Pass medicine 3 Flashcards
(106 cards)
1
Q
What is charles bonnet syndrome?
A
Charles-Bonnet syndrome (CBS) is characterised by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis).
2
Q
What are the risk factors for CBS?
A
PEAS
- Peripheral visual impairment
- Early cognitive impairment
- Advanced age
- Social isolation
- Sensory deprivation
3
Q
Which ophthalmological conditions associated with CBS?
A
age-related macular degeneration, followed by glaucoma and cataract.
4
Q
A 45-year-old man is admitted due to haematemesis. He reports drinking 120 units of alcohol a week. When is the peak incidence of seizures following alcohol withdrawal?
A
36 hours
5
Q
A 45-year-old man is admitted due to haematemesis. He reports drinking 120 units of alcohol a week. When is the peak incidence of delirium tremens following alcohol withdrawal?
A
72 hours
6
Q
What are the features of PTSD?
A
- re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
- avoidance: avoiding people, situations or circumstances resembling or associated with the event
- hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
- emotional numbing - lack of ability to experience feelings, feeling detached from other people
- depression
- drug or alcohol misuse
- anger
- unexplained physical symptoms
7
Q
What does purging behaviour include?
A
Purging behaviours in bulimia are not only vomiting, can be use of laxatives or diuretics or exercising
8
Q
What hair growth might AN patients have?
A
Lanugo
9
Q
A 46-year-old man with schizophrenia is brought to the surgery by one of his carers. His current medication includes clozapine and procyclidine. His carer reports that he is more tired than usual and generally unwell. She also thinks he may have put on weight. What is the most important test to perform?
Blood sugar Full blood count Urea and electrolytes Urine dipstick for protein Liver function tests
A
Clozapine - check FBC
The most important complication of clozapine therapy to exclude is agranulocytosis.
10
Q
A 41-year-old male has been on olanzapine for the past 2 years. He has recently looked up the side-effects of the drugs after suffering from an episode of tardive dyskinesia.
Which biochemical side-effect would this patient most likely suffer from?
Hypernatraemia Hypercholesterolaemia Hyperkalaemia Hypoprolactineamia Hyperparathyroidism
A
Hypercholesterolaemia
11
Q
What are the metabolic side effects of antipsychotics?
A
- dysglycaemia
- dyslipidaemia
- diabetes mellitus
12
Q
An 88-year-old woman is brought to her GP by her daughter because of new memory problems. She did not want to attend as she is worried about her memory and does not want to be diagnosed with dementia. She scores 12 out of 30 on a mini-mental state exam.
Her memory is globally impaired with failure to retain new information as well as failure to remember important events from her life. Her daughter reports this has been the case for the past two months and she was previously fine and had no cognitive concerns. Her daughter also reports she is struggling with sleep and her appetite has reduced significantly in this time although the patient does not think this is the case.
What is the most likely cause of her memory impairment?
A
Depression
Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia
13
Q
You are called by the husband of a 45-year-old patient who is registered at your practice. Her only history of note is type 2 diabetes mellitus treated with metformin. For the past three days he states that she has been ‘talking nonsense’ and starting to hallucinate. An Approved Mental Health Professional is contacted and makes her way to the patient’s house. On arrival you find a thin, unkempt lady who is sat on the pavement outside her house, threatening to ‘kick your head in’. What is the most appropriate action?
A
The patient is in a public place and threatening violent behaviour. The police should be contacted to transport her to a place of safety where she may be formally assessed.
14
Q
Can patients under the influence of alcohol or drugs be sectioned?
A
no
15
Q
What are the 2 types of lasting power of attorney?
A
Property and affairs Personal welfare (healthcare, living conditions and location)
16
Q
What is an IMCA?
A
An independent mental capacity advocate
An IMCA is someone appointed to support a person who lacks capacity but has no one to speak on their behalf. The IMCA makes representations about the person’s wishes, feelings, beliefs and values.
17
Q
What is the mental health act?
A
The MHA is a law that allows people with a mental disorder (includes mental illness, personality disorder, learning disability and disorders of sexual preference e.g paedophilia) to be sectioned i.e admitted to hospital, detained and treated without their consent- either for their own health and safety or for the protection of other people.
