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BRS 1b > psychiatry > Flashcards

psychiatry Flashcards

1
Q

what is delirium

A

a psychiatric manifestation of a physical illness

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2
Q

a stroke in which part of the brain causes post stroke psychosis

A

right middle cerebral artery, affecting the frontal and temporal lobes

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3
Q

common symptoms of post stroke psychosis

A

delusions of a persecutory or jealous type
auditory or visual hallucinations

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4
Q

the 2 types of perception abnormalities

A

altered perception - distorted internal perception of a real external object
false perception - internal perception without a real external object: hallucination

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5
Q

how does a critical illness cause delirium

A

critical illness causes increase in cortisol and cerebral hypoxia
which causes decrease in acetylcholine and dysfunction of hippocampus or neocortical areas (increase in dopamine and adrenergic responses)

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6
Q

why should antipsychotics not be used in those w with dementia

A

they increase the risk of stroke

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7
Q

what is the mortality gap

A

those with chronic mental illnesses are more likely to experience all round mortality
because they
may experience side effects from drugs
may be more likely to smoke, drink, take drugs
may have poorer diet or exercise
may have lower socioeconomic status

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8
Q

contrast the selectivity and adverse effects of citalopram and amitriptiline and what kind of drugs are they

A

serotonin reuptake inhibitors

amitriptiline
- trycyclic structure
- less selective
- many adverse side effects due to histamine and noradrenaline receptor blockade

citalopram
- selective
- adverse affects solely due to increase in serotonin

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9
Q

contrast the selectivity and adverse effects of haloperidol and clozapine and what kind of drugs are they

A

antipsychotics

clozapine
- non selective
- many adverse effects eg weight gain, metabolic syndrome, sedation

haloperidol
- very selective
- few adverse effects

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10
Q

what is alprazolam

A

a GABA A positive allosteric modulator

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11
Q

what is Baclofen

A

a GABA B agonist

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12
Q

positives and negatives of psychedelic treatment

A

+
non addictive
low psychological and brain toxicity
good therapeutic index

-
dysphoria
anxiety
nausea
headache
false memories

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13
Q

name the 2 main effects of psychedelic treatment

A

psychological peak
mystical type experience

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14
Q

give some indirect evidence for the monoamine deficiency hypothesis

A
  • low levels of 5HT3 in post mortem brains of those who had committed suicide
  • antihypertensive drugs which decrease monoamines can cause depression
  • high levels of monoamine oxidase A associated with MDD
  • high levels of 5HT3 receptors associated with low mood
  • low levels of tryptophan (a type of monoamine) associated with MDD relapse
  • clinically useful antidepressants all increase synaptic monoamine concentrations
  • monoamine depletion correlates with decrease in mood
  • depression related traits are associated with increase in 5-HT2A-receptor
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15
Q

what is the monoamine deficiency hypothesis

A

the hypothesis that depressive symptoms are caused by low levels of monoamine neurotransmitters such as serotonin, norepinephrine, dopamine

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16
Q

which method was used to find direct evidence of low serotonin in living brains of those who are depressed

A

do a PET scan of brain with an agonist radioligand (11C - CIMBI - 36)
then give a pharmacological challenge (amphetamine) which will stimulate release of serotonin
then do PET scan again
subtract the densities of each PET scan from, eachother to show how much serotonin was able to be released

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17
Q

what are the 3 biases seen in depression

A

attention bias - can’t disengage/move attention away from negative things, coordinated by anterior cingulate cortex (ACC)

memory bias - more likely to remember negative memories

perceptual bias - amygdala is more stimulated when see negative faces compared to happy ones

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18
Q

which antidepressants help to decrease recognition of anger/fear

A

noradrenergic + serotinergic antidepressants

19
Q

contrast heritability and insight in bipolar vs unipolar (MDD) disorder

A

insight
unipolar > bipolar

heritability
bipolar > unipolar

20
Q

what are the core symptoms of depression

A

anhedonia
anergia
low mood

21
Q

what are the 3 main domains of MDD

A

atypical features - increased sleep/appetite, heightened mood reactivity
melancholic features - no mood reactivity, anhedonia, psychomotor retardation
psychotic features - hallucinations, delusions

