CNS Flashcards
What is depression
A serious mental health disorder that negative affects how you feel, the way you think, and how you act. Involves a depressed mood or loss of pleasure or interest in activities for long periods of time.
What risk factors for depression
- Female
- Older age
- Personal of family history of depression
- Postpartum period
- Other mental disorders
- Substance mususe
- Chronic health conditions/poor physical health
- Stressful life events
7 Symptoms of depression
- consistent Low mood(mild, moderate or severe)
- appetite changes
- Poor concentration
- Suicidal thoughts
- Disturbed sleep
- feelings of worthlessness
- Fatigue
what is CBT
recognises negative/distorted thinking patterns in order to change thoughts/behaviours to respond to challenges in a more positive manner
What is guided self-help
Guided-self help workbooks allow patients to manage their depression themselves.
What is behavioural activation
Uses behaviour to influence emotional state
what is interpersonal psychotherapy
relieve symptoms by improving interpersonal functioning.
What is first line treatment for less severe depression
- offer guided self help first
- offer group or individual CBT or behaviour activation/therapy, group excercise or psychotherapy.
- SSRI only if patient preference
What is first line treatment for moderate to severe depression
individual cognitive behaviour therapy, behaviour activation/therapy or antidepressant medication SSRI or SNRI.
How should you start SSRI
Start low and gradually increase
How long is an SSRI course
around 6 months
How do SSRIs work
Inhibit serotonin re-uptake from the synaptic cleft, enhancing neurotransmission.
Name 6 SSRIs
- sertraline
- escitalopram
- Paroxetine
- Fluoxetine
- Citalopram
- fluvoxamine malaete
What is a severe cardio-related side effect of citalopram and also a contraindication
QT interval prolongation
What are 3 severe side effects of SSRIs
- First month suicidal thinking
- Serotonin syndrome
- Hyponatraemia
- Bleeding (hemorrhaging)
Can pregnant women take SSRIs/SNRI
MRHA: Yes but must be stopped/tapered down before delivery as there is an increased risk of post-partum haemorrhage when taken the month before delivery
Weigh risks Vs benefits
can SSRIs be given with aspirin, NSAIDS, anticoagulants
Weigh risks Vs benefits as it can increase bleed risk further
Elderly person on a SSRI presents with confusion and reduce consciousness, what can be the cause
Hyponatramia
- especially if they’re on diuretics
What 4 general side effects do SSRIS causes
GI issues
Cardiac issues
Nuerological
Skin
What 3 drugs classes interact with SSRIs
- MAOIs
- Serotonergic drugs
- Blood thinning drugs, NSAIDS, ASPIRIN, ANTICOAGS
Patient has renal impairment on escitalopram/citalopram
Reduce dose
SSRI pose an increased risk of what eye condition
Angle closure glaucoma, therefore is contraindicated
Should SSRI be given during mania
No - contraindicated
What are 4 neurological side effects of SSRIs
Insomnia
Dizziness
Drowsiness
Blurred vision
What occurs with SSRI withdrawal
Withdrawal symptoms
headaches,
GI symptoms
Palpitations
What drugs are SNRIs
Venlafaxine,
duloxetine
How do SNRI act
Inhibit neuronal Reuptake of noradrenaline and serotonin from synaptic clef
What 4 serious side effects of SNRI
- Serotonin syndrome
- Hyponatremia
- Steven-johnsons syndrome
- QT Interval prolongation
What electrolyte imbalance do SSRIs/SNRIs commonly cause
Hyponatremia (mostly in elderly)
What SNRI causes QT interval prolongation
Venlafaxine
What drugs may interact with SNRI/SSRIs to prolong QT interval
Amiodarone/dronedarone
What drugs are Tricyclic antidepressants
Amitrypyline
Lofepramine
Trazodone
Nortriptyline
What are the 3 mechanisms of TCA
- Inhibit serotonin re-uptake
- inhibit noradrenaline re-uptake
- increase sensitivity of post-synpatic serotonin receptors
Which TCAs have sedative properties
Amitrypline
Why does amitriptyline have sedative properties
Due to blockade of Histamine and muscarinic receptors which can drowsiness
What are TCA contraindicated in
Arrhythmias
Manic phase bipolar,
Heart block,
Immediately after myocardial infarction
What is the main side effects of amitryptyline
Anticholinergic syndrome:
Dry mouth
Blurred vision
Constipation
Urinary retention
Confusion/delirium
Tachycardia
Heat intolerance
What are counselling points for antidepressants
- May take 4 weeks for effects to be felt.
