Block 33 Week 2 Flashcards
ECT’s effect in NA?
- ·increased plasma catecholamines, especially adrenaline
- increased cerebral plasma tyrosine hydroxylase activity
- increased cerebral noradrenaline
ECT’s effect on beta receptors (chronic)
decreased beta-adrenoceptor density
Acute impact of ECT on serotonin?
· increased cerebral serotonin concentration
chronic impact of ECT on serotonin?
· increase in post-synaptic 5-HT2 receptors
ECT’s impact on GABA?
- acute increase in the release of GABA – may be responsible for the neuronal hypometabolic rate subsequent to ECT
- acute increase in GABA-B binding
ECT’s acute impact on dopamine?
- · increased cerebral dopamine concentration
- increased cerebral concentration of dopamine metabolites
- increased behavioural responsiveness to dopamine agonists
ECT’s chronic impact on dopamine?
- increased D1 receptor density
- increased second-messenger potentiation at dopamine D1 receptors
embryological shunt from PA to aortic arch?
The ductus arteriosus is the embryological structure that allows blood to shunt from the pulmonary arteries back into the aortic arch, therefore bypassing the pulmonary circuit.
adult remanent of the ductus arteriosus?
The remnant of this in the adult is called the ligamentum arteriosum and functions as an anchor for the aortic arch.
bulbus cordis ->
forms part of te ventricules
common cardinal vein ->
SVC
truncus arteriosus ->
aorta
GAD - drug treatments?
- if drug treatment required, use SSRI - usually sertraline
- if ineffective, offer alternative SSRI or SNRI
- if not tolerated, use pregabalin
interventions for mild to moderate panic disorder?
- low intensity interventions:
- individual non-facilitated self-help
- individual facilitated self-help.
- info about support groups
intervention for moderate to severe panic disorder?
- CBT
- AD if disorder long-standing or the person hasn’t benefitted from psych treatment
pharmacological management of panic disorder?
- AD - only drug that should be used in the longer term management of panic disorder
- offer an SSRI
- 2) imipramine or clomipramine may be considered.
inform patient started on AD of:
- risks including transient increase in anxiety at the start of treatment)
- and of the risk of discontinuation/withdrawal symptoms if the treatment is stopped abruptly or in some instances if a dose is missed or, occasionally, on reducing the dose of the drug.
mild functional impairment OCD management?
- low intensity psych treatments - including CBT and ERP
- if this doesn’t work: offer SSRI or more intensive CBT
moderate functional impairment OCD?
- SSRI or more intensive CBT
Severe functional impairment OCD Tx?
should be offered combined treatment with an SSRI and CBT (including ERP).
SSRIs in OCD?
- for adults with OCD, SSRIs should be used as the intial pharm treatment: fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram.
DSM-5 criteria for depression
five of the following symptoms, for at least two weeks, one of which should be low mood or loss of interest/pleasure:
- Low mood
- Loss of interest or pleasure
- Significant weight change
- Insomnia or hypersomnia(sleep disturbance)
- Psychomotor agitation or retardation
- Fatigue
- Feelings of worthlessness
- Diminished concentration
- Recurrent thoughts of death or suicidewithout a specific plan, or a suicide attempt or specific plan for committing suicide
DSM depression criteria: in addition the following must be present
- Symptoms cause significant distress and impair normal function
- Symptoms or episode not caused by another condition of substance
- Episode no better explained by other mental health illnesses
- No episodes of mania or hypomania
Mild depression =
few or no extra symptoms beyond the five to meet the diagnostic criteria