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3A REVISION > PSYCHIATRY > Flashcards

PSYCHIATRY Flashcards

1
Q

What is dementia?

A

A clinical syndrome of acquired, progressive usually irreversible global deterioration of higher cortical function in clear consciousness

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2
Q

Name 5 areas of cortical deterioration that can occur in dementia

A 
Memory
Orientation
Language
Comprehension
Judgement
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3
Q

Name 3 coexisting conditions often present with dementia

A

Behavioural problems
Depression/anxiety
Psychosis

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4
Q

When does dementia present?

A

Can be months/years after onset

25% have dementia over 90

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5
Q

What is the cutoff for early onset dementia?

A

Under 65

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6
Q

What is the most common type of dementia?

A

Alzheimer’s dementia, 55% of dementia

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7
Q

What is the onset of Alzheimer’s disease?

A

Gradual with memory loss

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8
Q

Name 3 changes observed in the brain in Alzheimer’s disease

A

Shrunken brain with sulcal widening and enlarged ventricles
Neuronal loss
Neurofibrillary tangles and amyloid plaques

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9
Q

What is the amyloid cascade hypothesis? (4)

A

Alzheimer’s is caused by too much beta amyloid protein production and not enough clearance
Beta amyloid forms amyloid plaques, cleaved from amyloid precursor protein by secretase
Build up also causes Tau dysfunction and neurofibrillary tangle formation
Leads to toxicity, inflammation

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10
Q

What neurotransmitters are deficit in Alzheimers? (3)

A

Acetylcholine
Noradrenaline
Serotonin

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11
Q

What gene mutation is associated with early onset Alzheimer’s?

A

Amyloid precursor protein

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12
Q

What causes Alzheimers? (7)

A 
Age
Low education
Obesity
Depression
Social/physical inactivity
Genes
Hypertension
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13
Q

Give 4 typical symptoms of Alzheimer’s

A

Memory impairment
Dysphasia
Visuo-spatial impairment
Problem solving/reasoning deficits

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14
Q

Treatment of Alzheimer’s?

A

Acetylcholinesterase inhibitors compensate for loss of acetylcholine
NMDA (glutamate) receptor antagonist prevents excitatory neurotoxicity

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15
Q

Name 3 acetylcholinesterase inhibitors

A

Galantamine, donepezil, rivastigmine

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16
Q

Name a NMDA receptor antagonist

A

Memantine

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17
Q

General management of Alzheimer’s? (4)

A

Treat other causes such as infection
Manage psychosis, aggression
Social support/nursing care
Group cognitive stimulation or behaviour management

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18
Q

What is vascular dementia?

A

Focal neurological symptoms appearing in a stepwise manner after strokes, associated with more patchy cognitive impairment than Alzheimer’s

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19
Q

What is mixed dementia?

A

Vascular and Alzheimer’s

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20
Q

What is the pathophysiology of vascular dementia?

A

At least one area of the brain infarcted on CT

9 times risk of dementia in year after stroke

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21
Q

Risk factors for vascular dementia? (4)

A

Hypertension
High cholesterol
Diabetes
Smoking

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22
Q

Symptoms of vascular dementia? (4)

A

Depends on area of brain affected
Stepwise cognitive impairment, memory decline
Behavioural and affective changes
Motor changes - hemiparesis, bradykinesia, ataxia

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23
Q

What is dementia with Lewy bodies?

A

Dementia associated with the presence of Lewy bodies and neurites in the basal ganglia and cortex

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24
Q

Symptoms of dementia with Lewy bodies? (5)

A 
Fluctuating cognition and alertness
Vivid visual hallucinations
Spontaneous Parkinsonism
Sensitivity to antipsychotics
Sleep disorder
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25
Q

What is the link between dementia and Parkinson’s?

A

25% of people with Parkinson’s will develop dementia

80% still alive after 20 years will have dementia

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26
Q

How is Parkinsons dementia differentiated from dementia with Lewy bodies?

A

If Parkinson’s precedes the dementia by >1 year, it is Parkinson’s dementia - i.e. motor symptoms first

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27
Q

What are the two types of Lewy body dementia?

A

Dementia with Lewy bodies

Parkinson’s dementia

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28
Q

How is dementia with Lewy bodies treated?

