PBL 4: The Will to Live Flashcards by Jason Lau

What is a mental state examination?

Tool used by doctors to help make psychiatric diagnoses by evaluating:
Appearance.
- Behaviour.
- Speech and form of thought.
- Mood.
- Thought content.
- Cognition.
- Insight.
- Other psychotic symptoms.
- Perceptions

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What is CBT?

Form of therapy which changes the way you think about situations

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What is citalopram?

SSRI drug used to treat depression (selective serotonin reuptake)

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What is mirtazapine?

NaSSA drug used to treat atypical depression (Noradrenergic and specific serotonergic antidepressant)

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What are S+S of depression?

Very low mood.
 Anhedonia; the inability to enjoy pleasure from activities.
 Self-hatred.
 Insomnia.
 Changes in appetite and/or weight loss.
 Reduced libido.
 Loss of motivation.
 Suicidal thoughts.
 Fatigue.
 Headaches.

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How long must symptoms be present for to diagnose depression?

2 Weeks

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What classifications of depression are there?

Subthreshold
Mild
Moderate
Severe

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Risk factors of depression?

 Older age.
 Unemployed.
 Other mental disorders.
 Drug abuse.
 Low socio-economic status.
 Certain professions.
 Trauma.
 Certain medication.
 Chronic illness.
 Genetics.

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What genetic links are there to depression?

5-HTTLPR gene (serotonin transporter promotor)

CRHR1 - HPA axis gene

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What is unipolar depression

Express only depression - no mania

Usually related to trauma

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What is bipolar?

Express both depression and mania - occurs earlier than unipolar and genetically linked

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What is the monoamine theory?

Depression is associated with decreased aminergic transmission

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What evidence is there for monoamine theory?

5-HTTLPR mutations have a link to depression.
Issues with dopamine transmission have been linked to depression.
Increased MOA activity has also been associated with depression.

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What indicates more complex relationship in monoaine theory?

Antidepressants instantly restore amine levels but take weeks to work

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What is delay of onset of drugs?

Desensitiation of autoreceptors e.g. 5HT1a as over time they will de-sensitize to drugs so will increase their firing rate again

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What do tricyclic antidepressants do?

Inhibit reuptake of serotonin and noradrenaline as well as affecting H1 and A1 receptors

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Give examples of tricyclic antidepressants

Amitrityline
Clomipramine
Imipramine

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Side effects of tricyclic antidepressants?

Dry mouth
Blurred vision
Constipation
Postural hypotension

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What do monoamine oxidase inhibitors do?

Inhibit action of MAO to increase neurotransmitter levels

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What does MAOa do?

Break down serotonin, adrenaline and noradrenaline

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What does MAOb do?

Break down dopamine and tyramine

What are MAOIs linked to?

Cheese effect

Give examples of MAO inhibitors

Phenelzine
Moclobemide
Isocarboxazid
Selegiline

What is the cheese effect?

MAOIs inhibit breakdown of tyramine in gut + liver

What happens if we have high levels of tyramine?

Release of catecholamines e.g. noradrenaline so headaches and hypertensive crisis

What food must be avoided if taking MAOIs?

Food with tyramine | Cheese, cured meats + yeast extracts

What do SSRIs do?

Increase level of serotonin in synaptic cleft

What are side effects of SSRIs?

Nausea GI upset Headaches Increased risk of suicide

What do SSRI drugs include?

``` Citalopram Fluoxetine Fluvoxamine Paroxetine Sertraline ```

What do SNRIs do?

Inhibit reuptake of serotnin and noradrenaline by affecting transporters

What are side effects of SNRIs?

Nausea Headaches Loss of appetite Loss of libido

Give an example of an SNRI

Venlafaxine

What do NaSSAs do?

Block presynaptic A2 adrenergic receptors, h-HT2 and H1 receptors (autoreceptors and heteroreceptors)

What happens if block H1 receptors?

Treat insomnia

Why are NaSSAs preferred?

Specficity

Give an example of an NaSSA

Mirtazapine

What do noradrenaline reuptake inhibitors do?

Block noradrenaline transport to increase noradrenaline levels

What else do noradrenaline reuptake inhibitors do?

Treat ADHD narcolepsy Obesity

Side effects of noradrenaline reuptake inhibitors?

Nausea Headaches Loss of appetite Loss of libido

Give an example of an NRI

Reboxetine

What is atypical treatment?

Lithium

How long should antidepressant drugs be continued for after remission?

6 months

What happens if people stop taking antidepressants?

Discontinuation syndrome

How does antidepressant drug continuation syndrome occur?

Taking medication for at least 4 weeks then stop

Symptoms of discontinuation syndrome?

``` Insomnia Headaches Agitation Anxiety Electric shock sensations Confusion ```

What is CBT?

Cognitive behavioural therapy - changes the way we think about something

What is CVT?

Electroconvulsive therapy - induces seizures via electrical currents

Which lobe is stimulated in CVT?

Frontal (short term) | Temporal (long term)

What is deep brain stimulation?

Subcallosal cingulate gyrus stimulation to improve mood

What are risk factors for suicide in depression?

 Male gender.  Middle aged.  Unemployed.  Divorced.  Low socio-economic status.  Previous suicide attempt.  Mental disorders.

What have serious side effects and are dangerous in overdose?

TCAs and MAOIs