PSYCH 123 Depression Flashcards
What defines mild depression?
2 core symptoms + 2 others
What defines moderate depression?
2 core symptoms +3/4 others
What defines severe depression?
Core symptoms are severe and 4 others that are intense. Can be +/- psychotic symptoms
What is step 1 of the stepped care model for management of depression?
Assessment and signposting
For who would step 2 of the stepped care model for managing depression apply? How would you manage?
Those with persistent sub-threshold symptoms of mild/moderate depressions
Manage with self help e.g. CBT
What would you start/implement if there are inadequate responses to interventions?
Antidepressants and high intensity psychological intervention.
Where are neurotransmitters synthesized?
Neurones
Where are most neurotransmitters located (excluding endocannabinoids)?
In the presynaptic terminal
What happens when there is prolonged stimulation at Glutamate receptors?
Hyper-excitability: seizures and strokes
What happens when Glutamate receptors are blocked and give an example of what they are commonly blocked by?
Sedation
Alcohol and Ketamine
What Glutamate receptors are permeable to both Calcium and Sodium?
Kainate and NMDA
What glutamate receptor is only permeable to Sodium?
AMPA
What is the main inhibitory neurotransmitter in the nervous system?
GABA
What drugs activate GABA receptors?
Benzodiazepines, lorazepam and alcohol
What happens when GABA receptors are blocked?
Hyper-excitability
What do astrocytes do?
Act as support cells or for damage repair
What do oligodendrocytes do?
Myelinate nerve cells
What are microglia?
Macrophages of the nervous system
What do ependymal cells make and where are they found?
They make CSF and are epithelial cells lining the ventricles
Where are the cell bodies of the neurones that make serotonin?
In the raphe nucleus
Where is serotonin stored in the GI tract and what does its release trigger?
Enterochromaffin cells and triggers peristalsis
Name a drug that activates and another that blocks the 5HT2A receptor.
Activates: LSD
Blocked by: clozapine - an atypical antipsychotic
What is sumatriptan and what receptor does it activate?
It is a migraine treatment and activates 5HT1B
What is the only serotinergic ionotropic receptor and name a drug that blocks it
5HT3 and is blocked by ondanseton an antiemetic
Name a contraindication in the prescription of SSRI’s
Under 18 ( increased risk of suicide),
Name briefly the mechanism of action of SSRI’s and give an example of two
They inhibit the synaptic reuptake of serotonin.
Citalopram and fluoxetine
Name an SNRI
Tramadol or sibutramine
Name a specific cardiac complication with citalopram
Prolonged QT interval
Name some side effects of SSRI’s
Hyponatraemia, nausea, anaemia, GI distrubances, loss of libido
In the cholinergic system where do the basal forebrain cholinergic neurones project to? What processes are they involved in?
The cortex and hippocampus.
Memory and cognition
Where do the cholinergic neurones of the basal stem tegmenteum project to and what are they involved in?
Thalamus, brainstem and cerebellum
Arousal and the sleep wake cycle
What two classes of receptor are there in the cholinergic system?
Nicotinic (ionotropic and excitatory) and Muscarinic (metabotropic)
Name disorders that are to do with dopamine
Schizophrenia, Parkinsons and Tourrettes
Where is noradrenaline made?
locus coerulus
Name a tricyclic antidepressant
Amitryptilline, butryptilline
How do TCA’s work?
Inhibit reuptake of NT (NA) by competing for binding at the presynaptic neurone
Name some anti-muscarinic side effects of TCA’s
blurred vision, dry mouth, constipation and urinary retention
Name some side effects as a result of blocking the alpha-1 receptor
Postural hypotension, tachycardia, ventricular dysrhythmias and prolonged QT interval
Name some contraindications of TCA prescription
prostatism, narrow angle glaucoma, recent MI, heart block
Where are endogenous opioids made and where do they project?
Hypothalamus –> peri-aqueductal grey and brainstem
Name the 3 classes of opioids
Enkephalins, Dynorphins and endorphins
