
How does late onset schizophrenia differ from schizophrenia?
Patients have less emotional blunting and personality decline compared to younger onset
112
Why is late onset schizophrenia often misdiagnosed?
Late-onset schizophrenia often goes undiagnosed because older patients with the disorder tend to be socially isolated
113
What are the clinical features of late onset schizophrenia?
delusions and hallucinations prominent
primarily paranoid
many symptoms similar to younger onset
Hallucinations in very late-onset schizophrenia are often prominent and can occur in multiple modalities, including auditory, visual, and olfactory partition” delusion, which leads the patient to believe that people or objects can transgress impermeable barriers
Less negative symptoms (less emotional blunting) and formal thought disorder compared to early onset schizophrenia
114
What are the risk factors for late onset schizophrenia?
Social Isolation
Sensory deficits
Reclusive and suspicious premorbid personality (always been very difficult)
More common in women than men
Relatives of very-late-onset patients have a lower risk for schizophrenia than the relatives of early-onset schizophrenia patients
115
What is the prognosis of late onset schizophrenia?
Chronic with partial remissions and exacerbations
Better outcomes than that in early-onset
Responsive to low dose antipsychotics?
Factors associated with positive outcome include early identification and treatment and good social support
116
When and who does delusional disorder F22 occur?
Population prevalence – 0.03%
Middle to late adulthood
Higher among women
Age of onset is earlier for men
117
What are the clinical features of delusional disorder F22?
```
Long standing Delusions main feature
Over 3/12 Hx
- single or related
- culturally appropriate
- No persistent Hallucination
- Can be transitory
- NOT 3rd Person
- No passivity or blunting of affect
- No Organic cause
```
118
What are the common delusions in elderly F22 diagnosis?
skin infestation
Illness or cancer (believe they had it or the doctors failed to diagnose it)
being spied on
Followed
Poisoned
Infidelity (quite high risk as people can act on this delusion)
119
What are the clinical features of psychotic depression?
Mood congruent delusions (depressed, low mood delusions)
Nihilistic Delusions
Cotard’s Syndrome (sensation that all your organs have gone rotten and smell)
Owing money (think they owe money to people)
Burden to others (very high risk of suicide)
Somatic Delusions
- unable to swallow (think they can’t do it, difficult to treat as they don’t take their medication, always check that it is a delusion and they don’t have an actual GI issue)
pain
Olfactory Hallucinations
2nd person derogatory Auditory hallucinations
120
What is Charles-Bonnet Syndrome?
Experience of complex visual hallucinations in a person with partial or severe blindness
Patients understand that the hallucinations are not real and often have insight compared to other disorders
121
What are the underlying principles behind the mental health act?
respect for patients' past and present wishes and feelings
respect for diversity generally
minimising restrictions on liberty,
involvement of patients in planning, developing and delivering care and treatment appropriate to them,
avoidance of unlawful discrimination,
effectiveness of treatment,
views of carers and other interested parties,
patient wellbeing and safety, and
public safety.
122
What is section 2 of the mental health act?
Duration – 28 days (cannot be renewed)
Purposes – assessment (although treatment can be given without patients’ consent)
Professionals involved - 2 doctors (one S12 approved), AMHP
123
What is section 3 of the mental health act?
Duration – 6 months (and can be renewed for another 6 months, and then yearly)
Purposes – treatment (can treat without consent for first three months, after that consent is needed)
Professionals involved – 2 doctors, 1 AMHP
124
What evidence is needed for section 2 of the mental health act?
Evidence required:
a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment; and
b) The patient ought to be detained for his or her own health or safety, or the protection of others
125
What evidence is required for section 3 of the mental health act?
Evidence required:
(a) The patient is suffering from mental disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment in a hospital; and
b) The treatment is in the interests of his or her health and safety and the protection of others; and
c) Appropriate treatment must be available for the patient
126
What is section 4 of the mental health act?
Duration – 72 hrs
Purposes – only in an “urgent necessity” when waiting for a second doctor would lead to “undesirable delay. no power to treat
Professionals required – 1 doctor and 1 AMHP
127
What evidence is needed for section 4 of the mental health act?
Evidence required –
a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment; and
b) The patient ought to be detained for his or her own health or safety, or the protection of others
c) There is not enough time for 2nd doctor to attend (risk)
128
What is section 5(4) of the mental health act?
