psychiatry Flashcards
Depression can be classed into two major categories
Major depression - depressed mood - loss of interest or enjoyment - low self esteem - reduced appetite - interrupted sleep - lack of libido Severe depression - guilt, worthlessness - bleak outlook of life - self-harm and suicidal ideology - psychotic states - self harm voices
How is depression treated
GOLD standard:
psychotherapy and antidepressant medications
Depression is associated with low basal levels of which neurotransmitter
Serotonin (5-HT) which is produced by raphe nuclei in the brainstem it controls
- sleep
- mood
- anxiety
Psychotherapy can take many forms
Just to name a few:
1. psychoanalysis
appropriate for people with insight and who want to take responsibility for their condition
2. behavioural therapy
- teaching, conditioning and desensitisation
3. CBT - cognitive behavioural therapy
involves education and adjusting automatic negative thoughts
4. Counselling (takes many forms)
What is the main predictive factor fro success in psychotherapy
Success is dependant not on type or form of therapy but by who delivers it
Describe various antidepressants
SSRIs - most commonly used, very safe and prevents serotonin reuptake and the synaptic membrane
MAO inhibitors - blocks the enzyme MAO which inactivates 5HT and DA
Mirtazepine - enhances 5HT
Selective noradrenaline reuptake inhibitors
Tricyclic antidepressants (amitriptoline) are not used now (5HT and NE reuptake inhibitors) - they are cardiotoxic and anti-muscarinic
Anxiety
is the most common mental health disorder
(it can appear in all types of mental illness - but not a true manifestation)
- panic disorder
associated with panic attacks and chest pain
- agoraphobia
fear of going into public
- social phobia
fear of social situations
- generalised anxiety disorder
excessive worrying about daily things
- obcessive compulsive disorder
uncontrollable compulsive rituals
- other phobias
irrational or persistent fear of objects or situations
What treatments are available for anxiety disorders
CBT is gold standard in conjunction with:
- educations
- relaxation
- structured problem solving
Medications are not recommended but can be used for sort term tension relief:
benzodiazepines (highly addictive and dependant drug) or SSRIs
Describe benzodiazepines
they are GABA agonists (midazolam = loss of memory, diazepam - insomnia)
- sedative
- hypnotic
- anxiolytic
- anticonvulsant
- muscle relaxant
indications
- ETOH dependance
- anxiety
- seizure
- agitation
short term side effects - depression
long term “ = cognitive impairment
use with care as it can reduce consciousness
Schizophrenia
- low prevalence disorder
- related to dopamine
features: - disturbed thoughts
- disturbed interpersonal relationships
- hallucinations
- progressive functional decline
- symptoms need to be present for 6 months for a diagnosis
- reduced life expectancy
Schizophrenias
- have auditory hallucinations in the third person
- delusions and bizarre ideas
- thought disorder
- they have no insight
Describe the coarse of schizophrenia
- prodrome
depressed mood with odd behaviours - active
psychotic symptoms, behavioural disturbance, catatonia (paralysis can occur) - residual
negative symptoms, blunted affect, impaired function, some psychosis
Treatment of schizophrenia
1. atypical antidepressants (if all fail - then use clozapine) typical antidepressants are avoided as they have extrapyramidal symptoms (tardive dyskinesia, parkinsonism) 2. ECT (catatonia or no response) 3. mood stabilisers 4. antidepressants 5. benzodiazepines 6. psychosocial - low stress and stimulation with support
Describe bipolar disorder
- low prevalance
- commonly underdiagnosed/misdiagnosed
- associated with depression, mania (1 week with functional decline) or hypomania (4 days no functional decline)
mania = irritability, expansive or elevated mood
Bipolar I and Bipolar II
I - one or more episodes of mania + depression
II - one of more episodes of depression + mania (F>M)
