tailieunhanh - Neurological Emergencies - part 4

Các chất ức chế monoamine oxidase (phenelzine, tranylcypromine) cũng có hiệu quả trong bệnh trầm cảm. Chúng được sử dụng bởi một số bác sĩ tâm thần là thuốc ưu tiên khi trầm cảm kèm theo lo lắng, triệu chứng ám ảnh tăng cân, hypersomnia, và mệt mỏi. | NEUROLOGICAL EMERGENCIES Monoamine oxidase inhibitors phenelzine tranylcypromine are also effective in depressive illness. They are used by some psychiatrists as the preferred drug when depression is accompanied by anxiety phobic symptoms weight gain hypersomnia and fatigue. For many years they have been underused because of fears of their interaction with tyramine-containing foods potentially resulting in a catastrophic rise in blood pressure. Various foods alcoholic drinks and drugs have had to be avoided by patients taking monoamine oxidase inhibitors. This problem has been overcome by the introduction of reversible and selective inhibitors of monoamine oxidase subtype A such as moclobemide. All antidepressants take up to 2-3 weeks to produce clinical effect. In some clinical situations this delay may be unacceptable and a speedier response to treatment is required. Electroconvulsive therapy ECT is the preferred treatment in these situations particularly when the risk of suicide is high or when the patient is stuporose and is not maintaining adequate nutrition or fluid intake. ECT may have to be given under the terms of the Mental Health Act 1983 if the patient is incapable of giving informed consent to treatment in England and Wales this involves obtaining a second opinion from a psychiatrist appointed by the Mental Health Act commission. Box shows the main indications for ECT in depressive disorder. There are no absolute contraindications to ECT. A decision should be taken after careful consideration of the risks of the various treatment options weighed against the risk of continuation of the depressive disorder. Box lists the conditions in which ECT should be avoided whenever possible. Mania The symptoms of mania are in many ways the opposite of those of depression. There is elevation of mood accompanied by an enhanced sense of well being physical and mental overactivity pressure of speech flight of ideas increased self-confidence and a loss of social