CNS and mental health

Question 1

Dementia

Answer 1

It is a clinical syndrome characterised by multiple cognitive deficits, including memory impairment and at least one other cognitive deficit that interferes with activities of daily life.
- Aphasia (difficulty with language or speech)
- Apraxia (Inability to carry out skilled movements or gestures)
- Agnosia (Inability to interpret sensations)

Question 2

Dementia screening

Answer 2

Time orientation - what is the date
Information - Tell me something that happened in the news recently
Recall test - Give a name and address and ask them to repeat it back in a few minutes
Clock drawing test - Mark all the numbers to show the hours of a clock and draw the hands to show a specific time

Question 3

First line treatment for dementia

Answer 3

In patients with mild to moderate Alzheimer’s disease, acetylcholinesterase is the first line treatment. (donepezil, rivastigmineine and galantamine)

Question 4

NMDA receptor antagonists for dementia

Answer 4

In moderate to severe Alzheimer’s disease or when ACh inhibitors are contraindicated/not tolerated
e.g. Memantine

Question 5

Parkinson’s disease

Answer 5

• Fall in nigrostriatal dopamine level
• inhibition of thalamus
• Reduced cortical stimulation
• Increase in acetylcholine

Question 6

Symptoms of parkinson’s disease

Answer 6

Disorder of voluntary movement - tremor, rigidity, bradykinesia (slow movement), akinesia (difficulty initiating movement), face is expressionless and unblinking

Speech is slow and monotonous
Writing becomes small and tails off at the end
Postural changes
Dribbling of saliva
Swallowing difficulties
Constipation
Dementia
Depression
Sleep disturbances
Pain in limbs

Question 7

Parkinsons disease treatment

Answer 7

Small number of patients respond poorly to treatment
Treatments not started until symptoms cause significant disruption
Therapy with two or more drugs may be necessary
Levodopa
Dopamine receptor agonists
Monoamine oxidase B inhibitors
Catechol-O-meythltransferase inhibitors
Anticholinergics

Question 8

Choice of drug in parkinson’s disease

Answer 8

Offer levodopa in early stages where symptoms affect persons daily life
Consider choice of levodopa, dopamine agonist or MAO-B inhibitor in early stages of parkinson’s where it does not affect persons quality of life

Question 9

What is bipolar disorder?

Answer 9

Mood disorder involving periods of mania followed by periods of depression

Question 10

Treatments for bipolar disorder

Answer 10

1. Lithium
2. Anticonvulsants - carbamazepine, valproate or lamotrigine
3. Atypical antipsychotics - Olanzapine most common but can also give risperidone, quetiapine, aripiprazole and asenapine

Question 11

Treatments for anxiety

Answer 11

1. Benzodiazepines
2. Z drugs
3. 5-HT1A receptor agonists
4. Beta adrenoceptor antagonists
5. Anti-histamines

Question 12

Benzodiazepines for anxiety

Answer 12

• They are GABAa modulators
• Decrease in anxiety, sedative effect, reduction in muscle tone
• Side effects: drowsiness, confusion, forgetfullness
• Temazepam, Lorazepam, Diazepam

Question 13

Z Drugs

Answer 13

They are a type of benzodiazepine that are GABAa modulators
- Structurally different to benzodiazepines
- Used as hypnotic, NOT ANXIOLYTIC
- Zolpidem

Question 14

5-HT1A receptor agonist

Answer 14

• Buspirone
• Class of drug that treats anxiety with less tolerance and less withdrawal symptoms compared to benzodiazepines

Question 15

Beta adrenoceptor antagonists

Answer 15

• Used to treat some forms of anxiety
• Propanolol
• Relieves some of the peripheral manifestations of anxiety (sweating, tremor, tachycardia and diarrhoea)

Question 16

Antihistamines

Answer 16

• H1 receptor antagonist
• Used as hypnotic due to its sedative effects
• Not used as anxiolytic