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Med 4 > CNS Week 2 Anxiety And Depression > Flashcards

CNS Week 2 Anxiety And Depression Flashcards

1
Q

What key behaviours does the limbic system integrate

A 
Emotions 
Reward driven activity: feeding and sex 
Motivation 
Social behaviours: friend and foe 
Memory of environment and experience
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2
Q

What Brain regions does the limbic system link

A

Hypothalamus, sensory, motor and frontal regions

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3
Q

Function of the parahippocampal gyrus

A

Route which information gets to the hippocampus

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4
Q

Function of the dentate gyrus

A

Gatekeeper of information flow into the hippocampus

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5
Q

Basic circuit of hippocampus for forming memories

A

Sensory information from multiple cortical areas -> entorhinal cortex -> dentate gyrus -> CA3 -> CA1 -> subiculum -> entorhinal cortex -> cortical areas

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6
Q

How is the hippocampus connected to the septal nuclei

A

They have a reciprocal relationship in which the septal nucleus inputs into the hippocampus and the hippocampus outputs to the septal nuclei

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7
Q

Summary of hippocampal inputs

A

1) Sensory information from throughout Cortex via entorhinal cortex > performant path to dentate gyrus
2) modulatory inputs from septal nuclei, brainstem nuclei influence the overall functioning

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8
Q

Summary of hippocampal outputs

A

1) via subiculum and entorhinal cortex to neocortex

2) via fornix to septal region, mamillary bodies, hypothalamus, median forebrain bundle

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9
Q

What is working memory (short term)

A

Limited capacity (7+/-2)
Rapid decay without sustained attention
Prefrontal cortex
Visual and auditory versions of working memory

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10
Q

Difference between declarative (explicit) and non declarative (implicit) memories

A

Declarative: events and facts

Non declarative: unconscious knowledge, motor skills and conditioned responses

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11
Q

2 different types of declarative memory

A

Semantic: general knowledge

Episodic: personal experience (role of the hippocampus)

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12
Q

How do we know that the hippocampus is key to episodic memory

A

Patient HM had a bilateral hippocampal amygdala entorhinal resection to help his epilepsy
Resulted in a profound deficit in episodic memory
He preserved his procedural memory (learning skills) and preserved memory of events before the surgery
This shows that the hippocampi are integral to episodic memory

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13
Q

Different types of spatial cells represented in the limbic system

A

Place cells
Head direction cells
Grid cells
Border cells

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14
Q

What is temporal lobe epilepsy

A

When one hippocampus is damaged and one is healthy causing seizures and memory problems

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15
Q

Summarise the hippocampus as a key memory structure

A

Inputs from multiple sensory cortices via entorhinal cortex
Specialised intra-hippocampal circuits
LTP- synaptic plasticity is the basis of long term memory
Spatial functioning
Disorders of hippocampus involve memory impairment

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16
Q

What are emotions

A

CNS response to certain stimuli

Output from:

  • autonomic
  • hormonal
  • behavioural

Innate and learned elements , multiple neural networks involved

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17
Q

Describe the anatomy of the amygdala

A 
Multiple sub nuclei 
Multiple sensory and limbic inputs 
Organise emotional responses to stimuli (hormonal, autonomic, behavioural) 
Both pleasant and harmful 
Special role in fear
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18
Q

What is kluver-bucy syndrome

A

Large bilateral anterior temporal lobe resections removing amygdala, hippocampus and surrounding temporal lobe

Very docile - no longer aggressive towards keepers
Indiscriminant sexual activity - low visual discrimination
Lost ability to visually discriminate edible from inedible
A breakdown of visual input to channeling drives

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19
Q

Describe the reward circuit

A

Midbrain dopaminergic neurons

Ventral tegmental area to nucleus accumbens
Median forebrain bundle

Orbitofrontal and medial frontal cortex, ventral striatum, Amygdala

Reward signals use environmental signals to drive behaviour

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20
Q

Location of the nucleus accumbens

A

Medial aspect of the basal ganglia

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21
Q

Function of the midbrain dopaminergic neurons

A

Show brief phasic bursts of activity after

  • rewarding stimuli like food or sex
  • stimuli predicting reward
  • causes wanting rather than liking
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22
Q

