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all notse Flashcards

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1
Q

mitrazapine what class of drug?

A

NASSA

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2
Q

side effect of this drug?

A

weight gain

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3
Q

what does it prevent reuptake of?

A

5HT, NA (5N taru mitra) - varyingly inhibit

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4
Q

what class of drug is clomipramine?

A

TCA

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5
Q

what peptide transmitters are involved in aversive defensive systems?

A

NA/CRF

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6
Q

hippocampus - approach or defensive?

A

defensive

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7
Q

biosynthesis of serotonin?

A

try 5 - tryptophan -> 5 hydroxytryptophan -> serotonin

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8
Q

5HT2 receptors - where are they found?

A

everywhere basically

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9
Q

5HT1 ?

A

blood vessels/CNS - (a-f) alan

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10
Q

receptor effect of 5HT1?

A

inhibitory

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11
Q

effect of 5HT2?

A

excitory

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12
Q

an agonist of 5HT2?

A

LSD

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13
Q

Some biological functions of 5HT?

A

cooker - mood, apetite, sleep, anxiety, aggression, memory, learning, addiction

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14
Q

what can SSRIs be used to treat?

A

panic attacks, OCD, eating disorders, premature ejaculation, PTSD, chronic pain (knee), social anxiety disorder, DEPRESSION

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15
Q

how long does it take to increase synaptic 5HT?

A

hours

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16
Q

how long does it take to imove mood?

A

2-3 weeks

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17
Q

what does the increased concentration of extracellular 5HT stimulate?

A

5HT1a autoreceptors to inhibit firing

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18
Q

when do you get return to norma firing?

A

in chronic treatment

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19
Q

what sort of dose can you start an SSRI at?

A

ev therapeutic dose

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20
Q

side effects?

A

anxiety, sexual dysfunction, increased risk of suicude initial with young patients, dyspepsia, vomiting, diarrhoea, constipation.

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21
Q

which SSRIS inhibit CYP450?

A

fluoxetine and paroxetine

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22
Q

what drugs do SSRIs therefore have an interaction with>

A

drugs metabolised via the same pathway i.e. CYP450 pathway

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23
Q

sexual dysfunction in pathophysioogy?

A

can be dopamine blockade and/or 5HT2 activation

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24
Q

how can this be reversed?

A

5HT2 antagonists or 5HT1a partial agonists

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25
Q

TCA - block reptake of?

A

5HT and NA

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26
Q

titration?

A

require a bit more individualised dose titration

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27
Q

at higher doses, patients might need ECGs, what could be seen on ECG?

A

QT prolongation

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28
Q

adverse effects?

A

constipation, dry mouth, blurred vision, effects on cardiac function, postural hypotension.

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29
Q

CHAD. what does cholinergic and adrenergic blockade cause failure of?

A

peripheral orthostatic reflex

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30
Q

3 MAOIs?

A

Phenelzine, isocaroxazid, tranylcypromide

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31
Q

what does mono oxidase A metabolise?

A

5HT, NA, tyramine

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32
Q

MAO B, what does it metabolise?

A

DA, tyramine, phenylethylamine

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33
Q

which drug causes sympathy mimetic effects?

A

tranylcypromide

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34
Q

what are MAOIs used to treat?

A

atypical depression

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35
Q

what does MAO do in the gut?

A

inactivates tyrosine

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36
Q

how do patients on MAO inhbitors get hypertensive crisis ?

A

tyramine (in food like cheese) cause more NA to be released. under normal circumstances it would be broken down by MAO. increased levels of NA caused constriction of blood vessels

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37
Q

foods that contain tyrosine?

A

cheese, yoghurt, yeast extracts, broad beans, pickled herring, alcohol

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38
Q

can also cause high serotonin. symtptoms of high serotoin?

A

flushed, headache, increased BP

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39
Q

treatment? up hill ruri

A

chlorpremazine and phentolamine (prem, ph a)

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40
Q

what is akathisia?

A

inner restlesness

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41
Q

tremor, dystonia, akathisia and TD can occur which which anti depressant?

