MEDI2022 Lecture Notes - Hypersalivation, Diphenhydramine, Alcohol Withdrawal Syndrome

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Extrapyrimidal symptoms and akathisia due to antipsychotics. Bipolar disorder: monotherapy not advisable switch from depressive to manic sx, initiate therapy with mood stabilizer + ssri/buproprion. Onset of effect: neurovegetative sx: 1-3 weeks, emotional and cognitive sx: 2-6 weeks, because of this discrepancy, beware of suicide risk in first 2 weeks. Treatment time: 6-12 months for first or second episode, two years if third episode, elderly, psychotic features, refractory depression or > 2 episodes in 2 years. Discontinue: abrupt cessation can cause discontinuation syndrome sx: anxiety, insomnia, irritability, mood lability, nausea/vomiting, dizziness, headache,d ystonia, tremor, chills, fatigue, lethargy, myalgia, should slowly taper over several weeks. Strategies for refractory depression: optimisation: ensure adequate dose, augmentation: add non-antidepressant agent such as thyroid hormone, lithium, atypical antipsychotic, combination: add another anti- depressant within or outside class. E. g. buproprion + ssri: substitute: charge primary anti- depressant to another within or outside class. Three times the therapeutic dose is lethal.

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