What happens when there is an absence of a reward after stimulus predicting a reward

A

There is a drop in neural firing

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23
Q

Describe characteristics of addiction

A

A compulsion to take a substance despite consequences
Loss of control over intake
Negative symptoms when access to substance is prevented
Wanting occurs despite tolerance to liking

Many factors determine whether occasional use becomes addiction including the drug, the person and the context

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24
Q

Role of drugs of addiction chemically

A

They acutely boost dopaminergic signalling

Chronically they down regulate reward signals to normal stimuli due to altered gene expression

Repeated use leads to craving, withdrawal and compulsive use

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25
Q

Describe the dorsal striato pallidal circuit (motor loop)

A

Allows coordinated behaviour

Information from substantia nigra -> dorsal striatum -> pallidum -> thalamus -> motor cortex

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26
Q

Describe the ventral striato palllidal circuit

A

Loop involved with motivational behaviour

VTA -> ventral striatum -> ventral pallidum-> thalamus -> limbic and prefrontal cortex

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27
Q

Describe the neurobiology of depression

A

Involves dysfunction of a complex network of limbic - striatum - frontal cortex

Amygdala - anxiety
Hippocampus - memory deficits (sometimes shows as a smaller hippocampus on MRI)
Reward circuits - anhedonia and motivation
Frontal lobe - motivation and decision making
Striatum - motor slowing

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28
Q

Summarise the pre frontal cortex

A

Inputs to and from key limbic structures

Important in decisions about reward and appetite behaviour

Motivation and regulation of behaviour

Disorders can include psychiatric and personality disorders

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29
Q

Top 7 leading causes of disability in ages 10-24 in 2019

A
  1. Road injuries
  2. Headache disorders
  3. Self harm
  4. Depressive disorder
  5. Interpersonal violence
  6. Anxiety disorders
  7. Lower back pain
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30
Q

What are DALYs

A

Disability adjusted life years

Overall disease burden expressed as a number of years lost to ill health

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31
Q

What is the commonest complication of pregnancy

A

Post natal depression

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32
Q

Effect of depression and anxiety disorders on GDP

A

1% loss of UK GDP

Leading reason people retire early from work

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33
Q

Describe the course of depression and anxiety disorders

A

50% long term condition with a relapsing and remitting course
50% in response to an adverse life event only eg loss of job / relationship

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34
Q

Risk of depression and anxiety disorders

A

Suicide
Self harm (often without suicidal intent)
Self neglect
Neglect of vulnerable others
Exploitation by others
Addiction
Homicide (often intended as an act of kindness in a perceived awful world)

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35
Q

Associated symptoms of depression

A 
Fatigue / loss of energy 
Weight gain 
Change in sleep 
Low libido 
Change in appetite 
Decline in hygiene 
Agitated / slow movement 
Poor concentration 
Feeling worthless / excessive guilt 
Suicidal thoughts / acts
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36
Q

What is the mental state examination steps (ASEPTIC)

A

Appearance: clothing, self care, eye contact, poor nutrition, agitation

Speech: slow, monotone, short answers

Emotion: mood

Perception: hallucinations, derogatory voices talking to them in 2nd person

Thought: worthless, hopeless, helpless, low self confidence, suicidal ideation

Insight: undeserving of help

Cognition: poor concentration and attention

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37
Q

What is adjustment disorder

A

Subthreshold response to specific life event (behaviour or emotional reaction)

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38
Q

What is dysthymia

A

Subthreshold depressive symptoms most days for 2+ years

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39
Q

What is seasonal affective disorder

A

Recurrent depression at the same time each year

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40
Q

What is grief

A

A normal reaction to significant loss

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41
Q

What is bipolar depression

A

Separate episodes of mania, >4 days of elation or irritability, increased energy and activity
But treating as normal depression can trigger a manic episode

