Psychiatric Treatments

Question 1

Name 3 atypical antipsychotics

Answer 1

Olanzapine
Risperidone
Quetiapine

Question 2

Name 3 typical antipsychotics

Answer 2

Haloperidol

Sulpiride

Question 3

How is clozapine monitored?

Answer 3

Weekly for first 18/52
Then fortnightly for 1 year
Then monthly

Question 4

What is a specific side effect of clozapine?

Answer 4

Hypersalivation (wake up with pillow soaked)

Question 5

Why do patients on clozapine have to gave frequent bloods?

Answer 5

To check their WCC

Clozapine can cause agranulocytosis and neutropenia

Question 5

What are some differences between atypical and typical antipsychotics?

Answer 5

Typicals are more likely to cause EPSEs and hyperprolactinaemia

Atypicals are more likely to cause metabolic side effects e.g. weight gain, dyslipidaemia, diabetes
Atypicals also exert a serotoninergic effect, thought to reduce negative symptoms

Question 6

What are some EPSEs of antipsychotics?

Answer 6

Parkinsonism: tremor, bradykinesia, rigidity
Dystonia
Tardive dyskinesia
Akathisia

Question 7

How do antipsychotics generally work?

Answer 7

Inhibiting dopamine activity, by blocking mainly D2 receptor

Target the mesocortical and mesolimbic pathway, unwanted pathways are nigostriatal and tuberoinfundibular

Question 8

What is a life threatening reaction to antipsychotics called?

Answer 8

Neuroleptic malignant syndrome

Question 9

What are some symptoms of neuroleptic malignant syndrome?

Answer 9

Fever
Muscle rigidity
Altered mental state e.g. confusion, LOC
Autonomic instability e.g. tachycardia, sweating, tremor, fluctuating BP

Question 10

How often is lithium monitored in a patient?

Answer 10

12 hours post first dose
Then weekly until stable for 4/52
Then every 3/12

Question 11

Which mood stabiliser is safe to give to a woman of child bearing age/ in pregnancy?

Answer 11

Lamotrigine

Question 12

What are some side effects of lithium?

Answer 12

Teratogenic 
Renal failure
Metallic taste
Hypothyroidism 
GI upset
Weight gain
Polydipsia and polyuria
Convulsions

Question 13

When would a mood stabiliser be prescribed?

Answer 13

To prevent depression or mania in bipolar or schizoaffective disorder

Question 14

What are some examples of SSRIs?

Answer 14

Sertraline
Fluoxetine
Citalopram
Paroxetine

Question 15

What is ECT used for?

Answer 15

Severe depression

Occasionally used for schizophrenia, good for catatonic type

Question 16

What are some examples of SSRIs?

Answer 16

Fluoxetine
Sertraline
Citalopram
Paroxetine

Question 17

Which SSRI is safest in people under age 18?

Answer 17

Fluoxetine

Question 18

What are some ADRs of SSRIs?

Answer 18

GI upset
Nausea
Weight changes
Headache
Sexual dysfunction

Question 19

What are some examples of mood stabilisers?

Answer 19

Lithium
Sodium valproate
Carbamazepine
Lamotrigine

Question 20

What marker is often raised in neuroleptic malignant syndrome?

Answer 20

Creatine kinase

Question 21

What are some appropriate investigations to do before prescribing an antipsychotic and why?

Answer 21

ECG, as they can lead to prolonged QTc which can lead to torsades de pointes
Baseline BMI, waist circumference, blood glucose and lipids (due to metabolic and anti histamine side effects)

Question 22

What regular blood tests are needed for a patient taking lithium carbonate?

Answer 22

U&Es as lithium is nephrotoxic
Lithium levels (as it has a narrow therapeutic index)
TFTs as lithium can damage thyroid and cause hypothyroidism

Question 23

What is the only absolute contraindication for ECT?

Answer 23

RICP

Question 24

Which antidepressant is safest post-MI?

Answer 24

Sertraline

Question 25

Why are SSRIs 1st line antidepressants?

Answer 25

Low side effect profile | Safe in overdose

Question 26

In an OSCE, when asked for management, how should this be presented?

Answer 26

BIOPSYCHOSOCIAL MODEL

Question 27

How should neuroleptic malignant syndrome be treated?

Answer 27

Stop the antipsychotic IV Fluids Dantrolene (can decrease release of calcium from the sarcoplasmic reticulum)

Question 28

How do antipsychotics affect prolactin?

Answer 28

Antipsychotics antagonise dopamine Dopamine inhibits prolactin (tubero-infundibular) Hence antipsychotics raise plasma prolactin Hence side effect e.g. galactorrhea

Question 29

How long should a px continue their antidepressants for once their depression has remitted?

Answer 29

Continue for at least 6 month after first episode of depression After a second episode, continue for 2 years

Question 30

Which drug is first line for ADHD?

Answer 30

Methylphenidate

Question 31

What is ECT?

Answer 31

Put patient under general anaesthesia (and give a muscle relaxant) Place electrodes on head and send an electric current though the brain to induce a tonic clonic seizure

Question 32

When is ECT indicated?

Answer 32

In severe depression, uncontrolled mania or catatonia

Question 33

Which antidepressants are safest in OD?

Answer 33

SSRIs

Question 34

What are some side effects of SSRIs?

Answer 34

``` Stomach upset Sexual dysfunction Serotonin syndrome Suicidal thoughts Sex drive decrease Sleep disturbance QTc elongation Sodium low so seizure threshold lowered in epilepsy ```

Question 35

What are some examples of SNRIs?

Answer 35

Venlafaxine | Duloxetine

Question 36

What are some examples of TCAs?

Answer 36

Amitriptyline | Clomipramine

Question 37

When are TCAs used?

Answer 37

For patients unresponsive to SSRIs | Can be used in neuropathic pain

Question 38

How does mirtazapine act?

Answer 38

5HT2 and 5HT3 antagonist Also has strong histamine activity so causes sedation Also causes weight gain

Question 39

What are some examples of hypnotics?

Answer 39

Benzodiazepines Zopiclone Zaleplon Zolpidem

Question 40

Which class of antidepressants have most marked sleep disturbance?

Answer 40

SNRIs

Question 41

What is oculogyric crisis?

Answer 41

When the eyes are held in upward deviation | Type of dystonic reaction to dopamine antagonists (eg haloperidol, metoclopramide)

Question 42

What is bromocriptine an example of?

Answer 42

Dopamine agonist Can use in Parkinson’s Reduces muscle rigidity but can cause impulse control disorders

Question 43

What is an example of a COMT inhibitor?

Answer 43

Entacapone

Question 44

What drug can be used to help control EPSEs and how does this work?

Answer 44

Procyclidine | It is an anti muscarinic so blocks cholinergic receptors to hell tremor and rigidity

Question 45

What side effects are more common with atypical antipsychotics?

Answer 45

Hyperglycaemia Weight gain Sedation QTc prolongation Hyperprolactinaemia (so infertility, galactorrhea) Hypotension (So monitor BP, weight, glucose, lipids, ECG)

Question 46

What can be seen on bloods in neuroleptic malignant syndrome?

Answer 46

Raised CK | Raised WCC

Question 47

What could precipitate lithium toxicity?

Answer 47

Dehydration, renal failure, diuretics, ACEi, NSAIDs

Question 48

How could lithium toxicity be treated?

Answer 48

Volume resuscitation with IV fluids | If severe, haemodialysis

Question 49

What are some features of lithium toxicity?

Answer 49

Coarse tremor (fine tremor seen at therapeutic levels) Seizures Acute confusion Hyperreflexia