Mental disorders Flashcards
What are the different anxiety related conditions?
- Generalised anxiety disorder (GAD): worries about wide range of events
- Panic disorder: reoccurring unforeseen panic attacks.
- PTSD
- Acute stress disorder
- Specific phobias
What diagnositic tool can be used to diagnose anxiety?
- GAD7
- PHQ9
What managements can be used for anxiety?
- CBT (notice the thought and consequence in different circumstances - focus on the thoughts and how much you believe it).
- beta blockers (can be used to lower HR and treat palpitations that patients experience)
What is the glucocorticoid receptor hypothesis?
During depression cortisol is found to be very high due to negative feedback mechanisms being dysfunctional. This causes changes to the neurons in the hippocampus.
50% of Cushing’s syndrome patients suffer from depression. and 50% patients with moderate depression show increased cortisol levels
What is the neurotrophic hypothesis?
Increased glutamate in depression causes cellular atrophy and decrease brain derived neurotrophic factor (BDNF) which usually protects neurons
What is the immunological hypothesis?
Depression can mimic the sick role due to raised inflammatory cytokines and interleukins.
What is the monoamine hypothesis?
Patients with depression have low levels of monoamines which are required for regulating mood.
How does Citalopram work?
Limits monoamine reabsorption into the pre-synaptic cell, therefore increasing the levels of monoamines available to the post-synaptic receptor. This means it works based on the monoamine hypothesis.
What are the two main tool used to assess the degree of depression?
- Hospital Anxiety and Depression (HAD) scale
- Patient health questionnaires (PHQ-9)
- NICE use the DSM-IV criteria to grade depression
What is the delivery of individual CBT for patients with depression?
- typically 16-20 sessions over 3-4 months
- consider 3-4 follow-up sessions over the next 3-6 months
- for moderate or severe depression, consider 2 sessions per week for the first 2-3 weeks
What is the delivery of interpersonal therapy (IPT) for patients with depression?
- typically 16-20 sessions over 3-4 months
- for severe depression, consider 2 sessions per week for the first 2-3 weeks
What is the delivery of behavioural activation for the patients with depression?
- typically 16-20 sessions over 3-4 months
- consider 3-4 follow-up sessions over the next 3-6 months
- for moderate or severe depression, consider 2 sessions per week for the first 3-4 weeks
What is the delivery of behavioural couples therapy?
typically 15-20 sessions over 5-6 months
What is SSRIs used to treat for?
Depression, PTSD, Anxiety and OCD
What is the mechanism of SSRIs?
Block serotonin re-uptake transporters (SERT)
Examples of SSRIs?
- Citalopram
- Escitalopram
- Fluoxeline
- Fluoxamine
- Paroxeline
- Sertaline
Side affect of SSRIs - with excess stimulation in brain
- Insomnia
- Irritability
- Anxiety
Side affect of SSRIs - with excess stimulation of spinal serotonin receptors
- Sexual side affects: erectile dysfunction
Side affect of SSRIs - with excess stimulation in serotonin receptor in GI tract
Nausea
vomiting
diarrhoea
What is the mechanism of SNRIs?
Block serotonin and norepinephrine re-uptake transporters = thus increase serotonin and norepinephrine levels
What is SNRIs used for?
- depression
- reduce pain e.g fibromyalgia and other neuropathic pain
Examples of SNRIs
- Venlafaxin
- Desvelfaxine
- Duloxeline
- Levomilnacipram
What are the side affects of SNRIs?
Same as SSRIs but due to its affect on noradrenergic receptors, it can increase BP and HR.
What is the mechanism of tricyclic antidepressant (TCA)?
Blocks serotonin and norepinephrine transporters HOWEVER different ones have different selectivity.
TCAs also block alpha 1 receptor, histamine receptor and muscarinic receptors