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42
Q

What is atypical depression

A

Sleep more, eat more, worse in evening

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43
Q

What is melancholic depression

A

Most severe, slowed down / agitated, worse in morning, early morning waking , weight loss

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44
Q

Factors to determining a patients suicide risk

A

Intention: has a plan to end their life: when, how, what they will do, planning for end of life eg putting affairs in order

Thinking: hopeless, helpless, painfulness of living

Behaviour: suicide can occur with very little planning - evidence of recklessness with life, recent self har, (x 10 risk), substance misuse, past violence

Medical risk: likelihood of death of injury eg hanging, asphyxia, fall

Protective factors: responsibilities eg to children, beliefs eg suicide is wrong, events to look forward to

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45
Q

What do blood tests look for as a cause of depression

A

FBC (anaemia, chronic disease)
U+ E/ LFT (renal or hepatic disease, hyponatraemia)
Bone profile (calcium, vit D)
Haematinics (ferritin, B12, folate, blood glucose)

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46
Q

Substances and physical health conditions as organic causes of depression

A

Alcohol and benzodiazepines are depressants, substance withdrawal

Prescribed interferon alpha (some cancers) , steroids, anti HIV, isotretinoin (acne), hormonal treatment eg contraception, Parkinson’s drugs (block dopamine), beta blockers

Endocrine, viral infections, head injury, neurological disease

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47
Q

Define fear

A

An emotional reaction to a specific, present, danger

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48
Q

Define panic

A

Intense fear accompanied by physical symptoms of autonomic arousal

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49
Q

Define phobia

A

Repeated fear associated with a non typical, specific, source of threat eg spiders, flying, public speaking

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50
Q

How are anxiety and depression different

A

Anxiety is psychological symptoms about the future- fear of what might happen versus in depression about loss that has already happened

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51
Q

How does a person with anxiety process thoughts about fear and panic

A

They overestimate threat / danger / vulnerability

Underestimate their own ability to cope

Underestimate rescue factors / resources eg chance and help from others

They have painful recurrent thoughts as if trying to solve an unsolvable problem

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52
Q

What is social anxiety disorder

A

Fear of being judged negatively by others

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53
Q

What is panic disorder

A

Panic attacks with avoidance of source or place of panic

Often with agoraphobia or other phobias - recurrent panic attacks to the point of fearing having a panic attack

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54
Q

Describe the panic cycle in a panic attack

A

Internal / external trigger eg crowded place, caffeine

Perceived threat

Anxiety eg intense fear

Avoidance and safety behaviour or physical / cognitive symptoms eg palpitations

Misinterpretation eg i am having a heart attack

Panic attacks stop because the body runs out of adrenaline

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55
Q

What is PTSD

A

Witnessed a terrifying life event eg assault, reliving nightmares and flashbacks, hypervigilance, avoidance of reminders

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56
Q

What is OCD

A

Obsessive thoughts around a threatening outcome + compulsions to try to neutralise this threat -> can sometimes forget what the obsessions were

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57
Q

What is health anxiety

A

Fear of having a serious illness, misinterpreting the symptoms

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58
Q

What is generalised anxiety disorder

A

Worry for >6 months out of proportion to stress with insomnia, muscle tension with headaches, backaches, autonomic physical symptoms

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59
Q

Describe electroconvulsive therapy for severe or treatment resistant depression

A

General anaesthetic and muscle relaxant, electricity given to produce a controlled generalised epileptic seizure
Course of up to 12 treatments

Vagal nerve stimulation and deep brain stimulation. Rarely used for very treatment resistant depression. Requires an operation to implant transcranial direct current stimulation

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60
Q

Describe transcranial magnetic stimulation for depression

A

Course of up to 20 treatments. No anaesthetic. No seizures. Can be focused but does not penetrate far into the brain so usually targeted at fronto-limbic circuits implicated in depression