A

Cholinesterase inhibitors (rivastigmine)
Possibly memantine
Caution with antipsychotics as high sensitivity
Social care, therapy

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29
Q

What is frontotemporal dementia?

A

Characterised by early personality changes and relative intellectual changes, with a younger mean age of onset

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30
Q

Pathological changes in frontotemporal dementia?

A

Affects frontal and temporal lobes
Loss of spindle neurons
Ubuquitin or tau positive inclusions

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31
Q

Symptoms of frontotemporal dementia? (5)

A 
Changes in behaviour and conduct
Loss of social awareness
Poor impulse control
Impaired comprehension
Difficulty with speech production
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32
Q

Treatment of frontotemporal dementia?

A

Cholinergic systems not affected so can’t use AD drugs
SSRIs may help disinhibition/impulses
Social care/therapy

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33
Q

What is normal pressure hydrocephalus?

A

Excess fluid accumulation in the ventricles without much increase in pressure overall, but may have local pressure effects

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34
Q

What causes normal pressure hydrocephalus? (4)

A 
Idiopathic
Subarachnoid haemorrhage
Head injury
Meningitis
all cause expansion of lateral cerebral ventricles
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35
Q

Symptoms of normal pressure hydrocephalus? (4)

A

Marked mental slowness
Apathy
Wide based gait
Urinary incontinence

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36
Q

Name a local affect of increased pressure in normal pressure hydrocephalus

A

Traction on frontal and limbic fibres surrounding the ventricles

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37
Q

Treatment of normal pressure hydrocephalus?

A

Ventriculoperitoneal shunt to drain fluid into abdomen

May only improve symptoms in some, has complications

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38
Q

What is Creutzfeldt-Jakob disease?

A

Fatal brain disorder - 90% die in 1 year, onset around 60

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39
Q

What causes Creutzfeldt-Jakob disease?

A

Prion proteins - misfolded proteins that can disrupt normal proteins, causing cell disruption and death
Mostly spontaneous

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40
Q

What is a non spontaneous cause of Creutzfeldt-Jakob disease?

A

Eating beef infected with bovine spongiform encephalopathy, mainly affects younger people

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41
Q

Early symptoms of Creutzfeldt-Jakob disease? (3)

A

Minor lapses of memory
Mood changes
Apathy

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42
Q

Later symptoms of Creutzfeldt-Jakob disease? (8)

A 
Clumsiness
Decreased coordination
Slurred speech 
Jerky, involuntary movements
Weakness
Dementia
Incontinence
Coma
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43
Q

Treatment for Creutzfeldt-Jakob disease?

A

None, opioids for pain, clonazepam for movement

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44
Q

What is Huntington’s disease dementia?

A

Dementia occurring at any stage of the progressive, inherited Huntington’s disease

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45
Q

Symptoms of Huntington’s disease dementia? (7)

A 
Abnormal movements and coordination (Huntington's)
Mood problems
Cognitive impairment
Difficulty with planning/organisation
Difficulty concentrating
Short term memory loss
Obsessive behaviour
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46
Q

How does Huntington’s disease dementia differ from Alzheimer’s dementia?

A

Recognition of people and places is intact until the very late stages

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47
Q

Treatment for Huntington’s disease dementia?

A

None for the dementia

Anti-depressants

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48
Q

What is HAND?

A

HIV Associated Neurocognitive Disorder, affects up to 50% of HIV patients

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49
Q

What causes HAND?

A

Either by HIV directly damaging the brain or the weakened immune system enabling other infections to damage to brain

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50
Q

(5) Symptoms of HAND?

A 
Difficulties with memory
Thinking and reasoning difficulties 
Decision making difficulties
Learning difficulties
Mood problems
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51
Q

Treatment of HAND?

A

At least 3 antiretrovirals, prevents cognitive impairment worsening - may reverse it
Rehabilitation

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52
Q

What is neurosyphilis?

A

Infection of the brain/spinal cord caused by Treponema pallidum, usually occurs in chronic untreated syphilis 10-20 years after first infection

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53
Q

Symptoms of neurosyphilis? (8)

A 
Blindness
Confusion
Personality change
Memory loss
Depression
Mood disturbance
Psychosis, visual disturbance
Seizures
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54
Q

How is neurosyphilis treated?

A

Penicillin - early diagnosis critical

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55
Q

What is Wilson’s disease?

