
Contents
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Psychiatric disorders Psychiatric disorders
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Consent Consent
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Anxiety Anxiety
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Dementia Dementia
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Anorexia nervosa,, Anorexia nervosa,,
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Alcohol Alcohol
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Antidepressant drugs Antidepressant drugs
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Tricyclic antidepressants (TCA) Tricyclic antidepressants (TCA)
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St John's wort (Hypericum perforatum) St John's wort (Hypericum perforatum)
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Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs)
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Anaesthesia for patients on SSRI Anaesthesia for patients on SSRI
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Monoamine oxidase inhibitors (MAOIs) Monoamine oxidase inhibitors (MAOIs)
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Preoperative withdrawal Preoperative withdrawal
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Anaesthesia for a patient on MAOI Anaesthesia for a patient on MAOI
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Antipsychotic drugs and lithium Antipsychotic drugs and lithium
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Antipsychotic drugs Antipsychotic drugs
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Lithium Lithium
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Sedation of agitated patients on the ward Sedation of agitated patients on the ward
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Approach to the patient Approach to the patient
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Drug therapy Drug therapy
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Anaesthesia for drug-misusing patients Anaesthesia for drug-misusing patients
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General considerations General considerations
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Anaesthesia Anaesthesia
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Opioids Opioids
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Cocaine and crack cocaine Cocaine and crack cocaine
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Ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) Ecstasy (3,4-methylenedioxymethamphetamine (MDMA))
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Anaesthesia for electroconvulsive therapy (ECT) Anaesthesia for electroconvulsive therapy (ECT)
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General considerations General considerations
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Physiological effects of ECT Physiological effects of ECT
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Further reading Further reading
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12 Psychiatric disorders and drugs
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Published:July 2011
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Psychiatric disorders
...
The anaesthetic implications of psychiatric illness are as follows:
...
Consent
Most patients can give consent normally (see p. 18). In England and Wales, the Mental Capacity Act (2005) and in Scotland the Adults with Incapacity Act (2000) clarify capacity and consent issues. Patients who are detained under the Mental Health Act (1983) may only be compelled to accept psychiatric treatment under the terms of the Act.
Anxiety
Anxiety in the anaesthetic room is extremely common and usually best managed with explanation, reassurance, oral premedication, or IV sedation (e.g. midazolam 2mg IV) titrated to effect. Anxiety disorder may be acute or chronic (symptoms are similar) or occur as part of other disorders (e.g. depression). Extreme agitation may make cannulation difficult. Patients may hyperventilate and have high levels of circulating catecholamines.
Dementia
Dementia refers to irreversible global deterioration in higher mental functioning. Fifty percent of cases are due to Alzheimer's disease.
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