22
Q

what are the main biological symptoms of depression

A

sleep
appetite
libido

23
Q

contrast a mania vs hypomania episode

A

mania
- last at least a week
- severe symptoms
- functional impairment

hypomania
- lasts at least 4 days
- mild to moderate symptoms
- no functional impairment

but if there are psychotic symptoms or the pt is hospitalised, its mania no matter how long the symptoms lasted

24
Q

what is unspecified bipolar disorder

A

lasts less than 4 days or doesn’t reach specific thresholds for mania / hypomania

25
Q

DSM diagnosis of depression

A

at least 2 weeks of low mood + 4/8 of the following

  • appetite alterations
  • sleep alterations (insomnia / hypersomnia)
  • anhedonia
  • anergia
  • guilt
  • suicidal thoughts
  • impaired concentration
  • pyshcomotor changes (agitation / retardation)
26
Q

why is it important to differentiate between unipolar and bipolar disorder before treating

A

if you give antidepressants thinking it’s unipolar but its actually bipolar disorder
- can cause acute manic/hypermanic episodes
- can cause mood episodes
- can worsen long term course of bipolar illness

27
Q

give some organic/iotrogenic causes of depression

A
  • endocrine
  • systemic illness: infection, SLE, cancer
  • neurological conditions: parkinsons, MS, alzheimers
  • deficiencies: B12, folic acid
  • medications
  • vascular depression: due to white matter hyperintensities which make the individual more vulnerable to stressors
  • post stroke depression: the more frontal the lesion, the more severe the symptoms
28
Q

what can you see in examination of an opioid addict

A

collapsed veins / track marks
endocarditis
skin abscesses
hepatitis/ hiv
pneumonia

29
Q

what can you see in examination of an alcohol addict

A

jaundice
clubbing
oedema
spider naevi
bruising
ascites

30
Q

what is given for opioid overdose

A

naloxone (narcan)

31
Q

what is taken for opioid abstinence

A

methadone
buprenorphine

32
Q

what is taken for alcohol abstinence

A

acamprosate

33
Q

what is seen in alcohol withdrawal

A

delirium tremens
- tremor
- anxiety
- hallucinations
- disorientation

34
Q

3 main diagnostic criteria for dependance syndrome (fulfilment of only one is sufficient for diagnosis)

A
  • lack of control over substance misuse
  • increasing precedence of substance use over other aspects of life
  • physiological signs of neuroadaption to the substance
35
Q

how does alcohol cause anxiolysis (a level of sedation in which a person is very relaxed and may be awake)

A

increased neurotransmission at GABA-A receptor

36
Q

how does alcohol cause reward

A

increased dopamine release in mesolimbic system

37
Q

how does alcohol cause amnesia

A

inhibits NMDA-mediated glutamate release

38
Q

what is somatisation

A

maladaptive functioning of an organ system without underlying tissue or organ damage
or where the symptoms are disproportionate to the underlying structural cause

39
Q

why are responses in highly emotional situations different for children compared to adults

A

pre frontal cortex has not yet fully developed in children
so the more matured limbic and reward systems will take over and affect behaviour more strongly than the immature prefrontal cortex

40
Q

environmental risk factors for ADHD

A

low birth weight
premature birth
prenatal smoking exposure

41
Q

contrast mild, moderate and severe dementia

A

mild
- can live independently but need help with some tasks
- seem normal to people who haven’t met them before
- can still take part in community activites
- cannot make complex plans/decisions

moderate
- can only do simple household tasks, need help functioning outside the house
- difficulty carrying out activities of daily living
- significant memory loss
- people around them can usually tell
- social judgment is impaired
- difficulty socialising and communicating with others

severe
- completely dependent on others
- fully disorientated in terms of time and place
- completely unable to make decisions
- urinary and faecal incontinence

42
Q

what is the triad of ADHD

A

inattention
hyperactivity
impulsivity

43
Q

behavioural and psychological disturbance of dementia

A

apathy
sleep changes
mood changes
agitation
aggression
irritability
hallucinations
delusions

44
Q

what clinical examination is done for dementia

A

MMSE - mini mental state exam

BRS 1b (10 decks)

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