A

Genetic disease where copper builds up in the body, symptoms related to liver and brain begin anytime from 5-35

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56
Q

Symptoms of Wilson’s disease? (7)

A 
Itching, vomiting, oedema (liver)
Dysarthria
Personality changes
Tremors
Visual/auditory hallucinations
KAISER FLEISCHER RINGS - dark rings circling iris
Impaired judgement
Mild cognitive deterioration - slow thinking, memory loss
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57
Q

What causes Wilson’s disease?

A

Autosomal recessive disorder caused by mutation in the Wilson disease protein gene (ATP7B)

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58
Q

Treatment of Wilson’s disease? (4)

A

Low copper diet, avoid copper cookware
Chelating agents - trientine, d-penicillamine
Zinc supplements
Liver transplant if severe

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59
Q

What are the two types of dementia?

A

Cortical and subcortical

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60
Q

Where to cortical and subcortical dementias affect?

A

Cortical - cerebral cortex

Subcortical - basal ganglia, thalamus

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61
Q

Types of cortical and subcortical dementias?

A

Cortical - Alzheimer’s, frontotemporal, possibly vascular

Subcortical - Parkinson’s, Huntington’s, AIDS dementia, alcohol related dementia

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62
Q

Symptoms of cortical dementias? (4)

A

Memory impairment
Dysphasia
Visuospatial impairment
Problem solving and reasoning deficits

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63
Q

Symptoms of subcortical dementias? (7)

A 
Psychomotor slowing
Impaired memory retrieval
Depression
Apathy
Executive dysfunction
Personality change
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64
Q

What is delirium?

A

Acute confusional state characterised by the rapid onset of a global but fluctuating dysfunction of the CNS due to an underlying infectious, vascular, epileptic or metabolic cause

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65
Q

How common is delirium?

A

Occurs in 1/3 of patients admitted to hospital, increases mortality and morbidity

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66
Q

Diagnosis of delirium? (5)

A

Impaired consciousness and attention + perceptual disturbance + cognitive disturbance + acute onset and fluctuating + evidence of physical cause

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67
Q

Types of delirium?

A

Hypo and hyperactive

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68
Q

Symptoms of delirium? (9)

A 
Fluctuating mood
Irritability, confusion, distraction
Apathy and depression
Transient persecutory, self referential delusions
Sweating, tachycardia, dilated pupils
Visual hallucinations
Memory loss
Incoherent speech
Day drowsiness, evening alertness
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69
Q

Risk factors for delirium? (7)

A 
Over 65
Dementia or Parkinson's
Hip fracture
Illness
Infection
Hypoxia
Low B12/folate
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70
Q

Differences between delirium and dementia? (4)

A

Delirium is more rapid onset
Delirium is more fluctuating course
Delirium has clouded consciousness
Delirium has vivid, complex thoughts and hallucinations

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71
Q

Investigations of delirium? (6)

A 
Ask about premorbid personality
Drugs/alcohol screen
Look for trauma
Bloods - FBC, inflammatory markers, U+E, LFT, TFT, calcium, B12/folate
MSU
CXR, Head CT/MRI
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72
Q

Management of delirium? (5)

A 
Identify and treat underlying pathology
Short term antipsychotic or benzodiazepine
Maximise orientation and hydration
Reduce constipation
Reduce polypharmacy
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73
Q

What is frontal lobe syndrome?

A

Damage to the prefrontal regions of the frontal lobe, characterised by deterioration of behaviour and personality

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74
Q

Cause of frontal lobe syndrome? (6)

A 
Head injury
Stroke
Infection
Tumour
Frontotemporal dementia
Genetics
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75
Q

Symptoms of frontal lobe syndrome? (6)

A 
Lack of spontaneous activity
Trouble with speech
Loss of concentration
Preserved memory but apathy
Loss of abstract thought
Perseveration
Can be withdrawn or uninhibited - mood change
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76
Q

Investigations of frontal lobe syndrome?

A

To find cause - e.g. brain imaging, inflammatory markers

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77
Q

Management of frontal lobe syndrome? (4)

A

Supportive care
Supervision if risky
Respite care
Therapy e.g. speech and language

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78
Q

What are complex partial seizures?

A

Focal onset seizures, most common type in adult epilepsy, begin in one side of the brain - often frontal or temporal - and may produce impaired awareness

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79
Q

How is depression related to complex partial seizures?

