L8 - L15 Flashcards
Major Depressive Disorder
- key symptoms : persistent sadness, loss of pleasure, fatigue
associated symptoms : disturbed sleep, poor concentration, low self confidence, suicidal , agitation, guilt
MDD must have:
- symptoms present for 2 weeks at significant level
<4 - not depressed
4 - mild depression
5-6 - moderate
>7 - severe
Depression Treatments
1st CBT - interpersonal therapy, meditation
2nd Antidepressants - SSRI’s, SNRI’s, MAOI’s , TCA’s
- sertraline 50mg
- mirtazapine (causes sedation for patients who have insomnia)
3rd Electroconvulsive - shock therapy + vagus nerve stimulation
Generalised Anxiety Disorder
- Diagnosing
GAD-7 & DSM5 : used to assess severity
- persistent anxiety and uncontrollable worry for at least 6 months
GAD Management
- Phases 1 to 4
- known presentations of GAD
- actively monitor & educate about GAD - diagnosed GAD not improving after education
- low intensity psychological intervention CBT - GAD with inadequate response to step 2 intervention
- high intensity psychological intervention or drugs (anxiolytics) - marked functional impairment & risk
- specialist treatment, complex drugs
Benzodiazepines BDZ’s
- Compliance
- dependence after 4-6 weeks of treatment
treats psychosis , epilepsy , psychotic symptoms
- dependency warning - decrease dose 1/8th every 2 weeks
- positive allosteric GABAa NT promoter
SSRI’s Compliance
- suicide risk so small supply given
- use full dose for 4-6month after symptoms have gone to prevent relapse
-non-compliance is common when patient mood has improved
- withdrawal is over 2-4 weeks
BDZ’s Safety + Lithium
Benzodiazepines
- withdrawal : convert to diazepam dose
- Discontinuation : reduce by 1/8 - 1/6 of daily dose every fortnight for 6months
Lithium
- treats BPD & recurring depression
- teratogenic
- must assess renal , cardiac , thyroid and metabolic function before starting
Alcohol Withdrawal
- treat with BDZ
Diazepam every day change
- 20mg 6hrly
- 15mg 6hrly
- 10mg 6hrly
- 5mg 6hrly
- 5mg 12hrly
Schizophrenia Glutamate Hypothesis
- Decreased function of NMDA-type glutamate receptors may affect positive & cognitive symptoms of SZ
- Decreased function of NMDA-type glutamate receptors may affect positive & cognitive symptoms of SZ
Phencyclidine + Ketamine :
- blocks NMDA-type glutamate receptor causing psychotic symptoms
