Anxiety and Depression

Question 1

List forms of anxiety

Answer 1

Panic disorder,
PTSD, 
OCD
Phobia,
GAD

Question 2

Describe symptoms of panic disorders

Answer 2

Temp change
Chest pain
Nausea
Overwhelming feelings
Intense and abrupt feeling of fear and discomfort

Question 3

Describe symptoms of OCD

Answer 3

Obsessive thoughts and compulsive behaviour

Question 4

Describe symptoms of PTSD

Answer 4

Sleep probs, insomnia, nighmares, flashback, isolation

After trauma, accident or natural diasaster.

Question 5

Describe symptoms of phobias

Answer 5

Specific/social
Specific- intense fear of something harmless
Social- fear of negative judgement, embarrassment and humiliation
Tolerate with dread/avoidance

Question 6

Describe symptoms of generalised anxiety disorder

Answer 6

Excessive uncontrolled worry of everyday things- physical symptoms

Question 7

Outline non pharmacological interventions for anxiety

Answer 7

CBT
Mindfulness
Exercise
Self help

Question 8

How do B adrenoceptor antagonists work?

Answer 8

Decrease autonomic effect

Don’t withdraw abruptly- rebound effect

Question 9

List anti anxiety drugs

Answer 9

SSRI- Sertraline, Escitalopram, Paroxetine
SNRIs- Duloxetine
Pregbalin- anti epileptic, effect on gut release?
BDZ- last option in crisis, short term use
Anxiolytic, sedative, muscle relaxant, hypnotic, anticonvulsant, amnesic, decrease aggression
Short half life- hypnotics- emazepa, nitrazepam, zolpidem
long- diaxepam, chlordiazepoxide, lorazepam,
Positive allosteric modulators of GABAa receptor complex
Occupy site between a and gamma, conformational change, GABA binds, increase chloride into neurone, hyperpolarisation- inhibition

Question 10

Outline the causes of depression

Answer 10

Severe; genetic>environmental, mild is converse. No single gene defect

Question 11

Define bipolar disorder

Answer 11

Cycle between depression and mania
Treatment- mania- acute phase- nalopendrol, olanzipone, quetiapine, mispendone
Ineffective- lithium, sodium valproate
Depression- quentapines, SSRI fluxetine and olanzapine.

Question 12

Describe SSRIs as the main treatment for depression

Answer 12

eg Citalopram, Sertraline
Favourable side effect profile, less toxic in overdose
Symptoms worse before improve, 2-4 weeks to improve
Take 6 mths after recovery to prevent relapse
Side effects; nausea, diarrhoea, vom, dizziness
Avoid in under 18s, floxetine if necessary
SSRIs prevent reuptake at presynaptic neurone membrane of 5HT

Question 13

Describe the use of SRNI (Serotonin–NA reuptake inhibitors)

Answer 13

eg Venlafaxine, diloxetine, similar to SSRI

Question 14

Describe the use of TCA- Tricyclic antidepressants

Answer 14

5HT and NA reuptake inhibitor eg Amitryptyline
Sedative- H1 antagonist, anti cholinergic effects- dry mouth, blurred vision, cardiovascular and epileptogenic effects in overdose
Lofepramine- low risk

Question 15

MAOI inhibitors

Answer 15

eg Preleizine, cheese reaction. Tyramine competes with NA for reuptake, hypertensive

Question 16

NasSA

Answer 16

NA and serotonergic anti dep eg murtazapine, alpha 2 auto and heteroreceptor antagonism

Question 17

NARI

Answer 17

NA reuptake inhibitor eg Reboxetine

Question 18

Should you use St John’s Wort?

Answer 18

NOOOOOOOOOOO!!!!!!! NEVER!!!!!!