A

Can occur in pre-ictal and ictal phases
More common post-ictal
Very common inter-ictal

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80
Q

How is psychosis related to complex partial seizures?

A

Rare pre-ictal
Can occur during a seizure or post ictal
Can develop inter-ictally, especially if temporal lobe

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81
Q

Symptoms of psychosis in complex partial seizures?

A

Similar to schizophrenia - delusions, depressive/manic psychosis, visual hallucinations

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82
Q

How are psychotic features of epileptic seizures treated?

A

Antipsychotics with least effect on seizure threshold - haloperidol

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83
Q

How is cognitive impairment related to epileptic seizures?

A

Common due to medication or persistent abnormal brain supply

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84
Q

What psychiatric symptoms can occur in hyperthyroidism? (3)

A

Depression and anxiety
Irritability, apathy
Psychotic depression

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85
Q

What psychiatric symptoms can occur in hypercortisolaemia (Cushing’s)? (2)

A

Depression

Mania

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86
Q

What psychiatric symptoms can occur in hypocortisolaemia (Addison’s)? (2)

A

Depression

Apathy

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87
Q

What psychiatric symptoms can occur in hypopituitarism? (3)

A

Depression
Irritability
Impaired memory

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88
Q

What psychiatric symptoms can occur in phaeochromocytoma?

A

Episodic anxiety

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89
Q

What psychiatric symptoms can occur in hypothyroidism, hyperparathyroidism, and primary hypoparathyroidism? (6)

A 
Depression and anxiety
Acute agitation, emotional lability
Apathy
Hallucinations after parathyroidectomy
Dementia
Delirium
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90
Q

What is psychosis?

A

Misinterpretation of thoughts and perceptions that arise from the patient’s mind as reality, including delusions and hallucinations

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91
Q

What are the first rank symptoms of schizophrenia?

A

Delusional perception
Thought interference (insertion, withdrawal, broadcast)
Passivity phenomena (inc. somatic)
Auditory hallucinations

92
Q

What are the second rank symptoms of schizophrenia? (5)

A 
Persecutory delusions
Delusions of reference
Persistent hallucination of any modality
Neologisms or other thought disorder/disorganised speech
Negative symptoms
93
Q

How is a diagnosis of schizophrenia made?

A

One first rank symptom or one of persecutory delusions and delusions of reference
Or two of the other second rank symptoms
Persisting for at least 1 month

94
Q

When is the peak incidence of schizophrenia?

A

Late teens/early adulthood

95
Q

What are positive symptoms of schizophrenia? (3)

A

Delusions, hallucinations, formal thought disorder

96
Q

What are negative symptoms of schizophrenia? (5)

A 
Poverty of speech
Flat affect
Poor motivation
Social withdrawal
Lack of concern for social conventions
97
Q

What are cognitive symptoms of schizophrenia? (2)

A

Poor attention

Memory loss

98
Q

What is paranoid schizophrenia? 2 symptoms

A

The most common type of schizophrenia with persecutory delusions and auditory hallucinations prominent
Often lack of negative symptoms

99
Q

What is hebephrenic schizophrenia? 4 symptoms

A

Often early onset and poor prognosis
Characterised by irresponsible, unpredictable behaviour, innapropriate mood and incongruous affect - giggling, odd mannerisms
Incoherent thoughts, fleeting delusions and hallucinations

100
Q

What is residual schizophrenia? 2 symptoms

A

When there has been a history of another type of schizophrenia and in the current illness, negative and cognitive symptoms predominate

101
Q

What is catatonic schizophrenia? 4 symptoms

A

Uncommon
Psychomotor disturbances prominent, often alternating between stupor and excessive activity
Rigidity, posturing, waxy flexibility
Echolalia and echopraxia

102
Q

What is simple schizophrenia?

A

Uncommon

Negative symptoms without overt/preceding psychosis

103
Q

What causes schizophrenia? (4)

A

Genetics - first degree relative, advanced paternal age
Neurodevelopmental problems
Social factors
Neurochemical changes

104
Q

What is the neurodevelopmental hypothesis?

A

Factors interfering with early development of the brain increase schizophrenia risk

105
Q

Give 5 examples of the neurodevelopmental hypothesis

A 
Winter births (foetus flu exposure)
Obstetric complications/perinatal injury
Developmental delay/mild neuro symptoms
Temporal lobe epilepsy
Cannabis use when young
Childhood abuse or bullying
106
Q

What findings (2) on brain imaging in schizophrenia supports the neurodevelopmental hypothesis?