- Common s/e: GI N/V, sweating, palpitations
- review after 1-2 weeks due to increased risk of suicide.
How long do you take antidepressants for after remission from depression
Take for at least 6 months after remission
What are 6 withdrawal symptoms of antidepressant medication
Sweating
Abdominal symptoms(n/v)
Tiredness
Palpitation
Dizziness/vertigo
Irritabillity
What are the 3 main pharmacological treatments for depression and what order
SSRIs –> SNRIs –> TCA
What is Generalized anxiety disorder
Generalized anxiety disorder is characterized by excessive worry about every day issues that is disproportionate to any inherent risk
Non-physical symptoms of GAD
- restlessness/nervousness
- trouble concentrating
- irritability
- Constantly on edge
- trouble sleeping
physical symptoms of GAD
- Dizziness
- palpitations
- muscle aches/tension,
- shaking
- Sweating
- dry mouth
- Shortness of breath
- Nausea/vomiting
When diagnosing GAD what blood tests are done to rule out other condtions
Anaemia and hyperthyroidism
In what step of the stepped approach to GAD treament do you give medication
step 3
What SSRI is given first for GAD
sertraline
What 3 SSRIS are used for GAD
Sertraline.
Paroxetine.
Escitalopram.
What should you give if sertraline is ineffective in treatment GAD
- Give paroxetine or escitalopram
- Give SNRI (duloxetine/venlafaxine)
What treatment should you give for GAD if SSRI and SNRI are not tolerated
Pregabalin
What drug is given for short-term treatment of severe anxiety
Benzodiazepines for two to four weeks only due risk of dependance
What schedule is pregabalin
Schedule 3
What drug class is pregabalin
Anticonvulsant
What is the mechanism of action of benzodiazepines
by enhancing the effects of the neurotransmitter GABA, which has a calming and inhibitory effect on the brain, thus reducing anxiety symptoms
What is a risk of benzodiazepines
Respiratory depression
What is Bipolar disorder
mental illness, which is usually characterized by episodic depressed and elated moods and increased activity (hypomania or mania).
Cause of bipolar disorder
Family history - genetic
traumatic life experiences can trigger genetic BD
Stress
Chemical imbalance in brain
What the 4 episodes of Bipolar
Mania
Hypomania
Depressive
Mixed
What is mania episode in bipolar disorder
Abnormally and persistently elevated mood lasting at least 1 week.