18
Q
When can the mental health act be used?
A
- Refusal of voluntary treatment.
- Other options have been considered but are not appropriate.
- Mental disorder must be known or suspected
- Harm risk significant.
- Appropriate treatment must be available.
Revise our mental health act
19
Q
What’s a CTO?
A
- community treatment order
- allows patients on s3 who are well enough to leave the hospital for treatment in the community
- patients can be recalled if they do not comply with treatment. Once recalled they may be detained for up to 72 hours for assessment.
20
Q
Section 2 Purpose? Order? Who can enforce? Duration?
A
- admission for assessment for up to 28 days, not renewable
- assessment but treatment can be given without consent
- an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
- one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
- the patient can appeal against detention to the mental health review tribunal (MHRT) during the first 14 days and to hospital managers at any time.
21
Q
What’s a section 3?
A
- admission for treatment for up to 6 months, can be renewed
- AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours. Cannot normally proceed in the NR objects.
- one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
- patients can appeal against detention to the mental health review tribunal (MHRT) (only once) during the first 6 months. They can make a n appeal to hospital managers once every 6 months.
- at 3 months all treatment must be reviewed by a second opinion appointed doctor (SOAD) unless patient consents to ongoing treatment.
- if extended they can appeal once in the second block
- patients can go on leave for up to 6 months on a CTP/s17 but must be seen by their clinical team every 2 weeks
22
Q
What’s a section 4?
A
Section 4
- 72 hour assessment order
- used as an emergency, when a section 2 or 3 would involve an unacceptable delay (no second doctor)
- a GP and an AMHP or NR
- often changed to a section 2 upon arrival at hospital
- no right to appeal
23
Q
What’s a section 5 (2)?
A
Section 5(2)
- a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
- can’t be used in A&E
- no right to appeal
- not a foundation doctor
24
Q
What’s a section 5 (4)?
A
Section 5(4)
- similar to section 5(2), allows a psychiatric nurse to detain a patient who is voluntarily in hospital for 6 hours
- can’t be used in A&E
- no right to appeal
25
What's a section 17a?
Section 17a
| Supervised Community Treatment (Community Treatment Order)
26
What's a section 135?
Section 135
a court order can be obtained (magistrate's warrant) to allow the police to break into a property to remove a person to a Place of Safety
27
What's a section 136?
Section 136
| someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
28
What's a section 117?
deals with aftercare responsibilities after a patient has been detained under s3
29
What's a section 62?
Concerns urgent treatments such as ECT for life threatening depression
30
A 24-year-old female smoker presents to your general practice with a 6 month history of difficultly sleeping, often awake for hours worrying before eventually falling asleep. This is affecting her ability to concentrate at work. During the consultation you notice that she appears agitated and fidgeting throughout. On looking at her notes you notice she has recently presented with a variety of symptoms including abdominal pain and palpitations.
Which condition is important to rule out in this patient's case, before proceeding with a diagnosis of generalised anxiety disorder?
```
Phaeochromocytoma
Insomnia
Wilson's disease
Hyperthyroidism
Depression
```
Anxiety - rule out thyroid disease
| Symptoms of anxiety and hyperthyroidism often overlap and hyperthyroidism can be a cause and an exacerbating factor.
31
A 68-year-old Asian lady presenting with a sudden onset of paranoid thoughts and suicidal ideation was admitted under section 2 of the Mental Health Act for a period of assessment. Her past medical history consisted of hypertension, type 2 diabetes mellitus and hypercholesterolaemia. Considering this first episode of sudden onset psychosis in an elderly lady, what important investigation is required to rule out other secondary causes?
```
Chest X-ray
CT head
PET scan
HbA1c
ECG
```
A CT head scan should be considered in elderly patients with new sudden onset psychosis to rule out an organic cause for their presentation
Organic causes must be considered and excluded before the psychosis can be attributed to a primary psychotic disorder. Consider brain imaging (CT or even an MRI) with initial onset of psychosis in the elderly to rule out organic causes (e.g. a brain tumour, stroke or CNS infection).