A

paroxetine

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42
Q

which hormone plays a key role in reward and motivation

A

dopamine

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43
Q

what is the main inhibitory neurone in developing brain

A

GABA

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44
Q

GABA actions in developing brain?

A

excitatory

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45
Q

GABA binding causes flow of which ions into post synaptic cell?

A

chlorine

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46
Q

do you get hyperpolarisation/depolarisation?

A

hyperpolarisation (cl-)

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47
Q

which ions flow into post synaptic cell from glutamate?

A

ca 2 +, causing depolarisation

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48
Q

two receptors that glutamate bind to?

A

NMDA and AMPA

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49
Q

which is faster?

A

AMPA

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50
Q

which one lets calcium through?

A

NMDA

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51
Q

GABA binding allows flow of either cl ions in to the cell or K ions out of the cell

A

yeah

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52
Q

antagonist of GABAa receptor?

A

flumazenil

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53
Q

agonists?

A

benzos, anaesthetics, ethanol, propofol

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54
Q

**GABA B agonists (GEE PROTEIN)

A

me and my back pack going to the show (baclofen, propofol)

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55
Q

Mood stabilisers? anti convulsants?

A

lamotrigine, valproate, carbamazepine

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56
Q

are they more effective at reducing manic episodes or depressive episodes?

A

manic

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57
Q

would you rather have type 1 BP or type 2?

A

type 1

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58
Q

ATYPICAL MOOD STABILISERS?

A

olanzepine, risperidone, quetiapine, ariprazole

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59
Q

other mood stabilisers?

A

lithium carbonate and nimodipine

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60
Q

what does lamotrigine do? Drug action)

A

blocks sodium channels

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61
Q

what overall effect does this have?

A

reduces cell firing

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62
Q

what also inhibit uptake of?___________

A

serotonin (MM)

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63
Q

Lithium. what does it do to BCL2? to 5HT auto receptors? inositol? GSK3?

A

increases apoptotic factor for BCL2, inhibition of 5HT autorecetors, depletion of inositol, inhibition GSK 3

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64
Q

what do you get in lithium overdose?

A

toxicity

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65
Q

there is a risk of inadvertent toxicity

A

y

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66
Q

what does lithium treatment require?

A

blood monitoring

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67
Q

anti psychotics show affinity for which receptor?

A

D2

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68
Q

in which circuit?

A

mesolimbic

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69
Q

movement disorders due to DA blockade in which pathway>

A

nigrostratial

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70
Q

hyperprolactinaemia?

A

tubero inffandibular

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71
Q

which part of the brain (in approach system) is involved in relative reward preference and rule learning?

A

OFC

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72
Q

periaqueductal grey matter - in approach or defence?

A

defence

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73
Q

average onset depression? bipolar?

A

27, 21

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74
Q

male to female ration depression, bipolar?

A

depression f2:1m , bipolar 1:1

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75
Q

in major depression what happens to cortisol?

A

increased

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76
Q

how would you test for this clinically?

A

increased cortisol in urine, saliva

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77
Q

what would the adrenal glands look like?

A

enlarged

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78
Q

in depression, TRH levels? TSH levels?

A

TRH up, TSH (pituitary) blunted

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79
Q

6 key regions implicated in mood disorders

A

orbital frontal cortex, hippocampus, ventromedial and prefrontal cortex, anterior cingulate nucleus, amygdala, DorsoLateral prefrontal cortex. down low

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80
Q

dense coactivation with AIC and ACC during almost all studies of emotion

A

y

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81
Q

there is dense connectivity with the anterior insular cortex and what?

A

anterior cingulate cortex

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82
Q

DO NOT use anti depressants to treat persistant sub threshold depressive symptoms or mild depression - risk benefit ratio is poor.

A

y

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83
Q

when do you consider anti depressants?