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61
Q

Purpose of cognitive behaviour therapy

A

Tackles reasons why depression or anxiety are still present, not what caused them

Generally the strongest evidence base of all psychotherapies

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62
Q

Describe the type of thinking in depression

A

Negative automatic thoughts eg I didn’t get a promotion but john did so all my colleagues think john is better than me

Cognitive distortions:

  • all or nothing thinking: i do things perfectly or I’m useless
  • emotional reasoning - i feel like a bad friend therefore i must be a bad friend
  • personalisation: my friend looked sad when I spoke to her earlier, it must be my fault
  • mental filtering: focusing on a small negative thing or ignoring positives
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63
Q

What is becks cognitive triad - negative thoughts about the self, world and future

A

I am a bad person

The world is a bad place

Nothing will ever get better

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64
Q

What is mindfulness based CBT

A

Identify unhelpful negative thoughts of depression, use meditation to disinvest these thoughts as being unimportant

65
Q

What is behaviour therapy

A

Exposure to fear in real life, virtual reality or imagination

66
Q

What is eye movement desensitisation and reprocessing (EMDR)

A

Trauma, eye movements during recollection intended to allow processing of raw memories

67
Q

What is problem solving counsellling

A

Depression due to specific life events or difficulties

68
Q

What is interpersonal therapy

A

Relationships, isolation - looking at recurring patterns

69
Q

What is family and martial therapy

A

Working on how people relate to each other at the same time

70
Q

What is psychodynamic psychotherapy

A

Subconscious, predisposing / precipitating factors

71
Q

What is supportive listening

A

Non judgemental support, helping the person to reframe their situation by listening, asking questions and repeating back to person in more natural ways

72
Q

What is emotion

A

An emotion is a positive or negative reaction to an appropriately evocative stimulus which involves: cognitve appraisal, physiological arousal, subjective experience, expressive beahvaiour and goal directed actiivty

Complex systems that prepare us to act in response to a stimulus

73
Q

How is emotion different to mood

A

Mood is a frame of mind or emotional state that is defined by ones internal state rather than external behaviour; moods are more long lasting and less spontaneous than emotions

74
Q

What did plutchik suggest

A

That there are 8 basic emotions grouped in 4 pairs of opposites

1) joy / sadness
2) affection / disgust
3) anger / fear
4) expectation / surprise

All other emotiuons are derived from combinations of this array

75
Q

Factor 1 of the process of emotion

A

Cognitive apprasial: evaluation of relevance of current situation to personal wellbeing : am i in trouble or am i ok
Then evaluation of capacity for dealing wirh the situation; what can be done about it?

If situation is appraised as unfavourable and coping potential is appraised as low then the emotional state experienced is likely to be sadness or anxiety

76
Q

Factor 2 of the process of emotion

A

Arousal: emotions are based on feedback of bodily changes: we feel sorry because we cry, angry bevause we strike, afraid becuase we tremble

Emotions are a directl result of the different patterns of physiologicla response associated with them; they are cognitive responses to information from the periphery

77
Q

How do lie detectors work

A

Beta blockers reduce anxiety / fear eg blood pressure or tightening of muscles
So when someome experiences anxeity or guilt when they lie specific patterns of physiological arousal accompanying these emotions should be detectable

78
Q

Describe the process of emotion

A

The sympathetic and parasympathetic parts of the nervous system act in balance in non excited states; when the balance has been upset the sympathetic nervous system prepares the body for specific actions and mobilises emergency and stress responses

79
Q

Voluntary facial movements

A

Controlled by the pyramidal motor system, a brain system that includes the motor cortex

80
Q

Involuntary facial movements

A

Controlled by the extrapyramidal motor system, which depends on subcortical areas; brain damage can disrupt either system

81
Q

What is the facial feedback hypothesis

A

The pattern of muscles during facial expression feeds back to the brain, providing it with information for subjective feel of an emotion