Additional symptoms
- impaired social and occupational functioning
- Delusions/hallucinations
What is hypomania in bipolar disorder
Similar to mania
- does not cause marked social/occupation functioning
- symptoms have least for 4 days
What is a depressive episode in Bipolar disorder
Atleast 2 weeks of
- Depressed mood
- Loss of interest or pleasure in nearly all activites
What is a mixed episode in
a period(1-2 weeks) of alternation between manic and depressive symptoms
What is the difference between Type 1 and Type 2 Bipolar disorder
Severity of manic episode
- Type 1 manic episode +/- depressive episode
- Type 2 must have depressive episode + one hypomanic episode
What is first line treatment for Bipolar disorder
Oral Antipsychotics
What is second line treatment for Bipolar disorder
Lithium trial
if none of the 4 antipsychotics worked
What is third line treatment for Bipolar disorder
Anticonvulsants
What 3 anticonvulsants are used for bipolar disorders
sodium valproate, lamotrigine and carbamazepine
What four antipsychotics are used for Bipolar disorder
Haloperidol, olanzapine, quetiapine, risperidone
What first generation(typical)antipsychotics
Haloperidol
Chlorpromazine
Prochlorperazine
Flupentixol
What is the mechanism of action of 1st generation antipsychotics
D2 antagonism of dopaminergic pathways of the brain (mesolimbic/mesocortical pathway)
why are some antipsychotics(haloperidol, chlorpromazine, prochloperazine) used for nausea and vomiting
D2 receptors are found in chemoreceptor trigger zone, thus antagonism of these receptors= anti emesis
What drugs are second generation (atypical) antipsychotics
Olanzapine, clozapine, quetiapine, risperidone, capirizine
What 3 major side effects of first generation antipsychotics
- Extrapyramidal symptoms
- Hyperprolactineamia/gynnaecomastia
- QT prolongation
- Hypotension(dose related)
Why do antipsychotics cause extrapyramidal symptoms
Dopamine receptor antagonism in the nigrostriatal pathway which is responsible for motor control
What extrapyramidal symptoms
Muscle spasms, tremor, rigidity, involuntary repetitive movements of the face(tardive dyskinesia), slow movement
Tardive dsykinesia
Involuntary movements
Tardive means occurring months later
What patient groups/conditions is anti-psychotics cautioned in
Elderly - lower dose
Dementia - risk of death/stroke
Parkinson’s - cause ExtraP s/e
What is the difference between first generation and second generation anti-psychotics
- Greater effect on serotonin receptor antagonism
- Looser binding than 1st gen
- Less extrapyramidal side effects.
What are 6 common side effects on second generation (atypical) antipsychotics
- Extrapyramidal symptoms
- Hyperprolactinemia/gynaecomastia
- QT prolongation
- Hypotension(dose related)
- Metabolic disturbances(weight gain, glucose intolerance-diabetes)
- sexual dysfunction
What is a severe effect of clozapine
Agranulocytosis
What is the 5 monitoring parameters for antipsychotics
- Prolactin baseline, 6 months, yearly
- Blood levels for toxicity
- Cholesterol levels
- HbA1c: baseline, 1 month, 4-6 monthly
- Lipid profile: baseline, 3 monthly
- Baseline ECG
What two antipsychotics metabolism is reduced by smoking cessation
Olanzapine and Clozapine
When should you stop clozapine
Severe constipation(causes hypomotility and faecal impact which can be fatal )
Myocarditis - chest pain, arrhythmias
Seizures
Agranulocytosis
Liver disorsers
What is schizophrenia
is a psychotic disorder characterised by hallucinations, psychoses, and delusions.
What are negative symptoms of schizophrenia
the absence of normal behaviour
- Socially withdrawn
- Lack of emotion
- Poor hygiene and grooming habits
- Catatonia
What are positive symptoms of schizophrenia
Hallucinations:
- Auditory
- Visual
- Olfactory(strange smells)
- Tactile(bugs crawling under skin)
Delusions
- paranoid thoughts
- false beliefs
Causes of schizophrenia
Stressful life events
Pregnancy and birth complications (Low birth weight)
Childhood trauma
Family heritage
Cannabis and substance use
First line treatment of schizophrenia
An oral antipsychotic drug in combination with psychological therapy should be offered to patients with schizophrenia.
When should you offer clozapine for schizophrenia
if schizophrenia is not controlled despite the sequential use of at least 2 different antipsychotic drugs (one of which should be a second-generation antipsychotic drug)
What option is there for patients with schizophrenia who are at high risk of non adherence
Long-acting depot injectable antipsychotic drugs
Do people on antipsychotics have to inform the dvla
yes
What side effects occurs with high doses on anti-psychotics
Skin Photosensitivity
How should you stop Anti-psychotics
Gradually
What is parkinson’s disease
Progressive neurodegenerative condition resulting from the death of dopaminergic cells of the substantia nigra in the brain, which is responsible for motor control
What are the motor symptoms of parkinson’s
- rigidity
- Rest tremor
- Postural instability
- Slow movement
What are non-motor symptoms of parkinson’s
Dementia
Depression
Sleep disturbances
Bladder/ bowel dysfunction,
Speech and language changes
Swallowing issues
Weight loss
