1 - Neuropsychiatric Disorders and Muscle Spasms

• Mood disorders - This is mental health condition that primarily affects the emotional state of a person.
• Mood disorders - They can cause persistent and intense sadness, elation and/or anger.
• Depression, Bipolar disorder - 2 most common mood disorders
• Depression - A common mental health condition. Symptoms include feeling sad and hopeless, difficulty with thinking, memory, eating and sleeping
• Bipolar disorder - A lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior.
• Premenstrual dysphoric disorder - occurs 7 to 10 days before menstruation and goes away within a few days of the start of the menstrual period.
• Disruptive mood dysregulation disorder - Affects children and adolescents. It involves frequent anger outbursts and irritability out of proportion to the situation. The anger is present most of the time, occurring before the age 10.
• ANTIDEPRESSANTS (MOOD DISORDERS)

  1. SSRIs
  2. Fluoxetine
• ANTIDEPRESSANTS SIDE EFFECTS (MOOD DISORDERS)

  1. Nervousness
  2. Anxiety
  3. Difficulty falling asleep or staying asleep
  4. Nausea
  5. Diarrhea
  6. Dry mouth
  7. Heartburn
  8. Yawning
  9. Hyponatremia
  10. Sweating
  11. Seizures
  12. Mania
  13. Hypomania
  14. Mixed manic states
  15. Elevation of hepatic enzymes
  16. Rash
  17. Vasculitis
• Antidepressants are contraindicated in hepatic failure; hypersensitivity; lactation; concomitant MAOIs or within 2 weeks of MAOI withdrawal.
• Morning - when ANTIDEPRESSANTS should be administered
• 4 weeks - how long you should monitor a patient taking ANTIDEPRESSANTS before increasing the dose
• Salt - can affect lithium levels
• Lithium is contraindicated in patients with cardiac disease, severe dehydration, sodium depletion, debilitation.
• BLACK BOX WARNING OF LITHIUM

  • Monitor clinical status closely, especially during initial stages of therapy; monitor for therapeutic serum levels of 0.6 – 1.2 mEq/L; toxicity is closely related to serum levels.
• Divalproex

  • Indicated for manic episodes, seizures.
  • Increases the level of GABA (inhibitory neurotransmitter) in CNS
• Divalproex is contraindicated in patients with hepatic disease
• Divalproex increases risk for bleeding with Warfarin
• DIVALPROEX SIDE EFFECTS (MOOD DISORDERS)

  1. Drowsiness
  2. Dizziness
  3. Nausea
  4. Blurred vision
  5. Vomiting
  6. Mild cramps
  7. Muscle tremor
  8. Mild hair loss
  9. Weight gain
  10. Bruising or bleeding
  11. Liver problems (hepatotoxicity)
  12. Pancreatitis
  13. Changes in menstrual cycle
  14. Suicidal thoughts
  15. Agitation
  16. insomnia
  17. Slight elevations in AST, ALT, LDH; increases in serum bilirubin, thrombocytopenia, lymphocytosis, leukopenia, eosinophilia, anemia, bone marrow suppression
• When taking LAMOTRIGINE, schedule periodic ophthalmologic exams with long-term use.
• When taking LAMOTRIGINE, make sure that chewable tablet forms should be chewed or crushed before being swallowed with a liquid
• CARBAMAZEPINE RARE BUT SERIOUS SIDE EFFECTS (MOOD DISORDERS)

  1. Reduced blood cell counts
  2. Soreness of the mouth, gums, throat.
  3. Mouth ulcers
  4. Flu-like symptoms
• When taking CARBAMAZEPINE for mood disorders, monitor patient's blood count regularly
• Aripiprazole - Antipsychotics, mood stabilizers; used for schizophrenia, bipolar disorder
• When taking ARIPIPRAZOLE for mood disorders, monitor for signs of neuroleptic malignant syndrome including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in BP and incontinence.
• Hypoglycemia - can be caused by ARIPIPRAZOLE; why you should monitor diabetic patients
• Muscle spasms - painful contractions and tightening of your muscles; common, involuntary, unpredictable
• MUSCLE SPASM CAUSES

  1. Mostly unknown or idiopathic
  2. Overuse of a muscle
  3. Dehydration
  4. Muscle strain
  5. Holding a position for a prolonged period
• SYMPTOMS THAT MUSCLE SPASMS ARE A PART OF A NEUROLOGICAL CONDITION

  1. Pain in the back, neck, or head
  2. Weakness in the muscle
  3. Skin numbness
  4. A pins-and-needles sensation
  5. A tremor
  6. Paralysis
  7. Paralysis
  8. Poor coordination
  9. Slow movements
  10. Double vision
  11. Sleep problems
• Ibuprofen - NSAIDs to reduce pain and address inflammation.
• IBUPROFEN for muscle spasms are contraindicated in patients with peptic ulcers, hypersensitivity, and active bleeding
• Acetaminophen - OTC medicine used to relieve mild to moderate pain and fever. It does not have any anti-inflammatory properties.
• ACETAMINOPHEN (MUSCLE SPASMS)

  1. Skin rash, pruritus
  2. Nephrotoxicity
  3. Hepatotoxicity
  4. Anemia
  5. Nausea, vomiting
  6. Constipation
  7. Abdominal pain
  8. Decrease sodium bicarbonate
  9. Decrease sodium and calcium
  10. Increase glucose and bilirubin
  11. Anaphylaxis
  12. Steven-Johnson syndrome
• ACETAMINOPHEN is contraindicated in patients with renal and hepatic impairment
• IV acetaminophen should be infused over 15 minutes.
• The antidote for ACETAMINOPHEN OVERDOSE is N-acetylcysteine given either orally or IV.
• Warfarin - should not be taken with ACETAMINOPHEN as it can increase the risk of bleeding
• Baclofen - Usually indicated in patients with cerebral palsy or multiple sclerosis.
• When taking BACLOFEN, assess peripheral edema using girth measurements.
• Methocarbamol - Used to treat muscle spasms resulting from injury, musculoskeletal disorders, tetanus