A

Increased ventricle size

Loss of grey matter

107
Q

Give 4 examples of social factors predisposing to schizophrenia

A

Socioeconomic deprivation
Urbanity
Negative life events e.g. bereavement
Family being overbearing

108
Q

What neurochemical changes are present in schizophrenia?

A

Final common pathway involves dopamine excess (overactivity in mesolimbic dopaminergic pathways), raised serotonin, decreased glutamate

109
Q

What is the treatment of schizophrenia? (4)

A

Antipsychotics for positive symptoms, to prevent relapse
If agitated, IM antipsychotic or benzodiazepine
CBT and family therapy
Social support and rehabilitation

110
Q

Name 3 typical antipsychotics

A

Haloperidol
Chlorpromazine
Supiride

111
Q

What is the major side effect of typical antipsychotics?

A

Motor problems - extrapyramidal symptoms

112
Q

Name 5 atypical antipsychotics

A 
Olanzapine
Quietapine
Risperidone
Amisulpiride
Clozapine
113
Q

What are 2 side effect of atypical antipsychotics?

A

Weight gain and diabetes

114
Q

How can adherence of antipsychotics be improved?

A

Monthly depot injections if do not adhere to oral

115
Q

How long should an antipsychotic be trialled before changing?

A

4-6 weeks

116
Q

When can clozapine be used?

A

When at least one typical and one atypical antipsychotic have been used without success

117
Q

What side effects of antipsychotics need to be monitored? (2)

A

Clozapine - blood tests to check for granulomatosis

Monitor ECG for increased QT syndrome in all

118
Q

How long after a psychotic episode should antipsychotics be continued?

A

1-2 years
5 years if further episode
High risk of relapse if stopped within 6 months

119
Q

What is acute and transient psychosis?

A

Psychosis lasting less time than needed for schizophrenia diagnosis - <1 month, group of disorders

120
Q

Symptoms of acute/transient psychosis? (5)

A 
Acute onset 
Delusions
Hallucinations
Perceptual disturbance
Disruption of normal behaviour
121
Q

How is acute and transient psychosis treated?

A

Usual spontaneous resolution, may be associated with acute stress
If persists treat as it is schizophrenia

122
Q

What is persistent delusional disorder?

A

Fixed, unshakeable delusion with other areas of thinking and function preserved

123
Q

What are the symptoms of persistent delusional disorder?

A

Long standing delusion

No hallucinations etc, no evidence of brain disease

124
Q

Treatment of persistent delusional disorder?

A

Psychotherapy - challenging beliefs

May be reluctant to medication - try antipsychotics

125
Q

What is schizoaffective disorder?

A

Affective and schizophrenic symptoms occur together with equal prominence, doesn’t justify either schizophrenic or depressive/manic diagnosis

126
Q

What are the types of schizoaffective disorder?

A

Manic, depressive, mixed

127
Q

How is schizoaffective disorder treated? (5)

A 
Antipsychotics - paliperidone
Mood stabilisers
Antidepressants
Psychotherapy and group therapy
Possible ECT
128
Q

What is puerperal psychosis?

A

Psychosis affecting women after childbirth, usually within 2 weeks of birth

129
Q

Symptoms of puerperal psychosis? (4)

A

Hallucinations
Delusions
Mania/depression
Confusion

130
Q

What is the treatment of puerperal psychosis? (CBT)

A

Antipsychotics
Antidepressants
Mood stabilisers
CBT

131
Q

Cause of puerperal psychosis? (3)

A

Traumatic pregnancy or birth
Family history
Previous schizophrenia/mood diagnosis

132
Q

What is bipolar disorder?

A

Disorder characterised by recurrent episodes of altered mood and activity, involving both upswings and downswings

133
Q

What are the 4 types that individual episodes can be in bipolar disorder?

A

Manic
Hypomanic
Depressive
Mixed

134
Q

What is hypomania?

A

Less severe form of mania causing less disruption to life, without psychotic symptoms

135
Q

What is a mixed episode in bipolar disorder?

A

Both manic and depressive, rapid cycling

136
Q

How is bipolar disorder diagnosed?