32
A 32-year-old male patient who has a known psychiatric diagnosis of paranoid schizophrenia was admitted under the Mental Health Act following a deterioration in his mental health. Clozapine was considered as the next most appropriate anti-psychotic to start him on and this was initiated as an inpatient. Once this patient's mental state was stabilised he was transferred back to the rehabilitation unit. Whilst at the unit, he was found to have missed his Clozapine doses for 2 consecutive days. What is the best course of action to address these missed doses of Clozapine?
- To continue Clozapine at the current dose & request a Clozapine plasma level assay
- To take the missed doses of Clozapine now & request a Clozapine plasma level assay
- Consider an alternative anti-psychotic
- Re-titrate the Clozapine doses again slowly
- Stop Clozapine completely
Re-titrate the Clozapine doses again slowly
If clozapine doses are missed for more than 48 hours the dose will need to be restarted again slowly
If doses are missed for more than 2 consecutive days (48 hours), you will need to restart their clozapine slowly (like when they first started on it). This restart of treatment needs to be under the direction of a Psychiatrist. This is because when you start Clozapine after a break of >48 hours, it can make side effects worse, such as blood pressure changes, drowsiness and dizziness. If there is a gap in treatment of 3 days (72 hours) then you may also require more frequent blood tests for a short period.
33
What monitoring is required for patients taking antipsychotic medication?
Full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFT)
- at the start of therapy
- annually
- clozapine requires much more frequent monitoring of FBC (initially weekly)
Lipids, weight
- at the start of therapy
- at 3 months
- annually
Fasting blood glucose, prolactin
- at the start of therapy
- at 6 months
- annually
Blood pressure
- baseline
- frequently during dose titration
Electrocardiogram
- baseline
Cardiovascular risk assessment
- annually
34
What are the features of an atypical grief reaction?
- delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins
- prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months
35
What monitoring should be done for patients on lithium?
- inadequate monitoring of patients taking lithium is common - NICE and the National Patient Safety Agency (NPSA) have issued guidance to try and address this. As a result it is often an exam hot topic
- after starting lithium levels should be performed weekly and after each dose change until concentrations are stable
- once established, lithium blood level should 'normally' be checked every 3 months. Levels should be taken 12 hours post-dose
- thyroid and renal function should be checked every 6 months
- patients should be issued with an information booklet, alert card and record book
36
What are the adverse effects of lithium?
- nausea/vomiting, diarrhoea
- fine tremor
- nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
- thyroid enlargement, may lead to hypothyroidism
- ECG: T wave flattening/inversion
- weight gain
- idiopathic intracranial hypertension
37
When does lithium toxicity leading to hypothyroidism usually manifests?
between 6 and 18 months after initiation of treatment
38
A 62-year-old known alcoholic was admitted to hospital 3 days ago following a fall. Nurses say that in the last 3 hours he has become aggressive, confused, has been complaining of 'pixies dancing around the bed'. On assessment you also note a coarse tremor and pyrexia. What is your best initial management?
The first line management in a patient with delirium tremens is lorazepam.
Haloperidol use is reserved for those who do not respond to oral lorazepam.
39
How would you switch from citalopram, escitalopram, sertraline, or paroxetine to another SSRI?
the first SSRI should be withdrawn* before the alternative SSRI is started
*this means gradually reduce the dose then stop
40
How would you switch from fluoxetine to another SSRI?
withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI
41
How do you switch from a SSRI to a tricyclic antidepressant (TCA)?
cross-tapering is recommend (the current drug dose is reduced slowly, whilst the dose of the new drug is increased slowly)
- an exceptions is fluoxetine which should be withdrawn prior to TCAs being started
42
How do you switch from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine
cross-taper cautiously. Start venlafaxine 37.5 mg daily and increase very slowly
43
How do you switch from fluoxetine to venlafaxine
withdraw and then start venlafaxine at 37.5 mg each day and increase very slowly
44
A 23-year-old male has been on antipsychotics for the past few months. He has been suffering from a side-effect of this drug, that you grade as severe, which causes repetitive involuntary movements including grimacing and sticking out the tongue. This side-effect is known to arise only in individuals who have been on antipsychotic for a while.
