Brent Elliott

@cadoganhealthc1

Consultant Liaison & Neuropsychiatrist, ACD, The Royal London & St Bartholomew’s Hospitals’ . Faculty of Neuropsychiatry Exec. Brain injury, epilepsy.

Vrijeme pridruživanja: listopad 2018.

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  1. 2. velj

    Brilliant, thank you for the feedback 🙏

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    Italian Journalist being harassed & being asked 'Where you from then?' by after he stood up for someone who was being harassed! RT if you stand with & others like him who are being bullied & attacked by such .

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    If anybody’s looking for a great neuropsychiatry follow please consider

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    ... just another point about ondansetron, the mechanism is different from pimavanserin, as 5HT3 receptor antagonists reduce excessive mesolimbic dopamine release and enhance cholinergic transmission in the hippocampus. Visual hallucinations are the primary focus of TOP HAT.

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    My first psych publication was a review in this area - visual hallucinations are often combined into a composite 'psychosis' score which could miss some of the complexity. Also reassurance and explanation very important

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    31. sij

    This weeks is on the of 'Psychosis in Parkinson's Disease'.

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    31. sij

    Our face masks are from???? You can't make this up.

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  9. 31. sij

    Thank you for taking the time to read this tweetorial. I hope it is helpful. Please feel free to correct any errors. If you have any suggestions how I might make these more useful eg for trainees/medical students please do let me know.

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  10. 31. sij
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  11. 31. sij

    ECT has not been systematically tested but may reduce psychosis and improve motor symptoms. Cannabidiol is currently the subject of a UK phase 2 clinical trial for PDP.

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  12. 31. sij

    Ondansetron: 5HT-3A antagonist (looks like pimavanserin), appears to reduce VH's and paranoid ideas but RCT's needed. Rivastigmine may be useful in patient with PDP with and without dementia.

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  13. 31. sij

    Pimavanserin: 5HT-2A inverse agonist licensed in US for PDP but not in Europe. Dose 34mg/d in divided doses. Takes 2-4 weeks to work. Reduce dose with CYP3A4 inhibitors.

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  14. 31. sij

    Doses used in PD are much lower than those used in schizoprhenia. Avoid first generation antipsychotics, olanzapine and risperidone. Antipsychotic treatment has been associated with improved prognosis.

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  15. 31. sij

    Antipsychotics (start low go slow): Quetiapine (12.5-150mg/d) commonly used, well tolerated but not always effective. Clozapine (usual dose in PD 12.5-150mg/d) is the 'gold standard' and doesn't worsen motor symptoms. Neutropenia risk 1%, not dose related, needs registration.

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  16. 31. sij

    then DA agonists, COMT inhibitors and L-Dopa, 4) Medication used to treat PDP includes antipsychotics, 5HT-2A receptor antagonists, 5HT-3 receptor antagonists, and acetylcholinesterase inhibitors. ECT may also have a role (2).

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  17. 31. sij

    Treatment: 1) Rule out delirium, alcohol & substance misuse, primary psychiatric disorder, 2) sleep hygiene, avoid excessively patterned furniture, reduce sensory overload/deprivation, 3) reduce anti-parkinsonian medication (amantadine, anticholinergics & selegiline first (2)...

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  18. 31. sij

    Pathogenesis: Degeneration of presynaptic 5HT neurons with compensatory upregulation of postsynaptic 5HT-2A receptors & overstimualation of postsynaptic serotonergic neurons + normal DA-ergic mechanisms.

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  19. 31. sij

    Risk factors: old age, REM sleep disorder, long duration of PD, cogntive impairment, depression, drugs (amantadine, selegiline, DA agonists, COMT inhibitors, anticholinergics, L-Dopa), deep brain stimulation (STN), genetic susceptibility.

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  20. 31. sij

    Othello syndrome (delusion of partner infidelity), complex delusional and psychotic states without insight. Delusional themes include sin, religion, guilt, theft etc (3)

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