A

past history of moderate/severe depression, initial presentation of sub threshold depressive symptoms that have been present for a long period i.e. 2 years. also for sub threshold or mild depression that persists after other interventions

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84
Q

what is the typical treatment started for moderate or severe depression (top of page (yellow and red)

A

combination of anti depressant and high intensity pharmacological intervention

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85
Q

rules from isolated incidents that apply in all cases?

A

pat dog bite - overgeneralising

86
Q

dichotomous thinking?

A

all or nothing or black and white thinking

87
Q

what is the term for focusing on one negative detail and this colours entire experience?

A

selective abstraction

88
Q

Personalisation?

A

relate external events to self without cause

89
Q

Minimisation/magnification

A

over estimating/underestimating magnitude of undesirable events

90
Q

drawing a conclusion in context of no evidence or contrary evidence

A

arbitrary evidence

91
Q

what is emotional reasoning?

A

i feel bad/guilty, therefore i am bad/have something to feel guilty about

92
Q

anorexia - BMI?

A

less than 17.5

93
Q

how do people with anorexia lose weight?

A

strict dieting/vomiting/excessive exercise/medication

94
Q

amenorrhoea

A

y

95
Q

starvation effects on the brain?

A

loss of grey and white matter, increased compulsive behaviour, decreased social skills, poor concentration and new learning stunted, enhanced response to hedonic and neurostat signals

96
Q

Investigations in anorexia?

A

haeatology/biochemistry/ecg/dxa

97
Q

people with anorexia can be more at risk of?

A

heart disease

98
Q

what heart problem can be picked up on egg?

A

long qt syndrome

99
Q

what is the name of the scheme to manage patients with anorexia?

A

MARSIPAN

100
Q

high risk AN?

A

13-14.9

101
Q

v high risk?

A

less than 13

102
Q

moderate

A

15-16

103
Q

age of onset ?

A

9-24 years

104
Q

moratlity rate?

A

20 percent - up to half are suicides

105
Q

aetiology? biological

A

puberty, weght loss, starvation effects

106
Q

physiological? (3)

A

brain atrophy, reduced attention and memory, hypothalamus dysfunction

107
Q

physiological? (4)

A

low self esteem, childhood sexual abuse, perfectionist, adolescence, black and white thikning

108
Q

renal complications of anorexia?

A

nocturia, acute or chronic renal failure, increased thirst (polydipsia)

109
Q

physical signs?

A

lanugo hair, dry skin, bruising, hair loss, muscle wasting,

110
Q

blood pressure and heart rate?

A

LOW and SLOW - bradycardia, low blood pressure

111
Q

Metabolic complications? blood sugar, temp, hydration status, LFTs? electrolytes?

A

hypoglycaemic, hypothermia, dehydrated, raised LFTs, low K, PO4, Mg, Ca

112
Q

Haematological?

A

anaemic (low b12, iron and foalate), low WBC, thrombocytopenia (low platelet)

113
Q

cortisol, TOG, thyroxin?

A

increased cortisol, decreased test, oest, gonadotrophin), decreased thyroxin

114
Q

co morbidities of AN? dance floor ***

A

DODS, diabetes, depression, OCD and Substance misuse

115
Q

what happens to the muscles and bones in anorexia?

A

muscle cramps, tetany, spasm, ospeoperosis and possible fractures

116
Q

Risk assessment - bad signs

A

BMI less than 13 with weight loss of over 1kg per week, prolonged QT, heart rate less than 40, SBP less than 80, core temp less than 34, unable to rise from squat position without using arms or legs, cognitive impairment

117
Q

refeeding syndrome is caused by?

A

Depletion of MPP. magnesium, phosphate and potassium.. already inadequate stores are used up as body starts to repair itself.

118
Q

GI side effects?

A

swollen salivary glands, dental caries, delayed gastric emptying, bloating and constipation

119
Q

Bullemia - 4 criteria? jamie 3 and attempts

A

persistant pre occupation with eating, irreversible craving for food, binges then attempt to counter the effects of binges.

120
Q

4 ways they attempt to counter?

A

NO EXERCISE!!! (model) starvation, laxatives, vomiting, drug misuse

121
Q

hydration status? K?

