Misc. - 1 Flashcards
Where does Cotard’s syndrom is seen ?
Depression ( most common)
Schizophrenia
Bipolar
as a delusion what is special about cotard’s?
it is less dramatic
what is cotards?
unshakable belief that one has lost their blood, internal organ, soul or is even dead.
The enzyme from GIT that increase satiety?
Cholecystokinin (CCK)
The enzyme from GIT that stimulates feeding?
Ghrelin
what do cholecystokinin work on to induce satiety?
Vegus Nerve ==>Medula Oblongata
What do Ghrelin work on to induce feeding?
Hypothalamus
where gastrin is released from
stomach and dudenum
what do gastrin do?
stimulates screte of gastric juice
where somatostatin is released form?
Stomachw
what does somatostatin do?
IN gastric inhibits gastrin
in dudenum inhibits secretin and CCK
in pancrease inhibits glucagon release
what is cisgender?
when there is congruency between assigned sex and experienced/identified gender
what is sex?
biological inidcator of male and female (sex chromosomes, gonads, sex hormones)
what is gender?
is a person’s identification or lived role in society
is gender binary?
no
are gender and sexual preferences covered with the same concept in ICD and DSM?
no
what did ICD 11 replace transsexualism and gender identity disorders with?
- Gender incongruency in adolescents and adults
-Gender incongruency in chilldren
are gender related issues considered mental disorders?
nope.
ICD 11 criterias for gender incongruency in Children
- marked incongruency between assigned sex and identified/experienced gender
-dislike towards incongruent body parts associat. with assigned gender (+2nd characteristics)
-Involved in toys, games and activities of the incongruent preferred gender
-at least 2 years - Gender variant behaviours and preferences cannot be the sole basis for dx
ICD 11 criterias for gender incongruency in adolescent and adults
-marked incongruency between assigned sex and identified/experienced gender leading to a desire to transition
-dx cannot be made prior to puberty
-Gender variant behaviours and preferences cannot be sole basis for dxw
what term dsm-5 used to define gender incongruency?
gender dysphoria
who long dsm-5 requires gender dysphoria symptoms to last?
6 months at least
despite a marked incongruency between gender and sex, what other symptoms dsm-5 reuires for dx of gender dysphoria
- desire to be rid of on’e sprimary sex
-desire for primary sex of other gender
-desire to be treated as the other gender
-Conviction that one has they typical feelings & reaction of the other gender
-Marked distress and impairment
main symptoms of GAD in ICD 11
-Apprehension (more than one setting)
-excessive worry
-muscle tension
-sympathetic autonomic overactivity
-subjective exper. of nervousness, restlessness and being on edge
-difficulty concentrating
-Irritability
-sleep disturbances
how hepatic failure affects prescription in mental health?
- reduced ability to metabolize (toxicity and enhanced dose related side effects)
-Reduced ability to synthesize plasma proteins (toxicity of protein bound drugs)
-Reduced hepatic blood flow (elevated levels of drugs subject to first pass)
How long main symptoms of GAD are required to last in ICD 11
Several months
How - reduced hepatic ability to metabolize affects psychotropics
toxicity and enhanced dose-related side effects
how -Reduced hepatic ability to synthesize plasma proteins affects psychotropics
toxicity of protein bound drugs
how - -Reduced hepatic blood flow affects psychotropics
elevated levels of drugs subject to first pass
safe antipsychotics in hepatic impairments
PAS the hepatics:
Paliperidone
Amisulpride
Sulpride
safe antidepressants in hepatic impairment
Sertraline
Citalopram
Paroxetine
Vorioxetine
safe mood stabilizers in hepatic impairment
lithium
safe sedatives in hepatic impairment
LOTZ
Lorazepam
Oxazepam
Temazepam
Zopiclone 3.75 (with care)
photosensitivity & heptaic toxicity are side effect which antidepressant herb?
St John’s wort
St john’s wort drug interactions?
Oral contraceptives
Warfarin
Ciclosporin
HIV drugs
Antiepileptics
potential active compounds in st john’s wort
Hypericin
Hyperforin
flavonoids
NICE stance on st johns wort?
urged not to avoid recommending it (due to issues with dose standardisation)
Maudsley stance on st johns wort?
same as NICE
safety profile of st john’s wort
same side effects as palcebo but do not mix it with other serotonergics to avoid serotonin syndrome
Cochrane revewi 2016 on effectiveness of st john’s wort?
mild to moderate depression ==effective
more effective than placebo
similarly effective to SSRI and TCAs
st john worts - P450 system
CYP3A4
what is KAVA
piper methysticum
what is kava known to be effective for?
sedative and anxiolytic properties
mechanism of action for kava
modulation of gabanergic neurons (like benzo)…
inhibition of voltage gate calcium and sodium channels
meta-analysis support for kava
yes
reduces symptoms of GAD cmpared to placebo
concern about kava
liver damage (hence remains off the recommendation list)
what is saffron suggested to be good for
antidepressant (mild to moderate) [more research required]
what is valerian thought to be good for
anxiety and insomnia (not robustly supported)
typical features for Post-concussion syndrome?
Headache
Fatique
Dizziness
Anxiety & Depression
