Treatment Options

Question 1

List the classes of treatment for mental health conditions

Answer 1

Psychological
Pharmacological
Social
Physical

Question 2

List the main neurotransmitter systems in the body .

Answer 2

Dopamine
Seratonin
Acetylcholine
Glutamate

Question 3

Side effects associated with lithium

Answer 3

Leukocytosis 
Insipidius (Nephrogenic Diabetes )
Tremors 
Hydration
Increased GI, skin and memory problems 
Under active thyroid 
Metallic taste

Question 4

Mr PS presented to A&E with complaints of hearing voices for 6 months, worried that police were following him to his work. On examination he had thought that aliens were controlling his thoughts and his bodily functions.

What is the likely diagnosis?
What are the pharmacological treatment options?

Answer 4

1. Schizophrenia

2.

Question 5

List the differences in the mechanism of action between atypical and typical antipsychotics and give examples of each

Answer 5

Typical: Antagonism of the D2 receptor in the mesolimbinc pathway
Eg: Chlorpromazine, Haloperidol, Prochlorperazine

Atypical: Antagonism of D 3 and 5HT2 receptors
Eg: Olanzapine, Quetiapine, Aripiprazole and Risperidone

Question 6

List the side effects associated with typical antipsychotics in particular

Answer 6

Parkinsons symptoms: Tremor, rigidity

Dystonia: Abnormal face and body movements

Akathisia: Restlessness

Tarditive dyskinesia: Rthymic involuntary movements of the face, jaw and tongue

Drowsiness

Apathy

Agitation

Question 7

List the side effects associated with atypical antipsychotics

Answer 7

Lower likelihood of EPSE

Metabolic syndrome

Rispridone = Increased prolactin

• sexual dysfunction
• osteoporosis
• breast development

Question 8

List the antimuscarinic side effects of antipsychotics

Answer 8

Dry mouth
Constipation
Urinary retention
Blurred vision

Question 9

List the anti adrenergic effects of antipsychotics

Answer 9

Postural hypotension

Question 10

List the anti histaminergic effects of antipsychotics

Answer 10

Sedation

Increase weight gain

Question 11

List the cardiac effects of antipsychotics

Answer 11

Prolongation of the QT interval
Arrthymias
Myocarditis
Sudden death

Question 12

List the metabolic effects of antipsychotics

Answer 12

Metabolic syndrome

• Obesity
• Diabetes
• Hyperlipidaemia
• HTN

Question 13

List the different stages of treatment in depression

Answer 13

1. SSRI
   - Fluoxitine
   - Citalopram
   - Sertraline
2. Try another SSRI
   - Mitazapine
   - Moclobromide
   - Lofepramine
   - Trazadone
   - OR SNRI ( Duloxitine)
3. Severe depression
   - Clompramine
   - Amitryptyline
   - Venlaflaxine

Question 14

List the side effects of SSRI’s and the key side effects of

• Paroxitine
• Citlopram
• Serataline
• Fluoxitine

Answer 14

Headache (*)
GI symptoms 
Insomnia 
Sexual dysfunction 
Hyponatraemia 

Paroxitine: Increase weight/ sexual dysfunction
Citlopram: QT prolongation
Seratraline: Diarrhoea
Fluoxitine: long 1/2 life

Question 15

List examples of TCA’s and list the side effects associated with this type of drug

Answer 15

Amitriptyline
Dosulphin
Lofepramine

Side effects

• Sedation
• CV EFFECTS ( decrease BP, increase pulse)
• Increased QT interval
• Arrhythmias

VERY DANGEROUS IN OVERDOSE

Question 16

List the side effects associated with Mirtazapine

Answer 16

Drowsiness
Weight gain
Oedema
Constipation

Question 17

List the side effects associated with Trazadone

Answer 17

Sedation 
Dizziness 
Headache 
Nausea 
Vomiting 
Tremor

Question 18

List the side effects associated with SNRI’s and give examples

Answer 18

Headache
Dry mouth
Constipation
Increased BP

Venlaflaxine
Duloxetine

Question 19

Indications for using lithium

Answer 19

Maintenance and mood stabiliser in bipolar affective disorder
Unresponsive severe depression
Actue mania

Question 20

List the levels of treatment for lithium

Answer 20

Therapeutic: 0.5-1mmol/L

Toxic: >1.5mmol/L

Dangerously toxic level: >2mmol/L

Question 21

Factors affecting lithium concentration

Answer 21

1. Dehydration
2. Kidney disease
3. Diuretics
4. Alcohol

Question 22

Side effects of lithium

Answer 22

Thirst 
Polydipsia 
Polyuria 
Increased weight gain 
Tremor 
Blurred vision 
Metallic taste 
Hypothyroidism 
Nephrotoxicity

Question 23

Signs of lithium toxicity

Answer 23

> 1mmol/L

• Increased drowsiness
• Slugishness
• Ataxia
• Coarse tremor
• Profound D&V

> 2mmol/L

• Toxic psychosis
• Coma
• Death

Question 24

Treatment of lithium toxicity

Answer 24

Stop lithium
Measure Li after 7 days
Osmotic diuresis
Haematological dialysis

Question 25

What are the guidelines for prescribing clozapine

Answer 25

Atypical antipsychotic Used for treatment resistant schizophrenia Prescribed if an inadequate response to >2 antipsychotics

Question 26

Side effects of clozapine

Answer 26

``` Dry mouth Constipation Postural hypotension Sexual dysfunction Galactorrhaea Increased glucose Increased QT interval Nause and vomiting ```

Question 27

What is disassociation

Answer 27

Immature ego defence when ones identity is temporarily and drastically modified to avoid the distress of a given situation

Question 28

Outline the components of section II of the mental health act

Answer 28

``` Admission for assessment Up to 28 days Cannot be renewed Signed by up to x2 dr or 1dr and 1MHP Give treatment ```

Question 29

Outline the components of section III of the mental health act

Answer 29

``` Admission for treatment ~6 months Can be renewed Signed by x2 Dr or x1Dr and 1AMHP Give treatment and perform Ix ```

Question 30

Outline the components of section IV of the mental health act

Answer 30

Emergency treatment Only 1 AMHP/1Dr Hold you in hospital for 72hrs CANNOT TREAT YOU

Question 31

Outline the components of section V of the mental health act

Answer 31

Detention of a patient already in hospital 5.4: Nurses holding power. No treatment (~6hrs) 5.2: Doctors holding power. (~72hrs)

Question 32

Outline the components of section 135 of the mental health act

Answer 32

Allows police to remove you from private property if a Dr thinks you could be harmful to yourself and/or others

Question 33

Outline the components of section 136 of the mental health act

Answer 33

Allows the police to take you from a public place due to risk to yourself and others .