Psychiatry

Question 1

Recognise and list the main dopamine pathways

Answer 1

Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular

Question 2

Name the psychiatric conditions commonly treated

Answer 2

Depression
Psychoses
Anxiety
Mood disorders - bipolar disorder

Question 3

List the key symptoms of depression

Answer 3

Low mood
Anhedonia
Low energy
>2 weeks

Question 4

Recognise key theories of pathophysiological mechanisms of depression and relate them to pharmacological targets

Answer 4

Monoamine hypothesis - deficiency in monoamine neurotransmitters
Neurotransmitter receptor hypothesis - abnormality in receptor
Monoamine hypothesis of gene expression - deficiency in molecular functioning

Question 5

Describe mechanisms of action of major antidepressant classes

Answer 5

First line = SSRIs e.g. Fluoxetine, Citalopram, Sertraline - limited side effects, long elimination half life
ADRs - anorexia, mania, suicide ideation, extrapyramidal syndromes *sudden cardiac death with citalopram
TCAs e.g. Amitriptiline, Clomipramine - pain relive, lots of side effects, long half life
ADRs - sedation, seizures, autonomic, tachycardia, postural hypotension, constipation
SNRIs e.g. Venlafaxine, Duloxetine
ADRs - withdrawal

Question 6

Recognise key symptoms of paranoid schizophrenia

Answer 6

Delusions, hallucinations, psychosis

Positive and negative symptoms

Question 7

Recognise key theories of pathophysiological mechanisms of depression and relate them to pharmacological targets

Answer 7

Dopamine theory - increased dopamine function

5-HT theory - decreased cortical glutamate function

Question 8

Describe mechanisms of action of major classes of antipsychotics

Answer 8

E.g. Haloperidol, Clozapine, D2 antagonist
Sedation, tranquillisation
Atypical (first line) - fewer extra pyramidal side effects, different preparations
ADRs - EPSE, weight gain, prolactin
Typical - sedating, wide range of action
ADRs - EPSE, neuroleptic malignant syndrome, postural hypotension, weight gain
Toxicity - CNS depression, cardiac toxicity

Question 9

Recognise key symptoms of anxiety

Answer 9

Avoidance
Fear out of proportion of situation
Symptoms of light headedness, SOB, nausea, palpitations

Question 10

Describe the mechanism of action of major classes of anxiolytics

Answer 10

Treat with CBT, antidepressants, anxiolytics
GABA, 5-HT, NA
Benzodiazepines e.g. Diazepam, Lorazepam

Question 11

Understand anxiolytic PKs and ADRs

Answer 11

PKs - full agonist –> increased GABA, lipid soluble, good bioavailability
ADRs - drowsiness, dizziness, GI disturbances, dry mouth

Question 12

How would you treat an overdose of a benzodiazepine?

Answer 12

IV flumazenil

Question 13

List symptoms of bipolar disorder

Answer 13

Depression mania

Question 14

List examples of mood stabilisers and relevant ADRs

Answer 14

Lithium, valproate, carbamazepine, lamotrigine

ADRs - memory loss, thirst, polyuria, tremor

Question 15

Explain why therapeutic monitoring of lithium is important

Answer 15

Nephrotoxic
Narrow therapeutic window
Check renal and thyroid function regularly

Question 16

Describe the terms ‘hallucination’, ‘delusion’ and ‘psychosis’

Answer 16

Hallucination - a perception in the absence of an external stimulus
Delusion - a fixed false belief, not cultural or religious
Psychosis - lack of contact with reality

Question 17

Understand the factors involved in mental illness models

Answer 17

Genetic, biological, psychological, cultural and behavioural factors