Psychopharmacology and Biological Treatments
Antidepressants
SSRIs (first-line), SNRIs, mirtazapine, tricyclics, MAOIs. Know onset (2-4 weeks), serotonin syndrome, discontinuation syndrome, hyponatraemia, and interactions (MAOI plus SSRI; tramadol; triptans).
Antipsychotics
First- versus second-generation; D2 blockade; extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome (fever, rigidity, autonomic instability, raised CK), metabolic syndrome, hyperprolactinaemia, QT prolongation. Clozapine monitoring.
Mood stabilisers
Lithium (narrow therapeutic index, renal and thyroid effects, toxicity), valproate (teratogenicity, hepatotoxicity), lamotrigine (rash, slow titration), carbamazepine (enzyme induction, hyponatraemia).
Other
Benzodiazepines (dependence, respiratory depression), ECT (indications: severe depression, catatonia, treatment resistance; cognitive side effects), and basics of TMS and ketamine.
Traps
Confusing NMS with serotonin syndrome; forgetting lithium toxicity precipitants (dehydration, NSAIDs, ACE inhibitors); missing valproate teratogenicity; ignoring anticholinergic burden in older adults.
Worked rule of thumb
Rigidity with fever and raised CK after antipsychotics suggests NMS; stop the drug and treat supportively. Clonus with hyperreflexia after serotonergic drugs suggests serotonin syndrome.