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Psychiatry > Anti-depressants > Flashcards

Anti-depressants Flashcards

1
Q

Why is the highest rate of suicide associated with anti-depressants in the first few weeks period?

A

Moos stays low but energy and motivation increases

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2
Q

What medication can cause serotonin syndrome?

A

SSRI + TCA /

MAOI / St Johns Wort / Ecstasy

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3
Q

What are the features of serotonin syndrome?

A

restless, fever, tremor, myoclonus (sudden involuntary jerking), confusion, fits, arrhythmias

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4
Q

How do you treat serotonin syndrome?

A

Supportive, monitoring and stop drugs

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5
Q

Who and when is the risk of hyponatraemia worse in?

A

Older thin females in summer.

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6
Q

Which anti-depressants are the worst for causing hyponatraemia?

A

SSRIs

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7
Q

Which antidepressants are least likely to cause hyponatraemia?

A

Lofepramine and mirtazipine

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8
Q

What are some side effects of mirtazipine?

A

Can be sedative and stimulate the appetite (so don’t give to fat people)

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9
Q

Which other two drugs apart from mirtazipine can be sedative?

A

Amytriptilline & Lofepramine

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10
Q

Trazadone is a TCA with a really bad side effect that is?

A

Priapism (erection that won’t go away)

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11
Q

Name some drugs which seriously interact with St. John’s wort?

A

Oral contraceptives, anti-coagulants and anti-convulsants

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12
Q

How long should you wait to see the effects of anti-depressants?

A

4-6 weeks

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13
Q

How long should you continue your anti-depressants for following recovery?

A

6-9 months

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14
Q

If multiple episodes of depression occur, how long should you stay on anti-depressants for?

A

2 years

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15
Q

If the anti-depressants aren’t working, before switching or augmenting, what should you consider?

A

Alcohol use may stop them working as alcohol is a depressant, check there are taking it right and for a reasonable length of time.

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16
Q

Which combination anti-depressants should never be used together of ?

A

TCA & SSRI

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17
Q

What are the main indications for lithium?

A

Treatment and prophylaxis for mania, Bipolar affective disorder (BAD), recurrent depression, aggressive or self-mutilating behaviour.

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18
Q

How is lithium excreted?

A

Via the kidneys so therefore clearance depends on renal function, fluid intake, Na intake

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19
Q

What is therapeutic range for lithium?

A

0.4-1.0mmol/L

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20
Q

Lithium is known for having a specific anti-suicide effect

A

LEARN

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21
Q

What baseline investigations are carried out before a patient is commenced on lithium?

A

Physical and weight, U/E’s, renal function, TFTs, Calcium, ECG & pregnancy test

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22
Q

How long does it take to reach stable lithium levels in the blood?

A

3 months

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23
Q

Which drugs should be avoided when a patient is on lithium and why?

A

ACE drugs, NSAIDs and diuretics (especially thiazide) they all interfere with lithium excretion. You can switch to a loop diuretic instead.

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24
Q

What are the early side effects of lithium?

A

Dry mouth, metallic taste, nausea, fine tremor, polyuria and polydipsia, fatigue

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25
Q

What are the late side effects of lithium?

A

Diabetes insipidous, hypothyroidism, ataxia, dysarthria, weight gain, arrythmias

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26
Q

What are the causes of lithium toxicity?

A

Renal failure, UTI, dehydration, NSAID use, diuretic use

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27
Q

What level of lithium is considered toxic?

A

> 1.5mmol/L

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28
Q

What are the early symptoms of a lithium toxicity?

A

Blurred vision, anorexi, nausea, vomiting, diarrhoea, coarse tremor, ataxia, dysarthria

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29
Q

What are the late symptoms of lithium toxicity?

A

Confusion, renal failure, delirium, fits, coma and death

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30
Q

How do you manage lithium toxicity?

A

Stop lithium, give fluids and start diuresis

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31
Q

What is the success rate of ECT in severe depression?

A

70-80%

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32
Q

What does NICE say that ECT should treat?

A

Severe life-threatening or treatment resistant depression, catatonia, or severe mania.

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33
Q

How often do you get ECT treatment?

A

2x weekly, approx 12 in total

34
Q

What do you receive before ECT?

A

Short general anaesthetic and muscle relaxant

35
Q

What are the common side effects of ECT?

A

Head ache, nausea and muscle pain and memory loss around the time of a seizure is common.

36
Q

For mild to moderate depression, what treatment does NICE recommend?

A

Low intensity psychological interventions NOT medication

37
Q

What is the IAPT?

A

Improving access to psychological Therapies- this is an initiative led to the training of large numbers of therapists and the provision of these therapists in primary care

38
Q

What is the treatment of moderate to severe depression?

A

Combination of antidepressant and high intensity psychological treatment (usually CBT or IPT)

39
Q

You must give advice also on lower intensity psychological interventions such as?

A

Sleep hygiene, regular exercise etc

40
Q

What does high intensity psychological interventions involve?

A

CBT (16-20 sessions) over 3-4 months, IPT (16-20 sessions) over 3-4 months, behavioural activation, behaviour couples therapy

41
Q

What was beck’s theory of depression?

A

It is caused by the cognitive triad of negative view of self, world and future

42
Q

What are cognitive bias?

A

Catastrophising, jumping to conclusions, all or nothing, black and white thinking, personalising, generalising.

43
Q

What are the three anti-depressants NICE recommends for mild to moderate alzheimer’s?

A

Galantamine, rivastigmine and donepezil (Acetyl-esterase inhibitors)

44
Q

What does NICE recommend for severe alzheimer’s?

A

Memantine (a NMDA receptor antagonist)

45
Q

What is a rumination?

