anti-depressants
1) SSRI (Selective Serotonin Reuptake Inhibitor):
Ie: fluoxetine, paroxetine, sertraline, citalopram.
S/E: headache, nausea, insomnia, agitation.
2) SNRI (Serotonin-norepinephrine reuptake inhibitor)
ie: venlafaxine, duloxetine.
S/E: hypotension, sedation, weight gain.
3) RIMA (Reversible Inhibitor of Monoamine Oxidase A)
ie: moclobemide
S/E: usually well tolerated.
4) NaSSAs(Noradrenergic and Specific Serotonergic antidepressants).
ie: mirtazepine
S/E: sedating, weight gain, dizziness.
5) NRI (Norepinephrine reuptake inhibitor).
ie: reboxetine
S/E: anticholinergic effects such as dry mouth, palpitations, constipation, dizziness.
6) TCA (tricyclic antidepressants)
ie: clomipramine, nortriptyline, imipramine.
S/E: anticholinergic effect- dry mouth, constipation,blurred vision and impaired concentration.
Extrapyramidal side effects of anti-psychotics
1) Dystonia
2) Parkinisonism
3) Akathisia
4) Tardive dyskinesia
Unexplained symptoms
Somatisation disorder
- multiple physical SYMPTOMS present for at least 2 years
- patient refuses to accept reassurance or negative test results
Hypochondrial disorder
- persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
- patient again refuses to accept reassurance or negative test results
Conversion disorder
- typically involves loss of motor or sensory function
- the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
- patients may be indifferent to their apparent disorder – la belle indifference – although this has not been backed up by some studies
Dissociative disorder
- dissociation is a process of ‘separating off’ certain memories from normal consciousness
- in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
- dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder
Munchausen’s syndrome
- also known as factitious disorder
- the intentional production of physical or psychological symptoms
Malingering
* fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
TCA
Common side-effects
- drowsiness
- dry mouth
- blurred vision
- constipation
- urinary retention
More sedative Amitriptyline Clomipramine Dosulepin Trazodone
Less sedative
Imipramine
Lofepramine
Nortriptyline
Schizophrenia: prognostic indicators
Factors associated with poor prognosis
- strong family history
- gradual onset
- low IQ
- premorbid history of social withdrawal
- lack of obvious precipitant
ECT
absolute contraindication is raised intracranial pressure.
Short-term side-effects
- headache
- nausea
- short term memory impairment
- memory loss of events prior to ECT
- cardiac arrhythmia
Long-term side-effects
* some patients report impaired memory
