PSYCHIATRY REVISION - GP
SCHIZOPHRENIA
- Sx: auditory hallucinations, thought insertion, withdrawal and interruption, thought
broadcasting, somatic hallucinations, delusional perception, feelings or actions
experienced as made or influenced by external agents, negative sx (catatonia)
- Dx: ≥1mo
- Tx: antipsychotic + CBT
Examples Side effects Notes
Typical 1st gen Chlorpromazine Extrapyramidal side effects Haloperidol most likely to
D2 antagonist Haloperidol - Dystonia and parkinsonism - cause neuroleptic malignant
Flupentixol procyclidine syndrome
Zuclopenthixol - Tardive dyskinesia - tetrabenazine
Pimozide Hyperprolactinaemia
Atypical 2nd gen Clozapine Diabetes Clozapine can cause
D2 and 5-HT Amisulpride Weight gain agranulocytosis, reduced
antagonist Risperidone seizure threshold,
Olanzapine constipation, myocarditis,
Quetiapine hypersalivation
Atypical 3rd gen Aripiprazole Use in <18y and patients
with hyperprolactinaemia
DEPRESSION
- Sx: low mood, reduced energy, reduced activity...
- Dx: ≥2w leading to functional impairment, HAD scale and PHQ-9 can quantify
- Tx: (continue antidepressants for 6mo to reduce relapse and stop over 1mo)
- Mild for <1y - watchful waiting or low-intensity psychological intervention
- Mild for >1y or moderate - psychological intervention + antidepressant
- Severe - high-intensity psychological intervention + antidepressant ± ECT
- #1 SSRI e.g. fluoxetine (<18y), citalopram, sertraline (cardiac hx)
- #2 alternative SSRI from above
- #3 mirtazapine (NaSSA) or venlafaxine (SNRI)
BIPOLAR
- Type I (mania and depression) vs type II (mania and hypomania)
- Sx: mania lasts ≥7d, causes severe functioning impairment, may need hospitalisation,
may have psychotic sx vs. hypomania lasts 3-4d and is much milder
- Dx: ≥2 episodes with both increased and decreased mood and activity
- Tx:
- Mania or hypomania - stop antidepressant + atypical antipsychotic
- Depression - fluoxetine + atypical antipsychotic
SCHIZOPHRENIA
- Sx: auditory hallucinations, thought insertion, withdrawal and interruption, thought
broadcasting, somatic hallucinations, delusional perception, feelings or actions
experienced as made or influenced by external agents, negative sx (catatonia)
- Dx: ≥1mo
- Tx: antipsychotic + CBT
Examples Side effects Notes
Typical 1st gen Chlorpromazine Extrapyramidal side effects Haloperidol most likely to
D2 antagonist Haloperidol - Dystonia and parkinsonism - cause neuroleptic malignant
Flupentixol procyclidine syndrome
Zuclopenthixol - Tardive dyskinesia - tetrabenazine
Pimozide Hyperprolactinaemia
Atypical 2nd gen Clozapine Diabetes Clozapine can cause
D2 and 5-HT Amisulpride Weight gain agranulocytosis, reduced
antagonist Risperidone seizure threshold,
Olanzapine constipation, myocarditis,
Quetiapine hypersalivation
Atypical 3rd gen Aripiprazole Use in <18y and patients
with hyperprolactinaemia
DEPRESSION
- Sx: low mood, reduced energy, reduced activity...
- Dx: ≥2w leading to functional impairment, HAD scale and PHQ-9 can quantify
- Tx: (continue antidepressants for 6mo to reduce relapse and stop over 1mo)
- Mild for <1y - watchful waiting or low-intensity psychological intervention
- Mild for >1y or moderate - psychological intervention + antidepressant
- Severe - high-intensity psychological intervention + antidepressant ± ECT
- #1 SSRI e.g. fluoxetine (<18y), citalopram, sertraline (cardiac hx)
- #2 alternative SSRI from above
- #3 mirtazapine (NaSSA) or venlafaxine (SNRI)
BIPOLAR
- Type I (mania and depression) vs type II (mania and hypomania)
- Sx: mania lasts ≥7d, causes severe functioning impairment, may need hospitalisation,
may have psychotic sx vs. hypomania lasts 3-4d and is much milder
- Dx: ≥2 episodes with both increased and decreased mood and activity
- Tx:
- Mania or hypomania - stop antidepressant + atypical antipsychotic
- Depression - fluoxetine + atypical antipsychotic
