Psychiatric Disease

Question 1

Name some other secondary symptoms of depression

Answer 1

Reduced appetite, sleep disturbance, feeling of hopelessness
Reduced concentration, irritability, reduced libido, risk of self harm, suicide
Can also have psychotic symptoms

Question 2

Name the 3 hypotheses of depression pathophysiology

Answer 2

Mono amine hypothesis (low serotonin, low NA )
Neurotransmitter receptor hypothesis (abnormality in receptors)
Gene expression mono amine hypothesis (molecular functioning)

Question 3

MoA of SSRIs

Answer 3

Block 5HT reuptake at presynaptic so increases 5HT time in synaptic cleft. (Selective)

Question 4

MoA TCAs

Answer 4

Inhibit neurotransmitter reuptake (NA and 5HT)

Blocking of receptors (Muscarinic, a1 adrenergic, histaminic)

Question 5

MoA SNRIs

Answer 5

At low doses, inhibits 5HT reuptake

At high doses, inhibits NA reuptake

Question 6

Describe pharmacokinetics of SSRIs ( and a contraindication)

Answer 6

Once daily dosage as long elimination half life
Well absorbed orally
Metabolised by Cyt P450
Reduce dosage in hepatically impaired

Question 7

Name common ADRs of SSRIs that would normally settle down after 10-14 days

Answer 7

Nausea
Anorexia
Vomiting

Question 8

What is a rare but severe ADR of SSRIs ?

Answer 8

Precipitation of mania

Question 9

TCAs pharmacokinetics

Answer 9

Well absorbed orally
Lipid soluble
Long half life
Liver metabolism, renal excretion

Question 10

Name some ADRs for TCAs

Answer 10

CNS: sedation, autonomic: dry mouth/blurred vision
CVS: increased HR, postural hypotension, severe arrythmias
GI: constipation

Question 11

What is a problem with TCAs ?

Answer 11

Too easy to intentionally OD and cause cardiac problems eg arrythmias

Question 12

SNRIs are second or third line. Why?

Answer 12

All side effects of SSRIs plus increased BP, dry mouth, sleep disturbances etc.
Also, relatively short half life so maya have withdrawal.

Question 13

Define psychosis

Answer 13

Lack of contact w reality

Question 14

Symptoms of paranoid schizophrenia (by symptom category)

Answer 14

Positive- hallucinations, delusions, thought disorders, abn behaviour
Negative- blunted affect, social withdrawal, poverty of thought and speech
Cognitive- selective attention, poor memory, reduced abstract thought
Affective- anxiety and depression

Question 15

What is the most popular theory for pathophysiology of schizophrenia?

Answer 15

Dopamine theory (too much dopamine)
However, this only explains positive symptoms

Question 16

Name the 4 main dopaminergic pathways

Answer 16

Mesolimbic (emotional response and behaviour)
Mesocortical (important in arousal and mood)
Nigrostriatal (key motor pathway damaged in PD)
Tuberoinfundibular (hypothalamus and pituitary)

Question 17

What are the 2 other theories for explaining schizophrenia?

Answer 17

Increased 5HT function
Decreased cortical glutamate

Mechanisms are unclear in both

Question 18

Typical (first gen.) antipsychotics: give an example drug in this class

Answer 18

Haloperidol

Chlorpromazine

Question 19

Atypical antipsychotics: give an example of a drug in this class

Answer 19

Olanzapine, Clozapine

Question 20

Name the core symptoms in depression

Answer 20

Low energy, low mood, anhedonia

Question 21

Actions of all antipsychotics

Answer 21

Sedation and tranquilisation

Question 22

Which class of antipsychotic is less likely to cause extrapyramidal side effects?

Answer 22

Atypical (eg olanzapine)

Question 23

Typical antipsychotics can cause which two specific severe ADRs

Answer 23

EPS- eg tardive dyskinesia

Neuroleptic malignant syndrome (potentially fatal reaction)

Question 24

Give an advantage of typical APs over atypical and a situation in which you would use haloperidol

Answer 24

More sedating (act mainly against positive symptoms)
Haloperidol can be safely used in emergencies

Question 25

Atypical anti psychotics ADRs vary bw drugs, Name possible ADRs

Answer 25

Significant Weight gain ( implications eg CVS risk eg non adherence) Sedation Increased Prolactin Sexual dysfunction

Question 26

Toxicity of anti psychotics can cause

Answer 26

CNS depression ``` Cardiac toxicity (arrythmias) Sudden cardiac death ```

Question 27

MoA typical Antipsychotics (eg haloperidol)

Answer 27

Competitive inhibitors at a variety of receptors | But main anti psychotic effects due to high affinity comp. inhibition of D2 receptors (also probably causes EPS/td)

Question 28

MoA of atypical anti psychotics

Answer 28

Blockade of both 5HT(2) receptors and D2 receptors

Question 29

What symptoms characterise the anxiety disorders?

Answer 29

``` Fear is out of proportion to situation Avoidance Fear dying/going crazy (due to X) Physical fight or flight type symptoms (light headed, SOB, nausea, palpitations, numbness, pins and needles) ```

Question 30

Outline treatment options for anxiety disorders

Answer 30

CBT | Pharmacological only if severe

Question 31

MoA benzodiazepines

Answer 31

full agonist enhancing GABA via GABA-BDZ receptor complex | Increases Cl- in so inhibitory

Question 32

Pharmacokinetics of benzodiazepines

Answer 32

Oral admin. Reaches peak plasma conc within 30-90 mins Highly lipid soluble Long half life Renal excretion

Question 33

ADRs benzodiazepines

Answer 33

Tolerance and dependence (hence short course then not again) Common- drowsy, dizzy, dry mouth

Question 34

Benzodiazepines are toxic in pregnancy. What issues due they cause?

Answer 34

Cleft lip and palate | Resp depression

Question 35

Treatment of benzodiazepine OD

Answer 35

IV flumazenil

Question 36

Name 3 classes of mood stabilisers

Answer 36

Lithium salts Anti epileptics (Atypical anti psychotics)

Question 37

What are some manic symptoms?

Answer 37

Feeling unusually excited/happy/optimistic or irritable Over activity. Reduced concentration and attention span Poor sleep leading to exhaustion Rapid speech, jumping from one idea to another Poor judgement (eg overspending). Increased interest in sex Psychotic symptoms- hallucinations, grandiose delusions

Question 38

Lithium salts ADRs

Answer 38

``` Reduction in memory / concentration Thirst, polyuria Tremor Drowsiness Weight gain ```

Question 39

Lithium salts other systems ADRs

Answer 39

Nephrotoxic | Hypothyroid

Question 40

What monitoring do patients on lithium salts require? (systems ADRs)

Answer 40

Renal excretion - check e GFR | Check thyroid function (thyrotoxic)

Question 41

MoA lithium salts

Answer 41

Theories ``` Competes w electrolytes for channels Neurotransmitter effects (eg Li raises 5HT) Second messenger systems ```

Question 42

Toxic effects of lithium

Answer 42

N&V Coarse tremor Cognitive impairment Agitation/restlessness

Question 43

How can lithium toxicity be managed?

Answer 43

Increase fluids Eg IV fluids Haemodialysis