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SEM3 BIOSCIENCE > PSYCHIATRY > Flashcards

PSYCHIATRY Flashcards

1
Q

how is depression diagnosed?

A

patient health questionnaire 9 based on DSM IV criteria for MDD

5 positive responses = diagnosis of MDD

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2
Q

a positive response to which question on the PHQ-9 triggers an automatic diagnosis of MDD?

A

suicidal ideation

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3
Q

according to the PHQ-9, which two symptoms have to be present (out of 5 in total) to diagnose MDD?

A

anhedonia

depressed mood

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4
Q

what things should be ruled out before reaching an MDD diagnosis?

A

no psychosis (hence bipolar)
not due to a physiological effects of a substance
not accounted for by bereavement

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5
Q

what are the most severe symptoms of depression?

A

psychosis (guilt)
loss of colour vision
catatonic retardation (inability to move)
suicide

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6
Q

are men or women more likely to get depression?

A

women are twice as likely to be depressed than men

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7
Q

from what molecule are catecholamines such as dopamine and noradrenaline synthesised from?

A

tyrosine

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8
Q

from what molecule are indolamines such as serotonin synthesised from?

A

tryphophan

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9
Q

in which region of the brain is noradrenaline synthesised in?

A

locus cerulus of the pons

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10
Q

which region of the brain is serotonin synthesised in?

A

raphe nuclei (brainstem)

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11
Q

which enzyme catalyses the conversion of tyrosine to l-dopa?

A

tyrosine hydroxylase

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12
Q

which enzyme catalyses the conversion of tryptophan to 5-hydroxytryptophan?

A

tryptophan hydroxylase

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13
Q

which enzyme catalyses the conversion of l-dopa and 5-hydroxytryphan to dopamine and 5-hydroxytryptamine (5-HT) respectively?

A

l-aromatic amino acid decarboxylase

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14
Q

what enzymes cause reuptake and degradation of serotonin at the synapse? (2)

A

SERT

MAO-A

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15
Q

what enzymes cause reuptake and degradation of noradrenaline at the synapse? (3)

A

NET
MAO-A
COMT

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16
Q

COMT functions to promote reuptake of which neurotransmitter?

A

noradrenaline

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17
Q

what is the precise function of MAO-A?

A

degrades noradrenaline and serotonin after reuptake in synaptic terminal

n.b. some degradation occurs in synapse

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18
Q

what is the precise function of the NET/SERT proteins?

A

reuptake of noradrenaline and serotonin for recycling/degradation

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19
Q

which subtype of noradrenergic receptor is of most clinical importance in psychiatry? Why?

A

a2 adrenoreceptor

acts through inhibitory G proteins to supress noradrenaline release via negative feedback loop

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20
Q

which antidepressant drug is a a2 adrenoreceptor antagonist?

A

mirtazapine

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21
Q

what is the relationship between synaptic noradrenaline release and synaptic 5-HT release?

A

noradrenaline release causes more 5-HT release

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22
Q

what effect on 5-HT does a1 adrenoreceptor activation have?

A

INCREASES 5-HT

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23
Q

what are the effects of a2 autoreceptor activation on naradrenaline?

A

DECREASES NORADRENALINE

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24
Q

what are the effects of a2 heteroreceptor activation on 5-HT release?

A

DECREASES 5-HT

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25
Q

what are MOA-A inhibitors used to treat?

A

MDD

MAO-A degrades 5HT and NA

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26
Q

what are MOA-B inhibitors used to treat?

A

Parkinsons

MOA-B degrades DOPAMINE

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27
Q

name 1 REVERSIBLE MAO-A inhibitors…

A

Moclobomide

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28
Q

name 2 IRREVERSIBLE MAO-A inhibitors…

A

Phenelzine

Tranylcypromine

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29
Q

name one specific side effect of MAO-A inhibitors

A

Hypertension

patients can’t metabolise monoamines, can lead to hypertensive crisis

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30
Q

How does antidepressant doseage effect drug efficiacy?

A

the higher the dose, the greater the affinity of binding to ALL receptors at the synapse

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31
Q

what is the kindling hypothesis?

A

depressive episodes become more easily triggered over time.

At first, huge stresses will trigger a depressive episode. With time, this stimuli will be need to be smaller in order to trigger

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32
Q

what is considered to be the gold standard of MDD management?

A

effective, individualised ADx treatment

talking therapies/CBT

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33
Q

what is negative cognitive bias?

A

processing of sensory stimuli which negatively impacts sense of self, world view and emotions (aka clinical pessimism)

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34
Q

which neural system is underactive in MDD?

