Antipsychotics

•    Typical (first generation):

o    Example: haloperidol, chlorpromazine.

o    Side effects:

    Extrapyramidal symptoms (EPS): dystonia, parkinsonism, akathisia, tardive dyskinesia.

    Neuroleptic malignant syndrome (NMS): fever, rigidity, autonomic instability, raised CK, renal failure.

    Hyperprolactinaemia (especially with high-potency agents).

•    Atypical (second generation):

o    Examples:

    Olanzapine: metabolic syndrome (weight gain, hyperlipidaemia, diabetes).

    Risperidone: dose-dependent hyperprolactinaemia.

    Clozapine: agranulocytosis (weekly FBC monitoring initially), myocarditis, seizures, hypersalivation.

    Quetiapine: more sedating; useful in bipolar depression.

•    Indications:

o    Schizophrenia spectrum, acute mania, severe agitation.

Antidepressants

•    SSRIs (e.g., sertraline, citalopram):

o    First-line for depression and anxiety.

o    Side effects: GI upset, sexual dysfunction, hyponatraemia (esp. elderly).

•    SNRIs (e.g., venlafaxine, duloxetine):

o    Useful if SSRIs ineffective.

o    Caution: venlafaxine can ↑ BP at higher doses.

•    Tricyclics (TCAs) (e.g., amitriptyline, nortriptyline):

o    Effective but limited by anticholinergic effects (dry mouth, constipation, urinary retention), orthostatic hypotension.

o    Toxic in overdose: arrhythmias (Na⁺ channel blockade).

•    MAOIs (e.g., phenelzine, tranylcypromine):

o    Dietary tyramine → hypertensive crisis ("cheese reaction").

o    Avoid with SSRIs (serotonin syndrome risk).

Benzodiazepines

•    Uses:

o    Short-term severe anxiety, acute agitation, alcohol withdrawal (chlordiazepoxide).

•    Risks:

o    Dependence and tolerance.

o    Withdrawal: insomnia, agitation, tremor, seizures.

•    Avoid long-term use (max 2–4 weeks generally).

Mood Stabilisers

•    Lithium:

o    Narrow therapeutic index (target 0.6–1.0 mmol/L maintenance).

o    Toxicity signs: tremor, ataxia, vomiting, diarrhoea, confusion → can progress to seizures and coma.

o    Monitoring: TFTs, U&Es, calcium, lithium levels every 3 months once stable.

o    Renal and thyroid dysfunction, hyperparathyroidism.

•    Valproate:

o    Useful in acute mania and maintenance.

o    Risks: hepatotoxicity, pancreatitis, teratogenicity (neural tube defects → avoid in women of 

                                                                                                                    childbearing potential unless no alternative).

•    Carbamazepine:

o    Alternative for bipolar; also used in trigeminal neuralgia.

o    Risks: agranulocytosis, hyponatraemia (SIADH).

Electroconvulsive Therapy (ECT)

•    Indications:

o    Severe or psychotic depression, catatonia, severe mania.

•    Effectiveness: rapid symptomatic relief.

•    Side effects:

o    Headache, transient retrograde/anterograde amnesia.

•    Contraindications: relative (raised ICP, recent MI).

Psychotherapies

•    CBT (Cognitive Behavioural Therapy):

o    Evidence-based for depression, anxiety, PTSD, OCD.

o    Targets negative thought patterns and behaviours.

•    Psychodynamic psychotherapy:

o    Focus on unconscious processes and early relationships.

o    Suited for personality disorders, long-standing interpersonal issues.

•    DBT (Dialectical Behaviour Therapy):

o    Specifically designed for borderline personality disorder.

o    Focus: emotion regulation, distress tolerance, interpersonal effectiveness.

•    IPT (Interpersonal Therapy):

o    Targets relationship problems, grief, role transitions.

o    Evidence-based for depression.

•    Motivational interviewing:

o    Especially for substance use disorders; non-confrontational, elicits change motivation.

Extra Revision Pearls

•    Serotonin syndrome: triad of autonomic instability, neuromuscular abnormalities, altered mental state; risk with SSRIs + MAOIs.

•    Akathisia (inner restlessness) → can mimic worsening anxiety; managed with beta-blockers or dose adjustment.

•    Clozapine is the only drug with proven efficacy in treatment-resistant schizophrenia.

•    Lithium toxicity precipitated by dehydration, NSAIDs, ACE inhibitors, diuretics.

•    CBT-i is most effective for chronic insomnia (better than hypnotics).

•    TCAs avoid in elderly → fall risk, cognitive impairment.

•    High-dose SSRIs used in OCD; require longer duration to assess efficacy (~12 weeks).