Darwin argues that the facial expression of an emotion will intesnfiy it while the suppression of an expression will reduce the meoiton

82
Q

Factor 4 of the process of emotion

A

Action readiness: the tendency to serve as an impulse for an action specific to the emotion being experienced

83
Q

Advantages of xray

A

Assess for fracture or radio opaque foregin body

Quick imag acquisition and inexpensive

84
Q

Disadvanatges of xray

A

Difficult to interpret due to overlying structures

No assessment of the brain

Non displaced fractures may be missed

85
Q

Advantages of CT scan

A

Imaging for most acute neurological presentations

Allows anatomical assessment in multiple planes

Excellent assessment in cases of trauma and most vascular abnormalities

86
Q

Disadvantages of CT

A

Prone to artefact

Evaluation of the brain is limited

Subtle abnormalities may be missed

87
Q

Advantages of MRI

A

Exquisite details of the cerebrum and cerebellum

Multiple planes and sequences allow detailed evaluation

Radiation sparing investigation

88
Q

Disadvantages of MRI

A

Time consuming and expensove

Cannot be used in all patients

Limited bone assesment

89
Q

Describe the bones of the skull

A

Formed of 28 bones

  • calvarium (6)
  • facial bones (16)
  • middle ear ossicles (6)

Mostly articulate via strong fibrous joints at suture lines

Temporomandibular joint and middle ear ossicles articulate via synovial joints

90
Q

What are the 6 calvarium bones

A

Single frontal bone

Paired parietal bones
Paired temporal bones

Single occipital bones

91
Q

What bones make up the facial bones

A

Midline single: vomer, sphenoid, ethmoid, mandible

Paired bilateral: lacrimal, nasal, inferior nasal concha, maxillary, palatine, zygoma

92
Q

Describe the paediatric skull

A

Unfused sutures allow for growth of the brain (metopic suture is most common - appearance of 2 frontal bones)

Metopic suture dividing the frontal bone can persist into adulthood

93
Q

What is the difference between sutures and fractures

A

Sutures are more jagged in appearance and symmetrical

Fractures more linear and unilateral

Abnormal suture widening is also indicative of fracture

Wormian bones and metopic suture can be mistaken for fracture in paediatric patients

94
Q

What are the sinuses of the sjull

A

Air filled spaces lines with mucous membrane

  • frontal
  • ethmoid
  • maxillary
  • sphenoid

Variation in normal anatomy is common

95
Q

Functions of the sinuses of the skull

A

Reducing the weight of the skull, air humidifcation and aiding in sound resonance

96
Q

What does asymmetry of the sinuses indicate

A

Indicates injury even if a fracture cannot be seen
If in doubt, a CT scan will allow for further assesment

An opacified sinus could also be due to obstruction or infective or inflammatory sinus disease

97
Q

Where is CSF produced

A

By the epithelium of the choroid plexus and then flows freely within the ventricles and subarachnoid space

98
Q

Usual volume of CSF

A

150-250ml with approx 700ml produced daily

Excess CSF is drained into dural venoous sinuses via arachnoid granulations

99
Q

Location of the circle of willis

A

In the sub arachnoid space

100
Q

course of the middle meningeal artery

A

Arises from the external carotid artery via the maxilary artery

Courses aling the inner table of the skull and supplies the cranial meninges

Enters the cranial vault via the foramen spinosum

Clinically relevant in cases of head trauma

101
Q

What are the dural venous sinuses

A

Venous channels located between the 2 layers of dura mater

Differ from systemic veins as they are valveless and run independent of the arteries

Form major venous drainage pathway predominantly to the internal jugular veins

102
Q

What are bridging veins

A

Perforate through the meninges allowing venous drainage of the superficial cerebrum

Prone to shearing in elderly patients leading to a subdural haemorrhage

Usually secondary to trauma but can be spontaneous

103
Q

What is a extradural haemorrhage

A

Usually a sign of fracture

Damage to the middle meningeal artery

104
Q

What is the behaviour therapy theory

A

An action based approach; relies on experimentally tested principles tested of learning theory
Modern approaches have been developed guided by learning theory and applied through innovative techniques in clinical intervention