A

dehydration and hypokalaemia

122
Q

signs in the eyes?

A

subconjunctival haemorrhage

123
Q

what are the callouses on knuckles called?

A

russells sign

124
Q

hypertrophy of what?

A

parotid gland

125
Q

teeth?

A

dental caries (acid)

126
Q

what proportion make good recovery with tx?

A

50 percent

127
Q

evidence based treatment?

A

CBT, SSRI (send step brother to table)

128
Q

Binge eating disorder - more males or females?

A

females

129
Q

compensatory behaviour?

A

no

130
Q

what is important about the food?

A

taste and quality

131
Q

which gene codes for glutamine?

A

CAG

132
Q

what happens if there are more CAG repeats in the genome?

A

bigger glutamine chains are present in the huntington protein. protein is misshapen.

133
Q

what do misshapen huntington proteins do to the brain?

A

gradually damage the brain. neuronal loss leads to huntingtons disease

134
Q

is there a genetic test?

A

yes, very easy

135
Q

what is life exp of alzheimers after diagnosis?

A

7 years

136
Q

what is one of the first areas in the brain to be affected in al?

A

nucleus basalis of meynert?

137
Q

early onset familial disease accounts for what percentage?

A

2 percent

138
Q

tend to have 3 affected individuals in family under the age of 60

A

y

139
Q

sensation of a lump in throat indicative of?

A

anxiety problem

140
Q

numbness/tingling sensation

A

same

141
Q

cognitive problems in anxiety?

A

mind going blank, self distant, racing thoughts

142
Q

which part of the brain acts as an emotional filter for brain assessing whether sensory material via the thalamus requires a stress or fear response?

A

amygdala

143
Q

where is cortisol released from?

A

adrenal

144
Q

GAD - how long do you have to have it? control? impact?

A

6 months, can’t control, significant impact

145
Q

what is the course of the condition like?

A

fluctuating

146
Q

what is dissipation? (genetic)

A

know you’re going to get a disease faster than your parents

147
Q

age of onset?

A

20-40

148
Q

free floating anxiety, what are the 4 main symptoms?

A

nervousness, trembling, muscular tensions, sweaty/lightheaded

149
Q

f:m ratio?

A

2 females to 1 male

150
Q

balanced translocation - what test?

A

fish (normally do ACGH, but that only picks up imbalances)

151
Q

what is GAD associated with (bedroom)

A

feeling restless, keyed up or on edge, difficulty concentrating, mind going blank, muscle tension, sleep disturbance

152
Q

GAD is associated with disability, medically unexplained physical symptoms, over utilisation of health care responses

A

y

153
Q

what antidepressant can be used in GAD?

A

venlafaxine

154
Q

what class of drug is this ?

A

SNRI

155
Q

Panic disorder - are they restricted to any particular place or set of circumstances?

A

no, they are unpredictable

156
Q

symtoms? including onset

A

sudden onset palipations, chest pain, choking sensation, diziness, feelings of unreality

157
Q

secondary fear of?

A

dying, losing control, going mad

158
Q

can be with/without what condition?

A

agoraphobia

159
Q

what can panic disorder NOT be due to?

A

a drug or effect of a drug. also not correct if it is better accounted for by another medical condition

160
Q

what percentage have agoraphobia?

A

50-67%

161
Q

waxing and weaning (moon) what does it mean?

A

usually moving towards full or past full blown

162
Q

at 10 year follow up, statistics?

A

1/3 well, 1/3 moderate improvement, 1/3 worse

163
Q

what other conditions can it be co morbid with? (sack bin)

A

other anxiety disorders, depression, alcohol , drug (DAD)

164
Q

what can trigger it in susceptible individuals ?

A

lactate infusions (weight in bike shelter) - by product of muscular activity

165
Q

what else?

A

rebreathing air (by increasing carbon dioxide)

166
Q

what would you see on a PET scan? increased metabolism where?

A

parahippocampal gyrus

167
Q

three types of phobia?

A

agorophobia, specific phobia, social phobia

168
Q

fear of being in siutations where escape might be unavoidable?