A

A deep or considered thought about something.

46
Q

What are obsessive thoughts?

A

They are ideas, impulses or images that enter the patient’s mind again and again in a stereotyped form- patient tries unsuccessfully to resist them. They are recognised as HIS OR HER OWN thoughts eventhough they are involuntary. May include fear of acquiring a disease, causing harm, causing harm to each other….’an decisive, endless conversation of alternatives, associated with an inability to make trivial but necessary decisions in day-to-day living.’

47
Q

What are compulsive acts or rituals?

A

Stereotyped behaviours that are repeated again and again, they are NOT enjoyable nor do they result in the completion of useful tasks.

48
Q

What is the function of this repetitive behaviour?

A

The function is to prevent some objectively unlikely event, often involving harm or danger to or caused by the patient, which they fear may occur otherwise.

49
Q

How is the behaviour recognised by the patient?

A

Symbolic, pointless or ineffectual

50
Q

If the acts are resisted by the patient, what happens?

A

The anxiety gets worse

51
Q

What is the treatment for OCD?

A

CBT, ERP exposure and response prevention - repeated graded exposure to anxiety provoking stimuli.

52
Q

What is the drug treatment for OCD?

A

SSRI (fluoxetine and sertraline) and TCA (clomipramine)

53
Q

Surgery for OCD?

A

ECT/psychosurgery (leucotomy)

54
Q

What is an acute stress reaction?

A

This is a transient disorder which develops in an individual without any apparent mental disorder in response to exceptional physical and mental stress.

55
Q

What are the symptoms and how long are they usually around for?

A

The symptoms are mixed but could include being in a daze, disorientation, amnesia, panic and they normally start within minutes of the stressful event and usually subside within hours or days.

56
Q

Name some symptoms of PTSD?

A

Hyperarousal/anxiety, with hypervigilence and increased startle reaction ie jumpy. Also experience numbness, emotional blunting, detachment from others, associated depression and suicidal ideation.

57
Q

What does ICD 10 say about PTSD?

A

DELAYED or PROTRACTED response to stressful event.

58
Q

How long is the latency period?

A

Onset follows the trauma with a latency period usually between 1-6 months

59
Q

What is the lift time prevalence of PTSD?

A

1-10%

60
Q

What are the predisposing factors for PTSD?

A

Compulsive, asthenic (weak physically) personality traits, previous history of neurotic illness, genetic (oversensitve amygdala & hippocampus, decreased hippocampal size of MRI)

61
Q

What are the risk factors for PTSD?

A

Scale of trauma, previous experience, level of support available

62
Q

What is the treatment for PTSD?

A

Trauma focused CBT, repeated graded exposure, testimony based techniques, EMDR (eye movement desensitisation and reprocessing) and antidepressants.

63
Q

What anti-depressants are used for PTSD?

A

Paroxetine and mirtazapine

64
Q

What is adjustment disorder?

A

It arises in the period of adaptation to a significant life change or stressful event

65
Q

What is the stressor/adjustment normally?

A

The integrity of an individuals social network (bereavement, separation experiences), or the wider system of social support and values (migration & refugee status). It can also be a major difficult development or transition (going to school, becoming a parent, retirement, failure to obtain a personal goal).

66
Q

What are the symptoms of adjustment disorder?

A

Depression, anxiety and inability to cope.

67
Q

What is a dissociative (conversion) disorder?

A

Its the development of a physical function normally under voluntary control, or loss of sensation (LOSS OF SOMETHING)

68
Q

Name some examples of dissociative disorders?

A

Amnesia, fugue (loss of awareness of ones identify), stupor (unresponsive), motor disorder, convulsions, trance & possession states, anaesthesia and sensory loss, no longer able to walk, no longer to feel something. NB: symptoms often reflect how a patient would think a disease would work, ie not in relation to dermatomes.

69
Q

What was dissociative disorders used to be called? DISSOCIATE = LOOSE

A

Conversion hysteria, ie. what freuds patients suffered from.

70
Q

What do patients present with when they have a somatisation disorder?

A

Multiple recurrent and frequently changing PHYSICAL symptoms.

71
Q

How long do the symptoms have to be there for in a somatisation disorder?

A

2 years

72
Q

What are the symptoms of somatisation associated with?

A

Symptoms are chronic and fluctuating, often associated with disruption of social, interpersonal and family behaviour.

73
Q

When is the onset usually of somatisation disorder, and is it more common in men or female?

A

onset usually<30, F>M

74
Q

What is the jist of other somatoform disorders?

A

Any other disorders of sensation, function and behaviour,
• not due to physical disorders
• not mediated through the autonomic nervous system
• limited to specific systems or parts of the body
• closely associated in time with stressful events or problems. · dysmenorrhoea
· dysphagia, including “globus hystericus”
· pruritus
· torticollis

75
Q

What is hypochondriosis?

A

This is a persistent preoccupation with the possibility of having one or more serious and progressive physical disorders, ie. worries that they might develop an illness Patients manifest persistent somatic complaints or a persistent preoccupation with their physical appearance. Normal or commonplace sensations and appearances are often misinterpreted by patients as abnormal and distressing.

76
Q

How many organs is attention usually focused on in hypochondriosis?

A

Usually one or two organs only

77
Q

Are preoccupations in hypochondriosis psychotic?

A

No, they are NON- PSYCHOTIC. Marked depression and anxiety are often present

78
Q

How does hypochondriosis affect men and women?

A

Equally M=F

79
Q

What is body dysmorphic disorder?

A

A type of hypochondriosis

80
Q

How long does hypochondriosis have to last for?

A

6 months with functional impairment

Psychiatry (24 decks)

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