Download Discussion of Chapter 10: Post- Disaster Psychotropic First Aid Kit

Discussion of Chapter 10: PostDisaster Psychotropic First Aid Kit
Written by Iliana Garcia-Ortega and Stan Kutcher
Dr Maureen Irons Morgan
Director, Mental Health and Substance Abuse, Ministry of Health, Jamaica.
April 2012
Mental Health: a state of well-being
—  “A state of well-being in which every individual realizes his or
her own potential, can cope with the normal stresses of life,
can work productively and fruitfully, and is able to make a
contribution to her or his community”
Mental Illness
—  A condition characterized by impairment of an individual’s
normal cognitive, emotional or behavioural function
Persons with mental illness post
disaster
—  1) Persons with pre-existing diagnosis of mental
illness (high vulnerability)
—  2)Persons developing mental illness in wake of
disaster
Mental Health Supports post disaster
— 
Mental health services
—  Professional help may be lacking, immediately following the
disaster (psychiatrists, psychologists, physicians, nurses,
counsellors)
—  Mental health services must have a disaster plan that includes
ensuring monitoring of seriously ill (Schizophrenic register
etc.),and maintaining access to services, including counselling and
psychotherapy, inpatient and outpatient care
—  Emergency duty rosters may be planned, sometimes police
support may be necessary to ensure safe access
—  Essential medications are part of disaster preparedness
Essential Medication
—  Antidepressant – Amitryptiline, 25mg ; 75-300 mg/day
—  Uses – depression, anxiety disorders eg. PTSD, chronic pain,
fibromyalgia
—  Side effects – dizziness or lightheadedness, drowsiness,
confusion, constipation, difficulty urinating, dry mouth,
—  discontinuation syndrome with abrupt discontinuation –
abrupt withdrawal after high dose, “flu-like” syndrome , likely
due to cholinergic and adrenergic rebound
Antipsychotic - Haloperidol
—  Injection- 5mg in 1 ml ampoule, or tablets 2mg, 5mg
—  Uses – acute and chronic psychoses, acute mania, agitation/
aggression , antiemetic, persistent hiccups, Huntington’s
chorea and dementia associated with behavioural problems
—  Initial dosage- 0.5-3 mg /day
—  Dose range 3-20 mg
—  Half –life 12-36 hrs
—  Complications – Neuroleptic malignant syndrome, a life
threatening adverse reaction to antipsychotic drug(muscle
rigidity, fever, autonomic instability)
Haloperidol
—  Precautions – use in extreme caution with Parkinson’s
disease, movement disorders and seizures. Also young men
and children more at risk for extrapyramidal side effects
—  EPS- dystonias and dyskinesias.Dystonias include oligogyric
crisis ,trismus, laryngospasm. Treat with IM or oral
benztropine. Avoid by using prophylactic benztropine or
biperidin
—  Other side effects – blurred vision, constipation, dryness of
mouth, sedation, weight gain, abnormal lactation
—  Tardive dyskinesia-long term , elderly women more at risk,
abnormal involuntary movements in tongue, lips and face
Anxiolytic /hypnotic - Diazepam
—  Tablets – 2mg, 5mg
—  Injection 5mg per ml in 2 ml ampoule
—  Gel or rectal solution, 5mg per ml in 0.5 ml; 2ml and 4ml
—  Uses – Anxiety, insomnia (acute), alcohol withdrawal,
depression with comorbid anxiety, panic disorder, seizures,
neuroleptic induced akathisia, behavioural problems in
patients with mania, psychosis, parkinsonism, muscle spasms,
complications with hallucinogens or overdose of stimulants
Diazepam
—  For seizure control – adults 5mg IV, range 5-20 mg IV
—  Adolescents – 2.5 mg IV, range 2.5 mg-10 mg IV
—  Paediatric – 0.2 mg IV, range 0.2-5mg IV
—  Long term effects – tolerance, dependence, withdrawal
syndrome. Dosage adjustment needed for elderly
—  Side effects – drowsiness, fatigue, sedation, confusion,
anterograde amnesia (especially at higher doses)
Antiparkinsonian - Biperiden
—  Injection 5mg (lactate) in 1 ml ampoule
—  Tablet 2 mg (hydrochloride)
—  Uses – Parkinson’s disease, extrapyramidal side effects
—  Initial dose 1 mg/day, range 2-12 mg/day, half-life 24 hrs
often can be tapered and discontinued after several weeks
without return of EPS
—  Side effects – constipation, dry mouth, tachycardia,
confusion, urinary retention, blurred vision
Antiepileptic - Phenobarbital
—  Injection 200 mg/ml
—  Oral liquid 15 mg/5ml, tablet 15 to 100mg
—  Uses – Generalized tonic-clonic, complex partial seizures,
prevention of seizures related to operative or traumatic
neurological events
—  Initial dose, child : up to 5 mg/kg daily (range – same)
—  Adolescent : 60-180 mg at night (range- same)
—  Adult : 1 mg/kg/day
—  Half-life 53-118 hrs
Phenobarbital
—  Can be used in status epilepticus, when benzodiazepine has
failed
—  Has addiction potential
—  Side effects – dry mouth, blurred vision, drowsiness,
euphoria or disorientation, urinary retention, postural
hypotension, constipation, agitation, disturbed behaviour
Mood stabilizer – Lithium
—  Tablets or capsule, 300 mg
—  Uses – treatment of mania, bipolar depression, prophylaxis in
bipolar disorder
—  Initial dose 300 mg twice daily
—  Dose range 600-1800 mg/day
—  Half-life 20-26 hrs (longer with impaired renal function and
in the elderly)
—  Comments- Check serum lithium concentrations. Monitor
renal and thyroid function. Maintain adequate fluid and
sodium intake
Lithium
—  Side effects- nausea, vomiting, diarrhea, dry mouth, weight
gain, fatigue, dizziness, fine hand tremor, polyuria,
polydipsia, hypothyroidism, cognitive blunting, psoriasis,
acne, alopecia, edema, teratogen.
—  Toxicity: ataxia, vertigo,dysarthia, confusion, nystagmus