Which medication is therefore most suitable to treat this side-effect?
```
Procyclidine
Tetrabenazine
Propranolol
Benztropine
Lorazepam
```
Tetrabenazine may be used to treat moderate/severe tardive dyskinesia
45
A patient you are looking after is started on imipramine for depression. Which combination of side-effects is most likely to be seen in a patient taking this class of antidepressants?
```
Dry mouth + urinary frequency
Hypertension + sweating
Gastrointestinal bleeding + dyspepsia
Headache + myoclonus
Blurred vision + dry mouth
```
Blurred vision + dry mouth
| These antimuscarinic side-effects are more common with imipramine than other types of tricyclic antidepressants.
46
How long do symptoms need to be present before diagnosing paranoid schizophrenia?
1 month
47
To diagnose OCD how long must the symptoms be present? What must you check?
2 weeks
| The thoughts are there own
48
What is a dissociative fuge?
Loss of memory (like in dissociative amnesia), but htere is also an apparently purposeful journey away from home, or the place of work, during which self-care is maintained.
49
What's a dissociative stupor?
A profound reduction in, or absence of voluntary movements, speech and normal responses to stimuli.
50
What are the signs and symptoms of wernicke's encephalophy?
Delirium (clouding of consciousness
Ataxia
Nystagmus
Ophthalmoplegia
51
How should you treat someone who has alcohol withdrawal symptoms?
Gradually reducing doses of benzodiazepines over 5-7 days with pabrinex injections. Oral thiamine and vitamin B tablets might not be enough
52
What are the features of dependence syndrome?
Drug Problems Will Continue To Harm:
Desire/compulsion to consume substance
Preoccupation with substance (neglect of alternative pleasures)
Withdrawal effects
Control impaired
Tolerance increased
Harmful effects known but continues to persist
At least 3 must be present to diagnose the condition
53
What's the suicide rate of bipolar affective disorder?
15%
54
What's the lifetime prevelance of BP disorder?
4.4% (includes Bipolar 1, 2 and NOS)
55
What are the family links of BP disorder?
```
First Degree Relatives of those with BPD –
elevated rates
– Bipolar I 4%-24%
– Bipolar II 1% - 5%
– Major Depressive Disorder 4% - 24%
```
Twin studies
– Concordance rates
Monozygotic 60-70%
Dizygotic 20%
56
Aetiology of BP disorder
```
Genes / FH
Precipitating Shift work
Medicines – starting
Medicines - stopping
Street drugs
Loss events
```
57
What's the DSM-V criteria for mania?
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week
the mood change must be accompanied by persistently increased activity or energy levels
```
B. During the period of mood disturbance, three (or more) of
the following symptoms
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep
(3) more talkative than usual
(4) flight of ideas
(5) distractibility
(6) increase in goal-directed activity
(7) excessive involvement in pleasurable activities that have a high potential for painful consequences
```
C. The symptoms do not meet criteria for a Mixed Episode.
D. Marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
58
What's the DSM-V criteria for hypomania?
A. A distinct period of persistently elevated, expansive or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
the mood change must be accompanied by persistently increased activity or energy levels
```
B. During the period of mood disturbance, three (or more) of
the following symptoms
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep
(3) more talkative than usual
(4) flight of ideas
(5) distractibility
(6) increase in goal-directed activity
(7) excessive involvement in pleasurable activities
```
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
D. The disturbance in mood and the change in functioning are observable by others.
59
Differentials for BP disorder?
```
– Schizophrenia
– Recurrent depressive disorder
– Drug-induced states
– Anxiety disorders / ADHD
– Borderline personality disorder
– Medical causes eg endocrine / CNS disease / medications (e.g. corticosteroids)
```
60
Prognosis of BP
Relapse rates are high
In order of 40-50% in 1 yr, increasing to >70% in 5 yrs
Systematic Treatment Enhancement Program for Bipolar Disorder (Sachs et al 2003) STEP BD
– In ‘recovered’ patients - 5% relapse each month, 80% of these relapses due to depression. (Baldassano 2006)
Tohen (2003). Approx 1-2 yrs after any treatment for a
mixed or manic episode relapse or switch rates 35% -
60%.
