Drugs in Psychiatry

I attended Psychiatry Workshop in Hospital Putrajaya today.

So, simple explaination for the main groups of drugs used in Psychiatry are as follows :

1. Antipsychotic : reduce Dopamine
2. Antidepressant : Prevent Serotonin destruction
3. Mood Stabiliser : cell membrane stabiliser
4. Benzodiazepine : GABA inhibition.

Rash

Petichiae - less than 3mm

Purpura - more than 3mm to 10mm
Echymosis - more than 10mm

All of these rashes do not blanch with pressure. 

Idiopathic Thrombocytopenic Purpura

- a.k.a Autoimmune Thrombocytopenic Purpura / Primary Immune Thrombocytopenic Purpura

- diagnosis of exclusion

- increase in peripheral platelet destruction due to presence of IgG autoantibodies on the platelet surface
- where? liver (Kupffer cells) and spleen (splenic macrophages)

2 types

1. acute - occurs typically in children, usually following infection, lasts less than 6 months
2. chronic - occurs in adults, lasts for more than 6 months

Ask about 

- drug-induced thrombocytopenia (e.g heparin, alcohol, quinolones, sulfonamides)

- auto-immune disease

- liver disease

- bleeding sx (epistaxis, hematochezia, menorrhagia, bruises, gum bleeding)

Phy

purpura - 

petichea - less than 3mm

Dx : TTP, malignancy (leukemia), drug-induced, autoimmune disease, 

Ivx : 

1. FBC - isolated Thrombocytopenia

2. PBF - megakaryocytes

3. Coag Profile - Normal

4. BMA - megakaryocytes

5. CT Scan of the Brain - if suggestive of ICB

Tx

- give IV corticosteroids (prednisone / methylprednisolone)

- IV Immunoglobulin

- platelet infusion if  only in severe bleeding (EMERGENCY)

- if fails, splenectomy

Mortality is due to uncontrolled bleeding

advice to parents - not to give patients with aspirin, ibuprofen, naproxen, inform the school on what to be done should the child gets bleeding d/t trauma at school, 

ITP is not hereditary

reference : http://emedicine.medscape.com/article/779545-medication

Epilepsy

Today, i did another BMJ Learning assessment. the topic is on epilepsy.

first line tx : Epilim (Sodium Valproate)
2nd line tx : Lamotrigine
if failed, then combine.

when to start anticonvulsant ?
- not after first unprovoked seizure episode UNLESS there are neurological deficit, abnormal EEG, abnormal brain imagining. otherwise, usually started after 2nd seizure episode.

Rectal Diazepam is safer than IV Diazepam. IV Diazepam should only be given in ICU setting.

In pregnancy, seizures does not increase in frequency and hence, do not require frequent monitoring. Antiepileptic has a low risk of teratogenic effect and is safe for breastfeeding. However, they should be started on folic acid prior to pregnancy.

If patient is fit-free for 2 years, then we can taper down the dosage slowly. If patient is on combi therapy, stop the drug one at a time.

In elderly patients, other than checking for electrolytes level, don't forget to order ECG.

Absence seizure does not have aura and lasts for a few seconds. Complex partial seizures meanwhile involves presence of aura, automatism and loss of awareness. simple partial is like complex partial but without LOA.

side effects of vigabatrin : irreversible visual field defect
side effects of phenytoin : gum hypertrophy, hirsutism, facial coarseness
side effects of carbamazepine : reacts with COCP or POP hence reducing the effectiveness. solution? increase the dosage of COCP/POP
SE if Epilim + Lamotrigine IF lamotrigine's dosage is increased fast : Steven Johnson's Syndrome

psychiatry related movie

I've just finished watching this movie and yes, it contains pyschiatric elements. Here, you can tell the presence of hallucinations and delusions though not clearly stated in the reviews whether the character does have any illness. i think the character also experiences an eating disorder. 


guess this adds up the list other than having to mention about "beautiful mind" all the time.