Psychiatry Flashcards
What are the core symptoms of depression?
- Low mood → varies little day-to-day, unresponsive to circumstances
- Anhedonia → reduced/little interest in most activities that were formally enjoyable
- Anergia → lack of energy, increased fatigability on minimal exertion.
What are the biological (somatic) symptoms of depression?
- Early morning wakening
- Insomnia
- Depression worse during morning → diurnal mood changes
- Loss of appetite with weight loss
- Reduced libido
- Cognitive
For a diagnosis to be made of depression, what factors (ie, not just the symptoms) must be present?
- Symptoms must be present for >2 weeks
- Symptoms are not attributable to other organic or substance causes → eg, normal bereavement
- Symptoms impair daily function & cause significant distress
What are the first line antidepressants? What are their common side effects & contraindications?
SSRIs - Sertraline, fluoxetine citalopram
- Common side effects → GI disturbance, loss of appetite, insomnia, sweating, increased risk of suicide. Initially for first couple of weeks, then generally improves.
- Contraindications → mania, poorly controlled epilepsy, long QTc for citalopram
What antidepressant is first line in patients struggling with eating & sleep? What are the side effects & contraindications?
Mirtazapine
- Side effects → increased appetite, weight gain, sedation, headache
- Contraindications → mania, < 18 years old
How is moderate generalised anxiety disorder managed (or mild which has failed to respond to 1st line treatments)?
- SSRIs → initially increase anxiety & agitation but will then improve
- SNRI second line → venlafaxine
- Propranolol → often used to treat the physical symptoms of anxiety, but is only short acting & does not help with the underlying anxiety.
- Benzodiazepines → stimulate GABA receptors which has a relaxing effect on the brain. However prolonged used can lead to tolerance & dependence.
How are phobias managed?
- CBT
- Exposure therapy
- SSRIs → particularly for agoraphobia & social phobia
- Benzodiazepine if appropriate → eg, before a flight or going to the dentist.
What effect does alcohol have on the brain?
- Alcohol is a depressant → stimulates GABA receptors which have a relaxing effect on the brain.
- Alcohol also inhibits glutamate receptors, causing a further relaxing effect on the electrical activity of the brain. Glutamate is an excitatory neurotransmitter.
- Long-term use results in the GABA system becoming down-regulated & the glutamate system becoming up-regulated to balance the effects of alcohol.
- If the patient stops drinking at this point, they will experience unpleasant & dangerous withdrawal symptoms.
What is the criteria for someone to be diagnosed with substance dependence?
In order to diagnose someone with substance dependence, they must have 3 or more of the following criteria present in the past year:
- Strong desire or compulsion to take the substance
- Difficulty in controlling substance-taking behaviour → onset, termination, levels of use
- Persistence despite awareness of physical or mental harm
- Priority given to the substance, with neglect of other interests & activities due to time spent acquiring & taking the substance, and recovering from its effects.
- Increased tolerance → where increased quantities of the substance are required to produce the same effect originally produced by lower amounts.
- Physiological withdrawal state when substance use has reduced or ceased → or continued use to relieve/avoid symptoms
What symptoms can develop during alcohol withdrawal?
- 6-12 hours → tremor, sweating, headache, craving, anxiety/agitation, nausea & vomiting
- 12-24 hours → hallucinations (visual, auditory, or tactile)
- 24-48hrs → seizures
- 1-7 days → delirium tremens (most common after 48hrs)
What is delirium tremens & how does it present?
- = a life-threatening condition characterised by a rapid onset of confusion often precipitated by alcohol withdrawal.
- Present 1-7 days after alcohol cessation (48hrs average)
- Presentation of DTs:
- Acute confusion
- Severe agitation
- Delusions & hallucinations
- Tremor
- Ataxia
- Autonomic arousal → heavy sweating, tachycardia, hypertension, fever
What are the symptoms of Wenicke’s Encephalopathy?
Wernicke encephalopathy tetrad → acute confusion, ataxia, nystagmus, opthalmoplegia
What 2 questionnaires are used to assess a person’s dependence on alcohol?
CAGE/AUDIT questionnaire
What is asked during a CAGE questionnaire?
C- do you ever think you should Cut down?
A - do you get Annoyed at others commenting on your drinking
G - do you ever feel Guilty about drinking
E - Eye opener, do you ever drink in the morning to help your hangover or nerves?
When is assisted alcohol withdrawal required?
If the patient is drinking >15 units per day or those scoring >20 on the AUDIT questionnaire
