Psychiatry Flashcards
What is psychiatry?
Disorders of mood, thought and behaviour with no/few physical signs and no visible pathology.
What is functional psychiatry?
Disorders that have a psychological cause e.g. Depression, anxiety, phobias, schizophrenia, bipolar disorder.
What is organic psychiatry?
Illness caused by disease affecting the brain e.g. Dementia, Parkinson’s, Huntington’s, stroke, epilepsy.
What is a psychiatric diagnosis based on today?
Symptoms and presentation (ICD-10) can be used.
What is anxiety?
A feeling of worry, nervousness or unease about something with an uncertain outcome.
What is the anxiety-performance curve?
Some anxiety/stress is need in order to increase performance, but too much stress can lead to decreased performance.
Which structures make up the limbic system?
Hippocampus
Hypothalamus
Amygdala
What is the function of the limbic system?
- memory
- emotion
- arousal
Describe the limbic-hypothalamic-pituitary-adrenal axis.
Limbic system stimulates hypothalamus to produce CRF (corticotropin releasing factor), pituitary releases ACTH (adrenocorticotropic hormone) and adrenal glands produce cortisol.
What is the function of cortisol?
Involved in stress and anxiety.
What is general adaptation syndrome?
The body’s response to stress.
What are the 3 stages of general adaptation syndrome?
1) alarm reaction - noradrenaline is released
2) resistance - cortisol is released which has a longer lasting action and allows maintenance of the stress response
3) exhaustion - continued cortisol secretion due to prolonged stress can lead to muscle wastage and immune suppression
State some symptoms of anxiety.
- sweating
- palpitations
- trembling
- difficulty breathing
- chest pain/discomfort
- nausea
What is generalised anxiety disorder?
When someone is always anxious.
What is thought to cause anxiety?
Thought that there are decreased GABA levels in the cortex, causing hyperactivity and panic.
What is pregabalin and what is it used for?
- GABA analogue (mimicks GABA)
- used for anxiety treatment and as a painkiller
Name 2 SSRIs.
Fluoxetine
Sertraline
What can SSRIs be used for?
Anxiety, depression or OCD.
What is the MOA of SSRIs?
Serotonin selective reuptake inhibitors - increase the amount of serotonin in the synaptic cleft.
What is the MOA of benzodiazepines? What are they used for?
Increase GABA transmission.
Can be used to treat anxiety.
What is significant about stopping benzodiazepines?
They are addictive, therefore shouldn’t be used long-term. This means that you can’t stop them suddenly as the withdrawal effects can be fatal - patient needs to be weaned off.
What is an obsession?
A thought that persists and dominates an individuals thinking despite them knowing that it is entirely without purpose and useless.
What is a compulsion?
An act that someone does to try and cancel out their obsession.
What is the diagnostic criteria for OCD?
Obsessions/compulsions/both present on most days for a period of at least 2 weeks.
What is thought to cause OCD?
- re-entry circuits in the basal ganglia
- reduced serotonin
What is PANDAS?
Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection.
Sudden onset of OCD symptoms or tics after infection with Group-A-beta haemolytic strep - antibodies react with neurones.
What is the treatment for PANDAS?
- ABX
- CBT
What causes post-traumatic stress disorder?
Hyperactivity of the amygdala, causing an exaggerated response to perceived threat.
Also decreased cortisol levels (cortisol inhibits traumatic memory retrieval).
What is PTSD?
Post-traumatic stress disorder, occurs within 6 months of a traumatic event of exceptional severity.
What is complex PTSD?
Has similar symptoms to PTSD, but there was no exceptional trauma that occurred. There is often a history of abuse.
What is the treatment for PTSD?
- medication e.g. SSRIs
- CBT
- EMDR (eye movement desensitisation reprocessing) - asked to recall things whilst watching a moving object
What are the 3 core symptoms of dementia?
- low mood
- lack of energy
- lack of enjoyment/interest
How is depression diagnosed?
2/3 of the core symptoms present continually for 2 weeks.
What is a normal adjustment reaction?
Can happen after a traumatic or difficult event, but is not the same as clinical depression.
State some differences between an adjustment reaction and clinical depression.
Adjustment reaction - sudden onset, energy not low, reduced or increased appetite.
Clinical depression - gradual onset, low energy, loss of appetite and weight loss, early morning waking, low self-esteem.
What is the difference between mania and hypomania?
Mania - when someone has an elevated mood.
Hypomania - lower level of mania.
How long do symptoms have to be present for before diagnosing mania?
1 week
What are grandiose behaviours?
Inflated self-esteem, a symptom of mania.
What is bipolar disorder?
Condition that causes people’s mood to swing from one extreme to the other - episodes of depression and mania.
How is a diagnosis of bipolar disorder made?
At least 2 episodes of mood disorder, where at least one is hypomania or mania - this means that you can have bipolar disorder without ever having had depression.
