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PM3B > mental health (spring) > Flashcards

mental health (spring) Flashcards

1
Q

define mental health

A

a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

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2
Q

define health

A

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

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3
Q

what is psychosis

A

Syndrome (a set of symptoms). includes:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized behaviour
  • Gross distortion of reality

It is the defining set of symptoms of:

  • schizophrenia
  • substance-induced psychotic disorders
  • schizophreniform disorder
  • schizoaffective disorder
  • delusional disorder
  • brief psychotic disorder
  • psychotic disorder due to a general medical condition

It may or may not be associated to:

  • mania
  • depression cognitive disorders
  • Alzheimer’s dementia
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4
Q

how is genetics liked to Schizophrenia?

A

Schizophrenia tends to run in families, but no single gene is thought to be responsible.

It’s more likely that different combinations of genes make people more vulnerable to the condition.

Evidence that the disorder is partly inherited comes from studies of twins. Identical twins share the same genes.

In identical twins, if a twin develops schizophrenia, the other twin has a 1 in 2 chance of developing it, too. This is true even if they’re raised separately.

In non-identical twins, who have different genetic make-ups, when a twin develops schizophrenia, the other only has a 1 in 8 chance of developing the condition.

While this is higher than in the general population, where the chance is about 1 in 100, it suggests genes are not the only factor influencing the development of schizophrenia.

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5
Q

what are positive and negative symptoms?

give the positive and negative symptoms of schizophrenia

A

Positive: disinhibited behaviours/thoughts

Negative: inhibited/withdrawn behaviours/thoughts.

Some can be either positive or negative or have aspects of both.

(Diagnosis and classification of symptoms is solely psychiatric. There are no objective biochemical, metabolic or clinical signs.)

Symptom types:

  • Thought disorder (+/-)
  • Abnormal beliefs/delusions (+)
  • Abnormal experiences (+)
  • Mood disorder (+/-)
  • Motor alterations (+/-)
  • Changes in social function (-)

positive symptoms:

  • delusions
  • hallucinations
  • distortions or exaggerations in language and communication
  • disorganised speech
  • disorganised behaviour
  • catatonic behaviour
  • agitation

negative symptoms:

  • apathy
  • anhedonia
  • cognitive blunting
  • neuroleptic dysphoria
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6
Q

match each symptom to hypothetically malfunctioning brain circuits

A
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7
Q

give genetic and environmental factors for Schizophrenia

A

Inherited genetic factors

  • Increased risk in families if one family member affected
  • In twins: Dizygotic(fraternal) 17%; Monozygotic (identical) 48%
  • Identification of susceptibility genes e.g. Neuregulin 1

Environmental factors

  • Birth complications, viral infection, inner cities, immigration, drug misuse
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8
Q

what is the Neurodevelopmental model for Schizophrenia?

A

Early environmental insult and/or genetic factors lead to changes in brain development with later environmental factors contributing to risk

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9
Q

what is the pharmacological dilemma of using dopamine to treat schizophrenia?

A

the mesolimbic Dopamine pathway overactivation can lead to schizophrenia positive symptoms exacerbation,

While antagonising the mesocortical dopamine pathway can worsen negative symptoms

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10
Q

what leads to positive symptoms in Schizophrenia?

A

Blockade of NMDA-R may prevent Glu-mediated excitation. NMDA-R hypofunction leads to Schizophrenia positive symptoms

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11
Q

NMDA-R hypofunction in psychosis might
be a consequence of…?

A

an autoimmune disorder

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12
Q

what causes reduced dopamine secretion?

A

Increased cortical serotoninergic tone, can lead to reduced dopamine secretion, downstream

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13
Q

Negative symptoms of schizophrenia on observation?

A
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14
Q

Negative symptoms of schizophrenia on questioning?

A
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15
Q

explain the diagram…

A

Acute psychotic episode typically alerts HCPs and allows patient to enter healthcare system for treatment

Symptoms tend to be initially mild but negative before showing increased positive dominance that steadily trails off into largely negative symptoms in the chronic phase.

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16
Q

give Prognostic signs for isolated episodes of and Prognostic signs for persistent (chronic) schizophrenia

A

Prognostic signs for isolated episodes include:

  • No family history
  • Stable premorbid personality
  • Acute onset
  • Emotional responses preserved
  • Early diagnosis and treatment

Prognostic signs for persistent (chronic) schizophrenia include:

  • Family history
  • Disturbed premorbid personality
  • Difficulty forming relationships early in life
  • Poor social adjustment/disrupted domestic life
  • Insidious onset
  • Loss of initiative and drive
  • Delayed diagnosis and treatment
17
Q

non pharmacological treatments for schizophrenia

A

Control acute attacks (prevent harm to self and others)

Resolve contributory social and domestic factors

Rehabilitate the patient. (attacks of psychosis have consequential effects on mood, emotion etc)

Begin long-term maintenance therapy if necessary.

18
Q

give examples of Antipsychotic (neuroleptic) drugs

moa?

what are they used to treat?

A

haloperidol, chlorpromazine (1st Generation)

D2 antagonists

Generally only treat positive symptoms

  • Onset slow
  • Depot formulation for secondary care – concordance/compliance
19
Q

Dopamine hypothesis with conventional antipsychotics…

what effect does reducing mesolimbic dopamine hyperactivity have?