105
Q

What is the aim of behaviour modification

A
  • increase frequency of existing adaptive behavior
  • decrease frequency of existing maladaptive behaviours
  • teach new appropriate behaviours
106
Q

Describe the ABC model of operant conditioning

A

A= antecedent stimulus (condition / situation in which the behaviour occurs)

B= behaviours - behavioural response (rat presses lever)

C = consequence - what happens as a result of the operant behaviour (food is given = reinforcement
Shock is given = punishment)

107
Q

Most widely used techniques for behaviour therapy

A
  • graded exposure eg systematic desensitisation
  • exposure and response prevention
  • social skills training
  • modelling ; behaviour rehearsal
  • reinforcement, punishenment and aversion therapy
108
Q

Describe the process of systematic desensitisation

A

A type of graded exposure
Construct a hierarchy of events related to original stimulus which elicits the maladaptive response for each patient

1) driving to clinic
2) entering treatment room
3) seeing clinic nurse

Train the patient to associate alternative response eg deep muscle relaxation with these events

109
Q

What is virtual reality therapy

A

Uses specially programmed computer software, visual immersion devices and artifically created environments to give the patient a stimulated experience

Graded exposure and habituation to a vivid experience, without the associated cots of an in vivo experience

Particularly effective in anxiety related disorders

110
Q

Describe cognitive therapy

A

Emphasises role of negative beliefs in the cause and maintenance of depression; magnification, minimisation and over generalisation

Involved identifying and replacing distorted thoughts and ultimately changing the associated habitual behaviour towards them

111
Q

What is becks negative triad

A

Negative thoughts about

  • oneself
  • the world
  • the future
112
Q

What is the diathesis stress model

A

The greater the vulnerability an individual has, the less stress is required for that individual to become ill
A) presence of a diathesis
B) level of stress
Determine the degree of risk for the onset or reoccurrence of an illness

113
Q

What is the differential activation hypothesis (cognitive reactivity)

A

Important factors determining whether ones initial depression or anxious state becomes more severe or persistent are the degree of activation and content of maladaptive thinking patterns that become accessible in the depressed state

114
Q

What is cognitive behavioural therapy (CBT)

A

Behavioural and cognitive therapies joined forces to create CBT
Based on the principle that behaviour is learnt, and can therefore be relearnt or reconditioned; focuses on the ‘here and now’

115
Q

Integrative methods of CBT

A
  • Disrupting irrational thoughts and beliefs
  • doing cognitive homework
  • changing ones language
  • using humour, emotive imagery, role play
  • desensitisation
  • skills training eg assertiveness
116
Q

Cognition of CBT

A

Recognising that emotional problems stem from maladaptive beliefs and recognising the importance of disrupting self defeating beliefs

Accepting we have the ability to change maladaptive thoughts and behaviours by counteracting them

117
Q

Advantages of CBT

A

‘Here and now’ approach
Therapeutic attention is focused on the present situation rather than historical or childhood facts; emphasis on current cognitive factors which can be accessed in order to change thinking, emotion and behaviour
- short term structure
- collaborative approach

118
Q

Disadvantages of CBT

A

Due to structured nature may not be suitable for people with more complex health problems

Due to its focus on current problems, possible underlying causes of mental health condiitons rooted in the past are not adequately addressed; but in recent years psychotherapeutic elements have also been adopted

119
Q

What conditions has CBT been effective in

A

Depression; amongst other disorders such as anxiety disorders, bipolar disorder, psychotic disorders, somatoform disorders, personality disorder, eating disorders

Also hypocondriasis, rheumatoid arthritis, chronic pain

120
Q

What is mindfulness based therapy

A

A process that leads to a mental state of non judgemental awareness and acceptacne of the present

The present moment experience includes ones sensations, thoughts, bodily states, consciousness and environment

