Atypical Antipsychotics
clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole: generally good side-effect profile, particularly for prolactin elevation
Adverse effects of atypical antipsychotics
weight gain
clozapine is associated with agranulocytosis (see below)
hyperprolactinaemia
Risk of developing schizophrenia
Risk of developing schizophrenia
monozygotic twin has schizophrenia = 50%
parent has schizophrenia = 10-15%
sibling has schizophrenia = 10%
no relatives with schizophrenia = 1%
Acute Stress Disorder vs PTSD
Acute Stress Disorder: within 4 weeks
PTSD: after 4 weeks
Alcohol Withdrawl
- Long Acting Benzo: Chlordiazepoxide or Diazepam
- Lorazepam if hepatic failure
- Carbamazepine
Anorexia biochemical features
Anorexia features
- most things low
- G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Panic Disorder Management
- CBT or Drugs
- Drugs: SSRI
- Emipramine or Clomipramine
Side Effects of Tricyclic Antidepressants
As well as 5-HT and NA, tricyclics interact with number of other receptors that contribute to their side-effect profile:
antagonism of histamine receptors
- drowsiness
antagonism of muscarinic receptors:
- dry mouth
- blurred vision
- constipation
- urinary retention
antagonism of adrenergic receptors
- postural hypotension
lengthening of QT interval
Name the Tricycli Antidepressants
More sedative
(ADCT)
Amitriptyline (Worst in overdose)
Dosulepin (Worst in Overdose)
Clomipramine
Trazodone
Less Sedative:
(Nil)
Imipramine
Lofepramine (Safest in overdose)
Nortriptyline
Name the Benzos
1. Short-Acting Benzodiazepines:
- Midazolam
- Oxazepam
2. Intermediate-Acting Benzodiazepines
- Alprazolam
- Lorazepam
- Temazepam
- Clonazepam
3. Long-Acting Benzodiazepines
- Diazepam
- Chlordiazepoxide
Name Typical and Atypical Antipsychotics
Typical First-Generation Antipsychotics
- Haloperidol
- Fluphenazine
- Chlorpromazine
Atypical (Second-Generation) Antipsychotics
- Clozapine
- Olanzapine
- Quetiapine
- Aripiprazole
- Risperidone
- Amisulpride
Name the SSRIs
Fluoxetine
Citalopram
Escitalopram
Paroxetine
Sertraline
- Fluoxetine and paroxetine have a higher propensity for drug interactions
- Paroxetine has a higher incidence of discontinuation symptoms.
- citalopram (although see below re: QT interval) and fluoxetine are currently the preferred SSRIs
PTSD Rx
- Trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
- drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then** venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline** should be tried.
- In severe cases, NICE recommends that risperidone may be used
Acute Stress Disorder
vs
PTSD
vs
Post Concussion Syndrome
Post concussion: symptoms start soon (within a few day) Plus a obvious h/o Concussion!
Acute stress disorder : symptoms onset < 1 month after traumatic event
PTSD: symptoms onset > 1 month after onset, last few months
Post concussion: symptoms start soon (within a few day) Plus a obvious h/o Concussion!
Interactions of SSRIs
- NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
- warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
- triptans - increased risk of serotonin syndrome
- monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
Side Effects of Lithium
L- leucocytosis
I- intracranial hypertension
T- tremor, Toxic to nephrons
H- hypothyroidism
I U- increased urine( nephrogenic DI )
M- mothers (expectant mothers can cause Ebstein`s anomaly)
Rx for Bulimia
- eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- children should be offered bulimia-nervosa-focused family therapy (FT-BN)
- pharmacological treatments have a limited role - a trial of high-dose** fluoxetine is currently licensed for bulimia but long-term data is lacking**
Bulimia Presentation
- binge eating
- followed by recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
- recurrent vomiting may lead to erosion of teeth and Russell’s sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting
Benzo’s M/A
Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels
Name the MAOIs
works by inhibiting the activity of monoamine oxidase, an enzyme that breaks down neurotransmitters like serotonin, norepinephrine, and dopamine. This increases the availability of these neurotransmitters in the brain.
- Phenelzine
- Tranylcypromine
MAO cannot be given to people taking which food?
Tyramine containing food eg: cheese, pickled herring, Bovril, Oxo, Marmite, broad beans
because of hypertensive reactions
Things to avoid seasonal affective disorder
sleeping tablets as this can make the symptoms worse
Factors associated with poor prognosis
Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
Strongest Risk factor for Schizophrenia
Family History