A

reduces positive symptoms but leads to exacerbated negative symptoms because it also reduces mesocortical dopaminergic tone.

20
Q

side-effects associated with anti-psychotic use?

A

Extrapyramidal symptoms- Manifest as movement disorders

D2 antagonist: prolactinaemia

M1 antagonism: constipation, blurred vision, dry mouth, drowsiness

21
Q

what is the Therapeutic index for conventional and atypical antipsychotic drugs?

A

conventional: Narrow therapeutic range
atypical: better therapeutic profile

22
Q

serotonin hypothesis and atypical antipsychotics…

What effect does reducing mesolimbic dopamine hyperactivity have?

A

reduces positive symptoms

The 5HT2A antagonism leads to increased DA tone in Nigro-striatal pathways, reducing EPS side-effects

Blocking Serotonin receptors in the cortex, leads to increased dopamine secretion downstream also reducing EPS and prolactinaemia

23
Q

describe Binding properties of atypical antipsychotics

A

Clozapine, olanzapine, and asenapine all bind relatively weakly to the 5HT1B receptor, while quetiapine and asenapine bind to the 5HT1D receptor.

Risperidone, paliperidone, ziprasidone, and iloperidone all have some affinity for the 5HT1B and 5HT1D receptors. In particular, ziprasidone binds more potently to the 5HT1B receptor than to the D2 receptor. Lurasidone does not bind to 5HT1B/D.

Aripiprazole and brexpiprazole each bind weakly to the 5HT1B receptor; aripiprazole also binds to the 5HT1D receptor; cariprazine does not bind to 5HT1B/D.

24
Q

Atypical antipsychotic side effects

A

People with schizophrenia smoke more.

D2 Antagonists lead to weight gain, diabetes, increased smoking (lowered dopamine neurotransmission in NAc) etc.

People with schizophrenia develop metabolic syndrome, especially with atypical new medication (Serotonin antagonism). In the old times people treated with haloperidol were skinny and stiff (parkinsonism).

25
Q

what makes an antipsychotic atypical?

A

D2 partial agonist actions…

Reducing mesolimbic dopamine hyperactivity reduces positive symptoms: es Aripiprazol

The partial agonism towards D2 in the mesocortical pathway, also reduces the negative symptoms

26
Q

drugs for Schizophrenia

A

Anti-psychotics

  • Typical (1st generation)
  • Atypical (2nd generation)

Typical

  • Developed in the 1950s and classified by chemical structure chlorpromazine
  • Butyrophenones, phenothiazines or thioxanthenes (see BNF)

Atypical

  • Selective (e.g. D2) dopamine antagonists
  • Some with 5HT antagonist effects (subtype specific - 5HT2A, C and 5HT1A)
  • Dopamine partial agonists

Treatment tailored to individual patient’s response and tolerance

27
Q

fill in the table…

A
28
Q

complete the table…

A
29
Q

Schizophrenia treatment side-effects. what side effects are related to dopamine blockade?

A

Motor (extrapyramidal side effects (EPS))

  • Acute dystonia (involuntary motor movement)
  • Akathisia (innner perception of an inability to ‘sit still’)
  • Parkinsonian
  • Tardive dyskinesia (writhing movements of tongue and facial muscles)

Hyperprolactinaemia (high blood prolactin levels)

  • >580 mIU/L women; >450 mIU/L men

Neuroleptic malignant syndrome

  • Skeletal muscle spasticity
  • Dysfunctional hypothalamic thermal regulation
30
Q

Side effects typically related to side-effects arising from drug interactions with other (non-dopaminergic) systems

A

Anti-cholinergic

Anti-histaminic

Anti-adrenergic

Weight gain

Diabetic symptoms in African-Carribean populations

31
Q

complete the table

A
32
Q

what are the multifunctional actions of quetiapine?

A

25mg- hypnotic

300mg- antidepressant

800mg - antipsychotic

33
Q

how long are treatments maintained for after an acute attack?

why does sustained treatment have disavantages?

A

12-24 months

Poor side effect profiles

34
Q

what is cannabis psychosis?

A

Psychosis is a symptom in schizophrenia

Acute use (‘one joint’) may be enough to induce a short-term psychotic episode

  • anxiety, depression, paranoid ideas, illusions, hallucinations, delusional beliefs (‘wanted’ and ‘unwanted’ effects).

This may be ameliorated by CBD

35
Q

list Illicit and Prescription drugs considered to pose a potentially greater risk in schizophrenia

A

Illicit:

  • Amphetamines
  • Cocaine
  • MDMA
  • PCP
  • Magic mushrooms
  • Alcohol
  • Mescaline, psylocybin, LSD
  • Khat
  • Solvents

Prescription:

  • α-adrenoceptor blockers
  • Antibiotics
  • Anticholinergics
  • Antiepileptics
  • Antihistamines
  • Antimalarials (mefloquine)
  • Digoxin
  • Dopaminergics
  • H2 receptor antagonists
  • Retinoids
  • SSRIs (e.g. Prozac)

PM3B (14 decks)

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