What are the 2 types of bipolar disorder and which is more severe?
Bipolar 1 - more severe, episodes of mania.
Bipolar 2 - milder, no mania, only hypomania, can’t have psychotic symptoms.
Name some physical illnesses that can cause depressive symptoms.
- thyroid dysfunction
- liver disease
- kidney disease
What are the main neurotransmitters related to mood?
Serotonin
Dopamine
Noardrenaline
Where is serotonin produced?
In the raphe nuclei in the brainstem - is then transported to the limbic system and cortex.
What is thought to cause depression?
Tryptophan depletion (precursor of serotonin).
Which mood disorders have a genetic link?
Most of them - depression, schizophrenia, bipolar disorder.
Name some predisposing factors for depression.
- genetic
- being female
- poor childhood experiences e.g. Abuse
Name some perpetuating factors for depression.
- stressful job
- relationship breakdown
- substance misuse
- studies
Name some precipitating factors for depression.
Life events related to loss:
- loss of a loved one
- loss of health
- relationship breakdown
Name 2 mood stabilisers.
Lithium
Sodium valproate
How long do SSRIs take to work?
Take a few days to work, but patients are told that it takes 6 weeks, as it takes this amount of time for mood to start improving (symptoms such as energy may improve before this, mood is one of the last things to improve).
What is quetiapine?
Antipsychotic drug
What is electroconvulsive therapy?
A last resort that can be used to treat depression if nothing else has worked.
What are SNRIs?
Serotonin-norepinephrine reuptake inhibitors.
What medication is used to treat bipolar disorder?
NOT anti-depressants as they are not effective and tend to make it worse. Instead, use mood stabilisers such as lithium, sodium valproate or carbamazepine, or antipsychotics such as quetiapine.
When prescribing medication for depression, what should you always ask?
Whether they’ve ever had a manic period before - to ensure that they don’t have bipolar disorder.
What is psychosis?
The presence of hallucinations or delusions.
What are hallucinations?
Perception without a stimulus e.g. Auditory, visual
What are hypnogogic hallucinations?
Hallucinations that are normal and experienced when going to sleep.
What are hypnopompic hallucinations?
Hallucinations that are normal and are experienced when waking up.
What are delusions?
Abnormal, unshakeable beliefs that are outside of cultural norms e.g. You think you are God/Jesus.
What is organic psychosis?
When psychotic symptoms are caused by problems with the brain e.g. Infection, drug or alcohol intoxication, encephalitis.
What is post-octal psychosis?
Psychotic symptoms following an epileptic fit.
What is schizophrenia?
A long-term mental health condition that causes many different psychological symptoms, including psychotic symptoms.
Name some first rank symptoms of schizophrenia.
- thought withdrawal, thought broadcast or though insertion
- auditory hallucinations
- passivity experiences (believes an action/feeling is caused by an external force)
- delusional perceptions (when something happens and being convinced that this means something else is going to happen)
- somatic hallucinations (feeling like you’re being touched when you’re not)
- lack of insight - don’t believe they are unwell
What are positive and negative schizophrenic symptoms?
Positive - added symptoms e.g. Delusions, hallucinations.
Negative - removed symptoms e.g. Underactivity, low motivation, withdrawal, self-neglect.
What are the brain changes seen in schizophrenia?
Enlarged ventricles
Reduced hippocampal formation
What is thought to cause schizophrenia?
Underactive mesocortical pathway
Overactive mesolimbic pathway
Hyperactive nigrostriatal pathway
Increased dopamine leads to psychotic symptoms
What is the autoimmune hypothesis for schizophrenia?
When anti-NMDA encephalitis causes schizophrenia, often due to an underlying tumour (most commonly an ovarian teratoma). Can be diagnosed by checking anti-NMDA antibodies.
What medication is given for schizophrenia?
- typical antipsychotics e.g. Haloperidol, chlorpromazine
- atypical anitpsychotics e.g. Quetiapine
What is the MOA of antipsychotic drugs?
Block D2 receptors, blocking mesolimbic and mesocortical pathways. Atypical antipsychotics have a lower affinity for D2 receptors than typical antipsychotics.
What is catatonic schizophrenia?
When someone with schizophrenia experiences stupor or rigidity for more than 2 weeks - unable to speak, respond or even move. Caused by less GABA binding, therefore loss of inhibitory effect.
What is the treatment for catatonic schizophrenia?
Lorazepam
What is drug induced psychosis?
Psychotic symptoms induced by a psychoactive substance e.g. Spice, black mamba, cocaine, methamphetamine, cannabis.
What is affective psychosis?
When the type of psychotic experience matches the patient’s mood e.g. Someone with mania may have grandiose delusions as they have an elevated mood, someone with depression may have delusions of guilt as they have a depressed mood.