A

After at least 2 episodes, at least one of which is hypomanic/manic

137
Q

What are the 2 main types of bipolar disorder?

A

I - manic and depressive episodes

II - recurrent depressive episodes and hypomania

138
Q

What is mania?

A

Alteration in mood, usually elated and expansive but can also be irritable, with increased energy and activity

139
Q

Give 5 symptoms of mania

A

Distractibility
Decreased need for sleep
Disinhibited - risky sexual or financial behaviour, dangerous driving
Heightened senses
Rapid thinking and speech - pressure of speech, flight of ideas

140
Q

What psychotic symptoms can occur in mania?

A

Mood congruent delusions

Auditory hallucinations

141
Q

When does bipolar usually present?

A

Peak in early 20s and lesser peak around 50

142
Q

What is the cause of bipolar disorder? (6)

A

Genetic
Hypothalamic-pituitary-adrenal and thyroid axes implicated
Psychological stress in childhood inc. abuse
Sleep disturbance
Postpartum
Severe physical illness/bereavement - life event

143
Q

How does psychological stress in childhood increase risk of bipolar?

A

Psychological stress leads to hypothalamic-pituitary-adrenal dysfunction and hypersensitivity to stress

144
Q

How is mania treated? (5)

A 
1st line haloperidol, olanzapine, quietapine, risperidone
2nd line lithium - better long term
Benzodiazepines short term/rapid tranq.
Psychotherapy
Physical monitoring - renal for lithium
145
Q

How is depression in bipolar disorder treated?

A

Antidepressants but only with a mood stabiliser as may precipitate rapid cycling, stop at start of a manic episode

146
Q

What is cyclothymia?

A

Chronic mood fluctuations over at least 2 years, with episodes of depression and hypomania of insufficient severity to meet bipolar diagnosis
May progress to bipolar

147
Q

How is cyclothymia treated? (2)

A

Lithium

Psychotherapy

148
Q

What is dysthymia?

A

Persistent depressive disorder, lasting for over 2 years interfering with daily life, usually does not go away for more than 2 months at a time
Major depressive episodes may be concurrent

149
Q

Risk factors for developing dysthymia?

A

Family history
Life trauma
Negative personality

150
Q

How is dysthymia treated?

A

Antidepressants

Psychotherapy

151
Q

What is depression?

A

Common illness that negatively affects thoughts, feelings and actions
Characterised commonly by lowering of mood, loss of energy, loss of enjoyment in activity that was previously enjoyable

152
Q

What is the classic triad of depressive symptoms?

A

Anhedonia
Low mood
Anergia

153
Q

How is depression diagnosed?

A

At least two of anhedonia/anergia/low mood present for 2 weeks

154
Q

Other symptoms of depression apart from the classic triad? (9)

A 
Reduced concentration
Flat affect
Low confidence/self esteem
Guilt, worthlessness, hopelessness
Decreased sleep
Decreased appetite
Reduced motor activity
Thoughts of self harm
Low libido
155
Q

How is depression classified?

A

Mild/moderate/severe
Depending on how many symptoms, how severe, degree of distress and impact on daily life
Depression with psychosis is always severe

156
Q

What is Beck’s triad?

A

Thoughts in depression often include negative thoughts about self, the world and the future

157
Q

What are the biological symptoms of depression? (3)

A

Decreased sleep
Decreased appetite
Decreased libido

158
Q

What is the typical sleep pattern in depression?

A

Early waking, maximal low mood in morning

159
Q

What psychotic features occur in depression? (5)

A 
Mood congruent
Nihilistic delusions
Delusions of guilt
Hypochondriacal delusions
Auditory, usually 2nd person hallucinations condemning the person or urging them to self harm
160
Q

Who is most at risk of depression?

A

Women, onset usually in 20s

161
Q

Causes of depression? (7)

A 
Possibly genetic
Monoamine neurotransmitter loss
Dysfunctional limbic system and prefrontal cortex
Psychosocial factors
Treatment with recombinant interferons
Severe illness
Medications i.e. isotrenoin
162
Q

How might antidepressants work on the monoamine neurotransmitters?

A

Serotonin, noradrenaline levels are reduced in the synaptic cleft in depression
Antidepressants increase availability
This results in secondary neoplastic changes that bring about antidepressant effect i.e. produce more brain derived neurotrophic factor promoting neurogenesis

163
Q

What are some psychosocial factors implicated in depression? (4)

A

Recent life trauma
Adverse social circumstances
Low socioeconomic class
Childhood bereavement, abuse

164
Q

How might psychosocial factors lead to depression?