61
How do you treat an acute episode of mania?
- Stop antidepressant (decide whether immediately or
slowly; clinical need and risk of withdrawal symptoms)
- Add antipsychotic , lithium or valproate
- If already taking an antimanic, optimize dose or
add another antimanic e.g. Li+ + valproate
- Short-term use of BZ e.g. lorazepam for behavioural disturbance
- If using antipsychotic, consider olanzapine, quetiapine, risperidone
62
Which antidepressant is most likely to cause manic switching?
Venlafaxine
63
Which drugs are effective at preventing bipolar relapse?
– Quetiapine ++
– Olanzapine + (continuation)
– Valproate +/-
64
What are the long term psychosocial treatments for bipolar?
- Using mood charts
- Psycho – education – symptoms, medications, side-effects, prognosis, …
- Early recognition of symptoms
- Modifying daily routine – Sleep, wake, stimulation, relaxation, etc
- Addressing adherence to medicines
- And some formal psychotherapies
65
What proportion of people with suicidal ideation attempt suicide?
12% in following year
66
What's the risk of suicide in the west?
10-30/100,000
67
What's the male to female ratio of suicide?
3:1
68
What are the risk factors for suicide?
```
• Age
• Male
– m:f = 3:1
• Socioeconomic factors
– Poverty
– Unemployment
– Social fragmentation
– Divorce
```
69
Who are the high risk groups for suicide?
* 90% have a diagnosable mental illness at time of death
* Mood disorder 12-20x
* 25% misuse or are dependent on alcohol
* 50% have alcohol in their system at death
* 1/3 have a personality disorder
70
What is the risk of suicide in the first month out of hospital?
100-200 fold increase
71
By what magnitude does self harm increase the risk of suicide?
60 x
72
What are the challenges of suicide?
* 25% are in treatment at time of death
* 50% have never had contact with psych services
* 60% complete on first attempt
* 70% communicate intent to others
73
What are the protective factors against suicide?
• Treatment and support for mental, physical,
and substance abuse disorders .
• Family and community support .
• Good problem solving skills
74
What proportion of teenagers report self harm?
20%
75
What are the risk factors for self harm?
```
• Age
– 15-24 age group
– 2/3 before age 35
– Rare before 10yrs
• Female
• Lower socioeconomic class
• Psychiatric disorder
• Hx of abuse
• Poor coping strategies
• Previous self harm
• Relationship breakdown
```
76
What is a unit of alcohol?
10ml or 8g of pure alcohol
77
How do you calculate the number of units?
%ABV x Vol (L)
78
Give examples of the amount of units in standard drinks
```
Pint of 3.5% beer 2 units
Pint of 5% beer 2.8 units
Glass of wine (175ml) 2.1 units
Glass of wine (250ml) 3 units
Can of 5% beer (440ml) 2.2 units
Can of super-strength lager 4 units
Measure of spirits (25ml) 1 unit
```
79
How many units can you have per week?
14
80
What's binge drinking?
Male: > 8 units
| Female: > 6 units
81
How many units is considered high risk?
> 50 units per week (male)
| > 35 units per week (female)
82
What proportion of the population are alcohol dependent?
1.4% of 18+
83
What facts do you know about the morbidity and mortality of alcohol?
“Top 5 causes of death and disability globally”
Causes 5.9% of deaths per year
Causes 5.1% of DALY’s per year
Harm to UK Economy £21bn per year
Contributes 1.7% GDP to UK
Effective Interventions (Canada, Czech Republic, Germany): Brief interventions advertising restrictions, tax increases, and instituting a minimum unit price
84
What are the screen tests for alcohol abuse?
FAST
AUDIT
CAGE
85
What are the questions on the FAST questionnaire?
1. How often have you had 6 or more units if
female, or 8 or more if male, on a single
occasion in the last year?
2. How often during the last year have you failed to
do what was normally expected from you
because of your drinking?