For a patient ALREADY admitted (can be psychiatric or general hospital) but wanting to leave
Nurses’ holding power until doctor can attend
6 hours
Cannot be treated coercively whilst under section
129
What is section 5(2) of the mental health act?
For a patient ALREADY admitted (can be psychiatric or general hospital) but wanting to leave
Doctors’ holding power – 72 hours
Allows time for Section 2 or Section 3 assessment
Cannot be coercively treated
130
Can police section people on the mental health act?
Yes.
S136 – person suspected of having mental disorder in a public place, compulsory detention from public place (not home) to a place of safety. Upto 24 hours – MHA assessment
S135 – needs court order to access patient’s home and remove them to
131
What is a community treatment order?
Extension of section 3 into community.
Conditions – take meds, attend appointments
Break conditions – 72 hours to return to hospital
Review 6 monthly
132
What is section 117 of the mental health act?
Duty to provide after care for people wo have been subject to certain sections of the act (3)
Support their mental health as long as required
Don’t have to pay for services
Must be discharged by local authority
133
What are the 4 key neurotransmitter systems?
Dopamine; serotonin; acetylcholine, glutamate
134
What pathways does dopamine effect and what conditions are the linked to?
Mesocortical - negative symptoms of psychosis
Mesolimbic - positive symptoms of psychosis
Nigrostriatal - Parkinson's disease
135
What is the dopamine hypothesis behind schizophrenia?
Overactivity of dopamine receptors (D2)
- Mesolimbic = hallucinations
Underactivity of dopamine receptors (D1)
- Mesocortical = blunted and apathetic
136
What is the main mechanism of anti-psychotic treatment?
Block D2 receptors
137
What are the side effects of D2 antagonists?
Extrapyramidal side effects: acute dystonic reaction [eyes roll back in head, neck spasm] (hours); Parkinsonism [days]; akasthesia (inner restlessness, pacing and agitated)[days to weeks]; tardive dyskinesia (grimacing, lip smacking, tongue protrusion [months to years]
138
What are some examples of some anti-psychotics?
Haloperidol; chlorpromazine; pipothiazine; olanzapine; clozapine is used in treatment resistant schizophrenia
139
What neurotransmitter is in the pathophysiology of depression?
Serotonin and noradrenaline
140
What are some types of antidepressants?
SSRIs (selective serotonin reuptake inhibitors); SNRIs (serotonin and noradrenaline reuptake inhibitors)
141
How do SSRIs work?
Reuptake pumps and transporters recycle any serotonin within the synapse
Inhibiting the reuptake pumps increases free serotonin
142
How do SNRIs work?
Inhibits the reuptake pumps
| Inhbits the noradrenaline transporter
143
Give some examples of SSRIs
Sertraline; Citalopram; Fluoxetine
144
Give some examples of SNRIs
Venlafaxine; Duloxetine
145
What are some side effects of SSRIs?
Sexual
Weight gain
Increased bowel motility
Agitation
146
How do tricyclics work?
Blocks both seratonin and noradrenaline pumps
BUT also blocks muscarinic and cholinergic receptors = “anticholinergic” side effects
Dry mouth
Blurred vision
Urinary retention
147
How would you treat bipolar?
```
Lithium
Sodium Valproate
Carbamazepine
Lamotrigene
antipsychotics
```
148
What is lithium used to treat?
Acute treatment of mania
| Relapse prevention
149
How does lithium work?
Inhibits cAMP production
150
What are the side effects of lithium?
Level (of lithium)- 0.6 to 1.0 mmol/L, Leukocytosis
Insipidius - Nephrogenic Diabetes (Increase in ADH)
Tremors = mild, Tremors = coarse ?Toxicity
Hydration - Dry mouth, diarrhoea, thirsty - must drink
Increased - GI, Skin, memory problems
Under active thyroid (decreased TSH)
Metallic taste, Mums beware = Ebsteins Phenomena
151
What levels would give you lithium toxicity?
Usually levels greater than 1.0mmol/L
152
What are the clinical features of lithium toxicity?
```
Onset usually sudden
Sudden dehyration - on holiday
Overdose
Other medications
Systemic illness
Coarse tremor, hyperreflexia,seizures, Heart block
```
153
How do you treat lithium toxicity?
STOP lithium, rehydrate, haemodialysis