A

Stress leads to increased cortisol which may cause low mood due to decreased brain derived neurotrophic factor

165
Q

How is mild depression managed? (5)

A 
In primary care
Treat any physical illness, substance misuse
Self help groups
Physical activity
CBT or IPT if mild
166
Q

When are patients with depression referred to psychiatric services? (5)

A 
High suicide risk
Severe illness
Unresponsive to treatment
Recurrent depression
Bipolar
167
Q

How is moderate or severe depression treated?

A

As mild depression but add antidepressants

At least 6 months, tapered when stopped

168
Q

What are SNRIs? Name 2

A

Serotonin noradrenergic reuptake inhibitors
Venlafaxine
Duloxetine

169
Q

What are SSRIs? Name 4

A 
Selective serotonin reuptake inhibitors - most common 
Gluoxetine
Citalopram
Sertraline
Paroxetine
170
Q

What is mirtazepine and 3 side effects?

A

Noradrenergic and specific serotenergic antidepressant

Dry mouth, drowsy, weight gain

171
Q

Name 2 tricylic antidepressants

A

Amitriptyline

Imipramine

172
Q

What are MAOIs? Name 2

A

Monoamine oxidase inhibitors
Phenelzine
Tranylcypromine

173
Q

How do antidepressants generally work?

A

Increasing neural transmission of monoamines - serotonin, noradrenaline

174
Q

How do SSRIs and SNRIs work?

A

Inhibit reuptake of neurotransmitters from the synaptic cleft
2nd messengers from monoamine binding to post synapse increase production of BDNF
This increases neuroplasticity and neurogenesis in the hippocampus

175
Q

How do MAOIs work?

A

Inhibit breakdown of neurotransmitters

176
Q

Side effects of tricyclic antidepressants?

A

Increased CV mortality (arrhythmias) so SSRIs safer in overdose

177
Q

Side effects of SSRIs and SNRIs? (5)

A

Initial agitation
Headache, nausea, anxiety
May increase suicidal ideation (except fluoxetine)

178
Q

Management if resistant to antidepressants? (2)

A

Augment with lithium, atypical antipsychotic or another antidepressant
ECT if severe especially with psychosis or stupor

179
Q

Why is effective treatment important in the initial depressive episode?

A

Recurrent episodes tend to be more severe and shorter disease-free periods if not treated effectively first time

180
Q

What are post partum blues?

A

Normal low mood, affect 30-50% of women after childbirth

181
Q

Symptoms of post partum blues? (4)

A

Emotional lability
Crying
Irritability
Worried abot coping

182
Q

Cause of post partum blues?

A

Elevated prepartum progesterone, big postpartum fall in oestrogen and progesterone implicated

183
Q

How is post partum blues treated?

A

Self resolving within a few days usually

Reassure and ensure supported

184
Q

How common is postpartum depression and when does it occur?

A

10-15% of new mothers, mainly first week but can be up to the first year after birth

185
Q

Symptoms of post partum depression? (5)

A 
Similar to depression but also:
Guilt/anxiety over the baby
Feeling inadequate
Unreasonable fears
Reluctance to feed or bond
Possible feelings of harming the baby
186
Q

Risk factors for postpartum depression? (5)

A 
History of depression
Low socioeconomic class
Single mother
Lack of support
Traumatic birth
187
Q

How is postpartum depression treated?

A

Psychotherapy

Antidepressants if needed - risk when breastfeeding to baby

188
Q

Why is it important to recognise and treat postpartum depression?

A

Prolonged maternal depression may affect later social and cognitive development of the child

189
Q

What is suicide?

A

Intentional self inflicted death

190
Q

Epidemiology of suicide?

A

8/100,000 annually
More men than women
Especially middle aged men

191
Q

What is self harm?

A

Intentional non fatal self inflicted harm

192
Q

Epidemiology of self harm?

A

3/1000 annually
More women than men
Mostly young women

193
Q

Causes of suicide and self harm? (4)

A

Availability of means
Lack of social support
Traumatic life events
Mental illness

194
Q

What mental illnesses predispose to self harm/suicide? (5)

A 
Depression
Schizophrenia
Substance misuse
Emotionally unstable/antisocial  PD
Eating disorder
195
Q

3 further causes of suicide?