3. How often during the last year have you been
unable to remember what happened the night
before because you had been drinking?
4. Has a relative or friend, doctor or other health
worker been concerned about your drinking or
suggested that you cut down?
86
What's the CAGE questionnaire?
Cut-down
Annoyed/Angry
Guilty
Eye-opener (score 2 or more)
87
What's the drink-drive limit?
0.35 ug/100ml
88
What blood test changes are associated with alcohol use?
```
LFTs raised
Gamma GT -> inflammation
Alk Phos
AST / ALT more than 2 is suggesive of ALD
Bilirubin -> jaundice
MCV raised above 100
Platelets reduced
Carbohydrate-Deficient Transferrin – raised (>1.7%)
```
89
Where is alcohol dehydrogenase found?
stomach and liver
90
What are the physical consequences of alcohol?
```
G/I – Cancer
- Liver cirrhosis
- oesophageal varices
CVS – hypertension
- cardiomyopathy
- ischaemic heart disease
CNS – excitotoxic brain damage (memory)
- Vit B1 deficiency: Wernicke-Korsakoff syndr.
- peripheral neuropathy
Trauma
```
91
How does alcohol work?
Agonist at the GABA-Benzodiazepine receptor
| Antagonist at the NMDA receptor
92
What does excess excitablity of the NMDA pathway cause?
Excitotoxic brain damage:
Damage to hippocampus
Memory loss
93
More than how many alcohol detoxifications is harmful?
2
94
How does detoxing cause harm?
Benzodiazepines do not block all withdrawals
Kindling of hippocampus
Multiple detoxifications make subsequent withdrawal symptoms worse
95
How do you treat alcohol withdrawal?
Chlordiazepoxide
Alternatives: Diazepam – stronger
Oxazepam – if liver failure
96
How do you treat delirium tremens?
```
ECG and electrolytes essential
Ensure haemodynamically stable
IVI
Nurse in low-lit, quiet environment
Sedation with oral lorazepam
IM lorazepam, haloperidol or olanzapine if oral sedation not possible
Continue alcohol detoxification
Treat inter-current illness
```
97
What's the classic triad of Wernicke's encephalophy?
+ staggering gait (not due to intoxication)
+ fluctuating level of consciousness
+ eye signs (nystagmus)
98
What are the indications for parenteral thiamine (pabrinex= vitamin B and C)?
```
Underweight
Vomiting
Other signs of malnourishment
Memory problems
Gait problems
```
99
What are the psychotherapies for alcoholics?
Motivational lnterviewing- Develop discrepancy
Relapse Prevention- Form of cognitive behavioural therapy
Behavioural Couples Therapy- Where one partner does not drink
Therapeutic Community- Residential Rehabilitation
Alcoholics Anonymous (12-step)- Mentor + social network may be most effective elements
100
What drugs are used in ancillary prescribing?
Acamprosate
Naltrexone & Nalmefene
Disulfiram
101
When is acamprosate used?
Neuroprotective
Start on Day 1 of detoxification
Continue while not drinking, and 6 weeks after
relapse
102
When are naltrexone/nalmefene used?
Reduces drinking in those not abstaining
Good for binge drinkers /dual diagnosis
patients
Recently licensed in UK
Reduces impulsivity
103
When is disulfiram used? How does it work?
Blocks acetaldehyde dehydrogenase
Build up of acetaldehyde leads to:
FLUSH REACTION / reduced BP / headache
Works by ‘threat’ of unpleasant consequences
Need supervision to ensure compliance
Warn of ‘hidden sources’ of alcohol e.g.
mouthwash, perfume.
Avoid if vascular disease, psychosis, suicidality
104
What are the first line treatments in bipolar?
Mania: Risperidone, olanzapine, valproate
Depression: Quetiapine, lamotrigine, SSRI
Maintenance: Lithium (often in combination with lamotrigine, quetiapine, valproate).
105
Give examples of mood stabilisers
lithium, carbamazepine, valproate
106
When is lamotrigine used?
In acute treatment of bipolar depression and prophylaxis of bipolar depressive
episodes
