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Dr.Safeyya Adeeb Alchalabi
intense
extrapyramidal
rigidity
clouding of
consciousness
dystonias
diaphoresis
pyrexia
autonomic
dysfunction
Transfer to acute medical ward or intensive care unit
Monitor ECG
blood pressure
renal status
Cessation of neuroleptics
Bromocriptine 5—10 mg orally three times daily
if unable to swallow
Apomorphine infusion 1 mg/h s.c.
no response
Dantrolene sodium 50 mg twice daily maximum for 3 days
autonomic
instability
(e.g. cardiac
arrest)
renal failure
due to
rhabdornyolysis
and
myoglobinuria
Lower with
atypical
antipsychotics
Mortality: 12 -18 %
reached the therapeutic dose
assessed 4—6 weeks
poor tolerability or inadequate response to
the maximum tolerable dose
switch to a different antidepressant
abrupt withdrawal should be avoided
cross-tapering should be use
All antidepressants (but especially paroxetine and venlafaxine)
have the potential to cause withdrawal phenomena when
stopped abruptly;
they should always be withdrawn slowly, preferably
over 4 weeks
give reassurance; symptoms
rarely last more than 1—2 weeks.
slow the rate of drug
withdrawal
return to the last dose tolerated
by the patient
check
compliance
review the
history for
social
factors
atypical
antipsychotic
may be added
The National Institute for Health and Clinical
Excellence (NICE) guidance on ECT
recommends that it be restricted to:
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severe depressive illness,
catatonia,
prolonged or severe mania.
postpartum psychoses.
NMS
treatment resistant
psychomotor retardation
psychotic features such as delusions and/or
hallucinations
life-saving if the patient is very acutely
suicidal
fails to maintain adequate nutrition or hydration
patient preference
past history of response to ECT
the need for a rapid response to treatment
the risks of other treatments exceed those for
ECT
elderly who have not responded to drug treatments or
have suffered unpleasant side effects
Remission rates in clinical trials are 60—70 per cent
prolonged or severe mania
the need for a speedy therapeutic response
as a safe alternative to high-dose medications
if patients have drug-resistant
'rapid cycling' mania
catatonic excitement or
immobility
the patient cannot tolerate medications
failed to respond to adequate doses of
antipsychotics including clozapine
Thank you