A

Chronic painful illnesses
Family history of suicide
Decreased brain derived neurotrophic factor at postmortem

196
Q

3 further causes of self harm?

A

Unemployed
Divorce
Socioeconomic deprivation

197
Q

What are the 3 types of suicide?

A

Altruistic - for the good of society
Anomic - reflects a society’s disintegration, loss of common values
Egoistic - an individual’s separation from otherwise cohesive social groups

198
Q

Suicide prevention strategies? (5)

A 
Detect and treat psychiatric disorders
Respond to risk
Prescribe safely
Manage self harm well
Reduce availability of means
199
Q

2 most common types of self harm?

A

Overdose

Physical self injury - cutting

200
Q

Management of self harm? (6)

A 
Medical stabilisation
Psych assessment 
Decrease risk of repitition - address psych illness or social problems
Prescribe lower lethality drugs
Psych therapy, self help groups
Dialectical behaviour therapy
201
Q

4 motivators for self harm?

A

Interruption of a sequence of events
Attention
Communication attempt
Wish to die

202
Q

What needs to be established in a psych assessment of self harm/suicide attempt? (6)

A 
Motives
Psych illness
Planning - leaving a note, will, attempt not to be found
Mode of harm
Social history
History of self harm
203
Q

What are the 3 categories of psychological therapy?

A

Supportive therapies
Cognitive and behavioural therapies
Psychodynamic psychotherapies

204
Q

What is group therapy?

A

Emphasises interrelationships within the group where problems are shared

205
Q

What is family therapy?

A

Systemic or behavioural - improved family functioning will improve patient

206
Q

What is CBT?

A

Cognitive behavioural therapy, helps to identify and challenge automatic negative thoughts and to modify underlying core beliefs

207
Q

When is CBT used? (5)

A 
Depression
Anxiety
Eating disorders
Personality disorders
Psychosis
208
Q

What are behavioural therapies?

A

Based on operant conditioning - positive reinforcement of desirable behaviours, withholding reinforcement if negative

209
Q

What are behavioural therapies used for?

A

Phobias
Tourette’s
Eating disorders

210
Q

What are psychodynamic therapies?

A

Unstructured, helps with long standing problems, based on psychoanalytic principles - therapist interprets what the patient says and makes links

211
Q

What is transference and counter transference?

A

Transference - patient experiences strong emotions with the therapist
Counter-transference - therapist experiences strong emotions toward the patient

212
Q

What is interpersonal therapy IPT and used for?

A

For depression, eating disorders

Focusses on interpersonal - close relationships and problems

213
Q

What is dialectical behaviour therapy DBT and used for?

A

Borderline PD! Esp. self harm

Incorporates CBT, and group skills training for alternative coping strategies

214
Q

What is eye movement desensitisation and reprocessing EMDR and used for?

A

PTSD
Aims to help patients access and process traumatic memories to resolve them
Recall the trauma while focussing on an external stimulus

215
Q

What is ECT?

A

Electroconvulsive therapy, by electric current through electrodes to brain uni or bilaterally temporal

216
Q

How does ECT work? (5)

A

Induces a modified cerebral seizure, causing neurotransmitter release, hormone secretion, synapto and neurogenesis, increase in blood brain barrier permeability

217
Q

Indications for ECT? (3)

A

Severe depression
Prolonged/severe/unresponsive mania
Catatonia
When all other treatments failed or if high risk

218
Q

Side effects of ECT?

A

Cognitive impairment
Dysarrhythmias
Headache

219
Q

What are the most commonly used anxiolytics?

A

Benzodiazepines

220
Q

Indications for anxiolytics? (4)

A

Insomnia
Short term for anxiety
Alcohol withdrawal
Control of violence

221
Q

Effects of anxiolytics? (3)

A

Sleep inducing
Anticonvulsant
Muscle relaxant

222
Q

Commonly used hypnotics?

A

Zopiclone, zolpidem

223
Q

How is benzodiazepine overdose treated?

A

Flumenazil

224
Q

What is methylphenidate?

A

Stimulant, used for ADHD (ritalin)

225
Q

Other indications for antidepressants? (5)

A 
Phobias
PTSD
Generalised anxiety
Bulimia
OCD

3A REVISION (17 decks)

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