A

agoraphobia

169
Q

what are the symtptoms of agoraphobia while on public transport/shopping centre/leaving home?

A

panic attack

170
Q

what does this often involve to avoid anxiety?

A

other people doing things for them or online (i.e. internet shopping)

171
Q

specific phobia cued by?

A

specific object or situation

172
Q

do they have insight?

A

yes, recognise the fear as excessive/unreasonable

173
Q

what is social phobia?

A

persistent fear of social or performance situations in which someone is exposed to scrutiny by others

174
Q

what does the individual fear?

A

they will act in a way that is embarrassing or humiliating

175
Q

common symptoms

A

blushing or shaking, fear of vomiting, urgency, fear of urination and defacation

176
Q

increase in bilateral activation of?

A

amygdala

177
Q

what happens in terms of cerebral blood flow?

A

increases bilaterally

178
Q

what RIMA anti depressant can you use?

A

meclobomide

179
Q

what drug class is this?

A

RIMA

180
Q

defence has a _________ origin?

A

midbrain

181
Q

when do you get tonic immobility? (freezing)

A

inescapable threat

182
Q

what sort of situation would it happen in?

A

sexual assault case

183
Q

symptoms?

A

decreased vocalisation, intermittent EC, rigidity and paralysis, muscle tremors in extremities, unresponsiveness to pain

184
Q

what is the orientating response?

A

immediate response to change in environment

185
Q

with increasing proximity to a predator, brain activation shifts from _________ to the ___________. (football pitch)

A

prefrontal cortex to the midbrain (defensive)

186
Q

which specific 2 areas in the midbrain?

A

PAG, SC (superior colliculi)

187
Q

acute stress leads to increase in what?

A

catecholamines and cortisol

188
Q

what is the purpose of cortisol release in stress?

A

to shut down the stress response

189
Q

what sites does it exert negative feedback on?

A

pituitary, hypothalamus, hippocampus, amygdala

190
Q

cortisol levels in PTSD?

A

low

191
Q

acute stress increases cortisol levels, but the RISE in cortisol levels are lowest in PTSD

A

y

192
Q

what psychiatric problems are co morbid?

A

depression, drug and alcohol misuse

193
Q

risk of suicide in PTSD?

A

6 x higher (c note, suicide note)

194
Q

DSM IV criteria?

A 
traumatic event. INTRUSIVE symtoms (1) or more
avoidance symtoms 3 or more
hyper arousal (2 or more)
195
Q

duration has to be?

A

4 weeks (red arrow to head)

196
Q

they also have to have distress and impairment in social/occupational functioning)

A

y

197
Q

avoidance and emotional symptoms?

A

avoid thinking about it, avoid reminders about event i.e. places, amnesia for important aspect of trauma, loss of interest in activities, detachment, emotional numbing

198
Q

hyerarousal?

A

sleep disturbance, irritability/anger, concentration difficulties, hyper vigilance, exaggerated startle response

199
Q

intrusive symptoms?

A

nightmares, flashbacks, physiological reactions, recurrent distressing recollection

200
Q

where are defence and orientating responses generated

A

midbrain

201
Q

what do high levels of cortisol damage?

A

the hippocampus

202
Q

brocas area in PTSD, what happens?

A

reduced blood flow

203
Q

how are memories described?

A

fragmented

204
Q

which part of the brain has a role in memory and the stress response?

A

hippocampus

205
Q

which part is involved in the role of fear during trauma and recollection?

A

amygdala

206
Q

“it feels like yesterday” i had that last broca

A

reduces bloodflow

207
Q

the emotional memory in PTSD is in which side of the brain?

A

RHS

208
Q

impairment of emotional event memory related to which part of brain? green box around it?

A

amygdala

209
Q

therapy treatment used ? C notE

A

CBT and EMDR should be used

210
Q

4 drugs that can be used?

A

first 2 - mitrazipine and paroxetine. 2nd take trip to pond. amytriptyline and phenelzine

psych (29 decks)

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