121
Q

What is mindfulness based cognitive therapy

A

Combines mindfulness techniques with CBT components and is empirically beneficial in depressive disorders

Neuroimaging evidence that it is effective in the brain

122
Q

What is the monoamine hypothesis of depression

A

The underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine and or dopamine in the CNS

123
Q

Why is the monoamine hypothesis of depression seen as inadequate

A

Doesnt provide a full explanation for the therapeutic action of antidepressants

Doesnt clarify the pathophysiology of depression

Doesnt explain why antidepressants take 2-3 weeks to work

Doesnt explain why antidepressants are effective in other disorders eg phobias

124
Q

What is the hypothalamic pituitary adrenal axis in depression

A

Depressed patients displayed HPA hyperactivation

Increased cortisol in saliva, plasma and urine

Increase CRH in CSF and in limbic brain region (region associated with processing emotion)

Increased size and activity of the pituitaty and adrenal glands

Impaired negative feedback

125
Q

How do antidepressants work in relation to the HPA axis

A

Antidepressants enhance the negative feedback and decrease the HPA axis hyperactivity

126
Q

How to treat mild depression in children and young people <18

A

Psychological therapy eg CBT

127
Q

How to treat moderate to severe depression in children and young people <18

A

Psychological therapy

Combined therapy ie psychological + fluoxetine (SSRI)

If unresponsive to combined therapy consider alternative psycholoigcal therapy

If side effects switch fluoxetine - sertraline - citalopram

128
Q

How to treat mild depression in adults

A

Appropriate psychological intervention

NICE does not recommend drug treatment unless under certain circumstances eg previous history of moderate / severe depression

129
Q

How to treat moderate/ severe depression in adulys

A

Combined therapy ie psychological + antidepressant

130
Q

3 main modes of action of antidepressants

A

1) reuptake inhibition (at the synaptic cleft)
2) receptor blockade - autoreceptor doesnt release neurotransmitter when activated
3) MAO enzyme inhibition (at the presynaptic neurone)

131
Q

Describe mode of action of tricyclic (TCA) antidepressants

A

Inhibit serotonin and noradrenaline reuptake

Sedative properties (H1 receptor antagonism) 
Anticholinergic effects eg dry mouth, blurred vision etc 
Cardiovascular effects can be fatal in overdose
132
Q

Examples of TCA antidepressants

A

Amitriptyline

Imipramide

133
Q

Describe mode of action of MAO inhibitors (monoamine oxidase)

A

Cheese reaction - tyramine displaces noradrenaline from vesical storage

134
Q

Examples of monoamine oxidase inhibitors

A

Phenelzine and tranylcypromine

135
Q

Describe selective serotonin reuptake inhibitors

A

First line option
Favourable side effect profile and less toxic in overdose

Eg citalopram, fluoxetine, paroxetine, sertraline

136
Q

Describe serotonin noradrenaline reuptake inhibitors

A

Similar to SSRIs

Eg venlafaxine and duloxetine

137
Q

Describe mirtazapine mode of action

A

Enhances NA and 5HT transmission

Presynaptic a2 adrenoceptors responsible for inhibiting noradrenaline release are blocked

Presynaptic 5HT2 responsible for inhibiting 5HT release are also blocked

138
Q

Symptoms of generalised anxiety

A

Worry for >6 months out of proportion to stress with insomnia, muscle tesnion with headaches, backaches, autonomic physical symptoms

139
Q

Interventions for generalised anxiety disorder

A

Autonomic symptoms:
- B adrenoceptor antagonists (propranolol)
Reduces autonomic effect
Do not withdraw abruptly to prevent rebound effects

Anxiety symptoms: psychological interventions
Offer SSRI- sertraline as 1st option
Do not offer benzodiazepine except for short term use during a crisis

140
Q

How do benzodiazepines work

A

They are positive allosteric modulators on GABA A receptor complex (ligand gated chloride selective channel)
BDZ occupy site on GABA a complex between a and y
Conformation change
Allows greater flow of Cl- ions into the neurone
Hyperpolarisation = inhibition

