Anxiety and depression

Question 1

What percentage of women develop depression after having a baby?

Answer 1

10%

Question 2

What percentage of mental disorders start before age 14?

Answer 2

50%

Question 3

Before what age have 50% of mood disorders started?

Answer 3

age 30

Question 4

What stops people with depression presenting?

Answer 4

Lack of insight
Low self-worth
Overwhelming thought
Pride
Stigma

Question 5

What is the diagnostic critera for depression?

Answer 5

Should last 2+ weeks
No hypomanic/manic symptoms sufficient to meet the criteria at any time in their life
2/3 of the following must be present
1- Depressed mood
2-Loss of interest of pleasure
3-Decreased energy

Question 6

Aside from the 3 diagnostic symtpoms what are some other symptoms that those with depression may present with?

Answer 6

Loss of confidence
Guilt
Suicidal behaviours
Inability to concentrate
Agitation
Sleep disturbances
Change In appetite with marked wt loss
Decreased libido

Question 7

What are the hallucinations like in depression?

Answer 7

Auditory, second person and derogatory

Question 8

Who is high risk for suicide?

Answer 8

S-Suicide plans or ideas of self-harm
U-Unexplained guilt or worthlessness
I-Inability to function
C-Concentration impaired
I-Impaired appetite
D-Decreased sleep/early waking
E-Energy low/unaccountable fatigue

Question 9

What is somatic syndrome?

Answer 9

Lack of emotional response
depression worse in mornings
wt loss
loss of libido

Question 10

What is atypical depression?

Answer 10

Mood reactivity
Wt gain
Hypersomnia
Leaden paralysis
Interpersonal rejection sensitivity

Question 11

Which group is psychotic depression more common in?

Answer 11

Elderly

Question 12

Anxiety is more like if what?

Answer 12

Alcohol/drug disorder

Question 13

What are the biological symptoms of anxiety?

Answer 13

Sweating
Trembling/shaking
Muscle tension
Faint
Difficulty breathing
Chest pain
N + abdo distress

Question 14

What are the behavioural symptoms of anxiety?

Answer 14

Avoidance of certain triggers
Exaggerated response
Difficulty sleeping
Excessive alcohol/drugs
Inability to relax
Always at GP

Question 15

What are the cognitive symptoms of anxiety?

Answer 15

Fear of losing control
Derealisation and depersonalisation
Hypervigilance
Worrying about everything

Question 16

What is the amygdala?

Answer 16

Emotional filter of brain assessing is sensory material (via thalamus) required a stress/fear response

Question 17

What is the amygdala modified by?

Answer 17

Later received cortically processed signal (Act fast, think later) from adrenal gland

Question 18

Why circuit are fear symptoms due to?

Answer 18

Fear symptoms due to amygdala centred circuit

Question 19

What circuit are worry symptoms due to?

Answer 19

Cortico-striatal-thalamic-cortical circuit

Question 20

What is generalised anxiety disorder?

Answer 20

Generalised, not fixed on one thing in particular

free floating, “meta worry”

Question 21

What is the treatment for GAD?

Answer 21

CBT
SSRI’s/SNRI’s
Pregabalin
Benzodiazapaines (short term only)

Question 22

How long should it take for treatment to take effect in GAD?

Answer 22

Up to 12wks to assess efficacy

absence of effect within 4wks-response unlikely

Question 23

What is panic disorder?

Answer 23

Recurrent, intermittent, severe when it happens, unpredictable

Question 24

What are the dominant symptoms of panic disorder?

Answer 24

Hyperventilation
Palpation
Marked anxiety

Question 25

What is panic disorder triggered by neurobiologically?

Answer 25

A build up of lactate/ increase in CO2

Question 26

If someone with panic disorder was measured with PET scans where would there be increased metabolism?

Answer 26

Parahippocampal gyrus

Question 27

What is the treatment for panic disorder?

Answer 27

1-Self-help 2-CBT 3-SSRI's/SNRI's (longstanding/no benefit from CBT) 4-Tricyclics

Question 28

Why are benzodiazepines not used with panic disorder?

Answer 28

They are associated with less good long term outcomes

Question 29

What is social phobia?

Answer 29

The fear of social scrutiny, fear being embarrassed or humiliated

Question 30

Neurobiological what is there in social phobia?

Answer 30

Increased bilateral activation of amydala

Question 31

What is agoraphobia?

Answer 31

Fear of going out (being in busy places with people)

Question 32

What are the potential treatments for social phobia?

Answer 32

CBT SSRIs/SNRIs (review at 12wks) MAOI (moclobemide) Benzodiazepines (short term only)

Question 33

What is a specific fear?

Answer 33

A marked, persistent fear that is excessive/unreasonable | Caused by the presence/anticipation of specific object

Question 34

Treatment for specific fear?

Answer 34

Behavioural therapy +CBT if necessary SNRIs/SSRIs if required

Question 35

What is OCD?

Answer 35

Recurrent obsessive intrusive thoughts and/or compulsive acts

Question 36

OCD is ego-dystonic. What does this mean?

Answer 36

It is in conflict with a persons ideal self-image

Question 37

What percentage of those with OCD have at least one major depressive episode?

Answer 37

60-90%

Question 38

What are the significant co-morbidities with OCD?

Answer 38

Schizophrenia Tourette's Other tic disorders Eating disorders

Question 39

Treatment of OCD

Answer 39

1-CBT/ERP 2- More intense psychological intervention / SSRIs 3- Consider ^ in dose after 4-6wks 4- Clomipramine 5-Augmentation with antipsychotic/clomipramine + citalopram

Question 40

Which two other substances work on the same receptor as benzodiazepines?

Answer 40

Barbiturates | Alcohol

Question 41

Name 3 benzodiazepines

Answer 41

Diazepam Klonopin Lorazepam

Question 42

What is the indication for benzodiazepines?

Answer 42

``` Acute treatment of extreme anxiety Hypnosis Alcohol withdrawl Mania Delirium Rapid tranquillisation Status epilepticus ```

Question 43

What is the mode of action of benzodiazepines?

Answer 43

They bind at a separate location to GABA and enhance the effect of GABA (therefore increasing inhibition)

Question 44

What type of receptor is GABA?

Answer 44

Inhibitory inotropic receptor

Question 45

What is the pharmacological effect of benzodiazepines?

Answer 45

``` Reduce anxiety and aggression Hypnosis/sedation Muscle relaxant Anticonvulsant effect Antegrade amnesia ```

Question 46

Why are benzodiazepines considered fairly safe in overdose?

Answer 46

They are unlikely to cause overdose

Question 47

TRUE/FALSE | Chronic treatment with benzodiazepines decreases response to GABA

Answer 47

TRUE

Question 48

If there is rapid withdrawal of benzodiazepines then it can look similar to DT. Gimme some symptoms

Answer 48

``` Confusion Psychosis Convulsions Tachycardia Sweating Agitation Hypertension Tremor ```

Question 49

How do you withdraw benzodiazepines?

Answer 49

1-Transfer patient to equivalent daily dose of diazepam/chlordiazepoxide 2-Reduce dose every 2-3wks in steps of 2-2.5g Time taken to withdraw can vary from4wks to a year+

Question 50

How do antidepressants generally increase serotonin?

Answer 50

By blocking the serotonin transporter

Question 51

What type of symptoms are B-Blockers best for?

Answer 51

Somatic symptoms e.g. palpitations, tremor