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By Michael Robertson

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In such circumstances additional medication regimes are necessary to alleviate the patient’s distress and reduce the risk of such harm. Indications for prn medication  he administration of prn medication is either initiated by nursing staff or the patient. The common T circumstances in which prn medication becomes necessary include: HET I AC U T E PS Y C H IATRI C M A N A G E M E N T 45 • Distress arising from psychopathological symptoms • Agitation arising in the course of an episode of severe mental illness • Anxiety reactions to psychological phenomena or the ward environment • Suicidal ideation or impulses to self-harm • Insomnia • Physical aggression • Severe disorganisation of behaviour engendering risk of misadventure • Intoxication or withdrawal from substances 46 Oral prn regimes for agitation or sedation Benzodiazepines Only one type of benzodiazepine should be charted as prn medication: • Diazepam 5-10 mg orally in a healthy adult every 2-6 hours.

Note less weight gain, hair loss and tremor than lithium or valproate. • Sedation, dizziness or ataxia. • Hyponatraemia is common. Monitor severity and cease if a significant reduction occurs. • Can reduce T4 and T3, without changing TSH. Not clinically significant. • Benign hepatic enzyme elevation may occur. If progressive, cease drug, as serious hepatic toxicity may rarely occur. Use and interactions Warn patients about side effects, especially rash and agranulocytosis, and teratogenicity.

The evolving role of topiramate among other mood stabilisers in the management of bipolar disorder. Bipolar Disorder. 2001;3:215-32. 60. Treatments 2 LEARNING OBJECTIVES • Describe the various iatrogenic risks of psychotropic agents • Identify psychotropic treatment regimes which are comparatively safe in pregnancy • Identify psychotropic agents which are comparatively safe to use in lactating women 39 Psychotropic drugs in pregnancy and breastfeeding Introduction As mental illness frequently affects adults in the child-bearing years, the use of psychotropic medications in pregnancy requires closer consideration.

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