By Michael Robertson

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Blood results 6. Weight (periodic measure of waist circumference)/ BP/Pulse 7. Action plan Table 2 – Standard Medical entry during first 18 weeks of clozapine therapy Clinical monitoring during clozapine therapy a) Haematological The most clinically significant adverse effect of clozapine therapy is the induction of agranulocytosis in up to 3% of patients. In order to prevent excess morbidity and mortality in clozapine therapy, the CPMS require regular testing of the patient’s white cell count and neutrophil count in order for clozapine therapy to continue.

NEJM. 1993;328:839-846. HET I AC U T E PS Y C H IATRI C M A N A G E M E N T 43 44 Fig 2. – ECT EEG (Trace B) Fig 3. – ECT EEG (Trace C) the motor component of the seizure. The arterial wave form remains stable in this trace, although there can be alterations in blood pressure post-ictally, mediated by vagal discharge which may lead to bradycardia. Occaisionally, there can be a pressor response post ictally, leading to significant hypertension. Indications for ECT ECT is most commonly administered for severe melancholic or psychotic depression, either when antidepressant treatment has been ineffective, or there are severe complications such as refusal to eat or catatonia.

F  ine intention tremor, occasionally so severe as to require cessation of the drug. Propranolol may help in some cases. 2. Significant weight gain (similar to valproate) 3. C  ognitive dulling and mild memory impairment in some patients. Beware of confounding with mild depression or hypothyroidism. 4. Hair thinning 5. Acne 6. Benign T-wave flattening on ECG 7. 0 X 109 is common) due to increased mobilisation from bone marrow stores. Toxicity Lithium is entirely excreted in the urine. Anything that impedes this excretion may cause blood levels to rise to toxic levels.

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Acute Psychiatric Management by Michael Robertson


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