Classification: Flashcards
What can most psych disorders be split into?
- Organic (2ndry to physical causes)
- Functional
List 3 causes of organic disorders:
- Cerebral tumours
- Endocrine disorders
- Psychoactive substance use disorders
List 2 function disorders:
- Psychoses
- Neuroses
What are 2 other classifications of psych disorders?
- Developmental
- Behavioural
(e.g. personality disorders, learning disability, eating disorders, psychosexual disorders)
What is ICD-10?
For each psych disorder, a description of main clinical features, associated features and diagnostic guidelines are provided.
List 3 types of physical management of psych disorders:
- Pharmacotherapy
- ECT
- Phototherapy
- Psychosurgery
List 2 types of psychological management of psych disorders:
- CBT
- Family therapy
List 2 types of psychosocial management:
- OT
- Rehabilitation
What can hypnotics be used for?
- Treating insomnia
What medications come under hypnotics/for treatment of insomnia?
- Benzodiazapines
- Z- drugs (work in the same way as BZDs)
In what patient group should BZDs and Z-drugs be avoided in?
The elderly due to risk of ataxia and confusion falls.
Alternative is melatonin
What are the issues with hypnotics?
- Tolerance develops within 3-14/7 on continuous use
- Withdrawal can rebound insomnia
(short courses should be used in acutely distressed patients (2-4/52) )
List 3 antianxiety medication classes:
- BZDs
- Buspirone
- B blockers
Why are beta blockers used in anxiety?
Reduce the autonomic symptoms (tremors, palpatations)
What should be prescribed in chronic anxiety?
(>4/52) - may us an antidepressant combined with a BZD until the antidepressant takes effect.
List 2 bendodiazepines:
- Diazepam (long -acting)
- Temazapam (short-acting)
- Lorazepam
List 2 beta blockers:
- Bisoprolol
- propanolol
- Atenolol
When should be used in panic disorders which are resistant to antidepressives?
Lorazepam or clonazepam (BZD)
What regime should BZD be used in?
- Short periods (max. 2-4/52)
- Lowest dose
- For severe anxiety
In what type of BZD is withdrawal more common?
Short acting (such as temazepam)
How long does it take for one to develop tolerance to BZD?
3-14 days
What should be done to avoid withdrawal symptoms?
Reduce BZD regime very slowly
What should you advise patients on BZD to not do?
Driving - psychomotor impairment is a SE of BZDs.
What can be used in BZD overdose and why?
Flumazenil (BZD antagonist)
What are the side effects of 1) mild/mod BZD overdose and 2) extreme BZD overdose?
1) Intensification of therapy or, paradoxical excitation
2) Hospital admission required due to: coma, areflexia, cardiorespiratory depression, apnoea
List 3 other mediactions that can be used as anxiolytics apart from BZD and Beta-blockers?
- Melatonin (insomnia in >55s)
- Z-drugs (non-BZD - Zopiclone)
- Buspirone (short-term use in anxiety. does not alleviate BZD withdrawal)
List the 5 classes of anti-depressants:
- SSRIs (selective serotonin re-uptake Inhibitor)
- TCAs (Tricyclic anti-depressants)
- SNRIs (serotonin and noradrenaline re-uptake inhibitor)
- NaSSA (Noradrenaline and specific serotonergic AD)
- MAOIs (monoamine oxidase inhibitor)
How long do antidepressant usually take to work? What is the risk during this time?
Usually take 10 days to start working and 4-6 weeks until fully effective.
Potential increase anxiety and suicidal ideation in first few weeks of Tx.
What is the first line treatment of antidepressants? Give an example of 3 drugs in its class:
SSRIs - fluoxetine, sertraline, citalopram
What are the symptoms of SSRI withdrawal syndrome?
Dizziness
Nausea
Headache
Sweating
Which class of antidepressant is most effective in the treatment of bulimia nervosa?
SSRI
List the 7 SSRI side effects:
(7 S's) Sleep difficulties Suicidal thoughts Stress (anxiety) Stomach upset Size (weight) Sexual dysfunction Serotonin syndrome
List 5 indications for anti-depressants:
- Depression
- OCD
- GAD
- Panic disorder
What antidepressant is best used in nocturnal enuresis?
TCAs (e.g. amitriptyline)
Give an 3 examples of TCAs:
- Amitriptyline
- Clomipramine
- Imipramine
What are the SE of TCAs?
(TCA):
T - Toxic to heart (arrhythmia, heart block)
C - CNS (dizziness, sleep problems, confusion)
A - Anticholinergic (dry mouth, urinary retention)
Give 3 features of a TCA overdose. What is the treatment for TCA overdose?
- Seizures
- Hypotension
- Sinus tachycardia
Rx:
- ABCDE
- Activated charcoal (if <1hour)
- Sodium bicarbonate for cardiac issues
- Diazepam for seizures
What anti-depressant is typically used for major depression or GAD? and give one example of one:
SNRIs - Duloxetine
What the the SE of SNRIs?
S - same as SSRI +
H - Hypertension
A - Agitation
T - Tachycardia
When are MAOIs typically used? Give an example of one:
Refractory depression, depression with severe anxiety, phobic disorders (basically complicated pictures.
Phenelzine
What must be avoided when using MAOIs?
- Food with tyramine-containing foods (hypertensive crisis)
- Use with L-Dopa and TCAs
List the 4 side effects of MAOIs:
(HAHA): H - Hypotension A - Anticholinergic SE H - Hypertensive crisis A - Anxiety/agitation
What is serotonin syndrome?
(MAN):
1) Mental status changes (agitation, pressured speech)
2) Autonomic instability (tachycardia, diarrhoea, shivering)
3) Neuromuscular abnormalities (clonus, hyperreflexia, tremor, seizure)
What is the treatment for serotonin syndrome?
BZDs
List 5 non-pharmacological treatments for depression:
- CBT
- Exercise therapy
- Psychoeducation
- Interpersonal therapy
- ECT
