Psychiatry

Question 1

mental disorder

Answer 1

clinically significant disturbance to cognition, emotional regulation, or behaviour
dysfunction in processes underlying mental functioning

important to recognize cultural differences

Question 2

treatment of psychiatric disorders

Answer 2

psychotherapies - address thoughts, behaviours, emotions, and relationships
pharmacotherapies - drugs are often symptom specific
somatic therapies - stimulation of neural circuits

Question 3

depression

Answer 3

major depressive episode - 5 symptoms for 2 weeks
depressed mood, anhedonia
average onset - 25-30
disruptive enough to impair normal function

Question 4

Major depressive disorder

Answer 4

recurrent illness
onset may be sudden or gradual
likely to re-occur

environmental element in addition to genetic vulnerability

Question 5

adverse childhood experiences

Answer 5

negative events that occur in childhood that are associated with increased rates of health conditions

abuse, neglect, environmental exposures

protective factors may mitigate some of the risk - strong protective figure

Question 6

anatomical aspects of major depression

Answer 6

medial prefrontal cortex
hypothalamus and HPA axis
hippocampus

reduced brain volume - impaired neurogenesis

Question 7

monoamine hypothesis of depression

Answer 7

functional deficiency of NE and/or 5-HT at specific synapses in the CNS

disorder of networks - circuits + interactions

involves more NTs and systems

Question 8

anti-depressant treatment

Answer 8

all antidepressants are ~ equally effective - 60-80% response rates

differences are due to side effects and metabolism

treatment for 1+ years to reduce risk of relapse

Question 9

MAO inhibitors

Answer 9

stop breakdown of NTs in synapse = higher concentration

Question 10

tricyclic antidepressants

Answer 10

inhibit the active reuptake of NA and 5-HT back into nerve terminals
increased availability of NTs at central receptors
lots of side effects

Question 11

SSRIs

Answer 11

strong inhibitors of 5-HT reuptake
little effect on NA reuptake
less side effects; safer

Question 12

SNRIs

Answer 12

inhibit the reuptake of 5-HT and NA from synaptic cleft

Question 13

ECT

Answer 13

effective treatment for severe depression
used for treatment-resistant depression, depression with psychotic features

interrupt electrical activity
maintenance - recurring treatment

Question 14

other uses of antidepressants

Answer 14

other disorders: anxiety, eating disorders, personality disorders, chronic pain syndrome

Question 15

anxiety

Answer 15

normal adaptive response - becomes a disorder when it results in dysfunction and personal distress
frequency and severity

very common ~18%

Question 16

panic disorder

Answer 16

unpredictable + recurrent panic attacks
physical symptoms and overwhelming sensations

panic attacks are common ~85% - not disorder in themselves

Question 17

social anxiety disorder

Answer 17

anxiety about social situations → avoidance or exposure = anxiety attacks

Question 18

specific phobias

Answer 18

anxiety from exposure to specific stimulus → avoidance

Question 19

generalized anxiety disorder

Answer 19

excessive anxiety most days for 6+ months

Question 20

neurochemical basis of anxiety disorders

Answer 20

overactivity of neural circuits involved in fight/flight/freeze behaviour
mostly involve serotonergic and noradrenergic synapses

Question 21

anatomy of anxiety

Answer 21

limbic system:
thalamus - sensory interpretation → sends to cortex
amygdala - triggers fear response → sends signals to locus ceruleus and hypothalamus
hippocampus - emotion and memories
locus ceruleus - receives signals from amygdala and sends NA signals to trigger fight/flight response

Question 22

treatment of anxiety disorders

Answer 22

combinations of CBT and medications
meds:
- antidepressants
- benzodiazepines
- b-blockers - block NA flood during fight/flight response

Question 23

benzodiazepines

Answer 23

binding sites on GABA-A receptor - potentiate GABA-mediated increase in chloride permeability

psychological dependence does develop in some patients