141
Q

What is bipolar disorder

A

A cycle between depressed mood and mania

Depressed mood - period of at least 2 weeks with core symptoms accompanied by at least 4 other symptoms
Mania - elevated mood; increased energy, incomprehensible speech, racing thoughts, poor concentration

142
Q

Pharmacological interventions of bipolar disorder

A

Mania: antipsychotics
Longer term: lithium, valporate, olanzapine

Managing bipolar depression: 
SSRI fluoxetine with olanzapine 
Quetiapine alone 
Olanzapine alone 
Lamotrigine alone
143
Q

Symptoms of lithium toxicity level >1.0 mmol /L

A 
Severe diarrhoea 
Vomiting or anorexia 
Coarse hand tremor 
Muscle twitching 
Dehydration 
Drowsiness 
Confusion 
Muscle weakness 
Slurred speech
144
Q

Symptoms of lithium toxicity level >2.0mmol/L

A 
Convulsions 
Renal failure 
Electrolyte imbalance 
Hypotension 
Clouding of consciousness 
Coma and death
145
Q

What does a routine assessment of cognitive funciton look at

A

History of cognitive deficit, premorbid level of functioning: educational and occupational history

146
Q

What does the mini mental state examination ask

A

1) what is the year, season, month, date, day and where are we (country, county, town, hospital)
2) name 3 objects, repeat, repeat unitl correct
3) begin at 100 and count backwards by 7s or spell world backwards
4) ask for names of previous 3 objects
5) show pencil and watch and ask them to name,
Ask to repeat ‘no ifs ands or buts’
Take paper in right hand, fold in half and put on floor
Read and obey this message
Write a sentence
Copy a design

147
Q

Scores for MMSE

A 
Max= 30 
Mean for normal young = 30 
Mean for normal elderly = 27.6 
Elderly depressed pts = 25 
Elderly with depression, cognitive impairment = 19 
Dementia = 9.7

Mild cognitive impairment = 23-26

148
Q

What do neuropsychological tests do

A

Cover the range of mental processes from simple motor performance to complex reasoning and problem solving

149
Q

What is a developmental brain syndrome

A

Generalised low cognitive functioning as a child

150
Q

What is acquired brain syndrome

A

Acute organic brain syndrome eg delirium is common as a symptom of infection and will clear up with the infection
History of sudden onset (often in association with physical illness)
Impaired level of consciouness

151
Q

Order of cognitive impairment in alzheimers disease

A 
Prominenet impairment of episodic memory: early 
Visuospatial impairment: early 
Dysphasia: later 
Dyspraxia: later 
Dysexecutive syndrome: later

Well preserved personality and social behaviour

152
Q

Order of cognitive impairment in frontotemporal lobar degeneration
(Frontotemporal dementia, semantic dementia, progressive aphasias)

A

Prominent dysexecutive syndrome : early
Coarsening of personality: early
Expressive dysphasia: early
Memory impairment: later

153
Q

Times when neuropsychology is not likely to be helpful or appropriate

A 
Recently bereaved 
Florid psychosis 
Patient severely or terminally ill 
Patient has systemic infection 
Severe behavioural disorders 
Assessed less than 6 months ago
154
Q

What is immediate (working) memory

A 
Digit span (increasing from 2: at 1/sec) 
Immediate recall of name and address
155
Q

What is recent memory

A

5 min delayed recall of name and address

Recall events of the day

156
Q

What is remote memory

A

Autobiographical data

157
Q

What is sudden onset dysfunction

A

Check for retrograde amnesia and post traumatic amnesia

158
Q

Examples of visuoconstructional tasks

A

Copy drawings of cube, flower and house

Place numbers and hands on clockface

159
Q

What is visuospatial neglect

A

When copying a drawing leaving out one side of the features eg only drawing half a clock

Med 4 (12 decks)

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