A

DORSAL neural system

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35
Q

which neural system is overactive in MDD?

A

VENTRAL neural system

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36
Q

which region of the brain is responsible for the recognition of facial expression?

A

Amygdala

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37
Q

in depression, the amygdala is ………… and the hippocampus is ………….

A

LARGE

SMALL

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38
Q

low levels of what factor is thought to be responsible for the decrease in hippocampal size in depression?

A

BDNF

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39
Q

according to DSM5 diagnostic criteria, what are the criteria that differentiate BP1 and BP2?

A

psychosis
7 or more days
severely effects work/life
requires hospitilisation

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40
Q

what is the 12 month prevalence of BP1?

A

0.5-1%

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41
Q

what is the 12 month prevalence of MDD?

A

4-5%

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42
Q

what is the mean age of first mood onset for BP1 and BP2?

A

18

mid 20’s

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43
Q

what is the mean age of first mood onset for MDD?

A

late 20’s

44
Q

by how many years is life expectancy reduced in BP?

A

9-20 years (mental!!!)

lifetime suicide risk of bipolar is 15 times that of general population

45
Q

what comorbid conditions are common in BP?

A

anxiety
ADHD
impulse control
drug or alcohol abuse

46
Q

which 3 psychiatric disorders have the highest degree of heritability?

A

bipolar
schizophrenia
autism

47
Q

what would you expect to see after giving MAO-A inhibitors / TCA to a patient with undiagnosed bipolar disorder?

A

precipitation of a manic episode

48
Q

BP1 is genetically linked with which other psychiatric disorder?

A

Schizophrenia

49
Q

BP2 is genetically linked with which of psychiatric disorder?

A

MDD

50
Q

what type of drug should be prescribed is if a patient is experiencing psychotic symptoms associated with a manic bipolar episode?

A

Dopamine D2 receptor antagonists

antipsychotics

51
Q

in terms of dopamine levels in the striatum, what is the difference between bipolar psychosis and SCZ psychosis?

A

BP - Da elevated throughout the striatum

SCZ - Da elevated ONLY in associative striatum

52
Q

What is the role of dopamine dysfunction in psychosis?

A

Da dysfunction is apparent in all forms of psychosis within different disorders

53
Q

what are the three phases of bipolar disorder?

A

mania/hypomania
depression
maintenence (between the two)

54
Q

which drug is effective at treating all three phases of bipolar disorder?

A

Lithium

55
Q

which drugs are effective at treating manic bipolar episodes?

A

lithium
valproate
carbemazepine

56
Q

which drugs should be used to treat depression associated with bipolar disorder?

A

LOW DOSE quetiapine
lithium
lamatrogine

57
Q

which drug is the gold standard for treatment of the maintenance phase of BP?

A

LITHIUM

58
Q

what are the three mechanisms by which valproate is teratogenic?

A

Potent inhibitor of histone deacetylase
Induces oxidative stress
Interference with folate metabolism

59
Q

excluding valproate, which other antipsychotic is unsafe for use in pregnancy?

A

carbemazepine

Increases risk of NTD but DOESN’T increase risk of developmental delay

60
Q

what is the shape of the graph that relates anxiety and arousal?

A

Yerkes-Dodson law

Bell shaped curv

61
Q

what are the 5 symptoms that make up the anxiety diagnostic criteria?

A 
poor concentration
insomnia
muscle tension
fatigue
restlessness

have to have 3 of them for GAD diagnosis

62
Q

what is the diiference between generalised and specific anxiety disorders?

A

generalised anxiety has no environmental cues

63
Q

the symptoms of anxiety are as a result of overstimulation in which endocrine system?

A

autonomic

excessive sympathetic arousal

64
Q

what is the lifetime risk of one suffering from GAD?

A

1 in 20

65
Q

tension headaches are a cardinal sign of GAD. In which muscle is the tension coming from?

A

Frontalis portion of occiptiofrontalis

66
Q

how is GABA synthesised?

A

decarboxylation of glutamic acid

catalysed by glutamic acid decarboxylase

67
Q

what is the mechanism of action of baclofen?

A

GABA B agonist

Used clinically as a muscle relaxant

68
Q

how many GABA molecules bind each GABA receptor? Where do they bind?

A

between alpha and beta subunits

2

69
Q

which is the only 5HT receptor that is not metabotrophic?

A

5-HT3

70
Q

the most common form of the GABA A receptor has how many subunits?

A

2 x alpha
2 x beta
1 x gamma

71
Q

how many transmembrane domains does each of the GABA A receptor subunits have?

A

4 TM domains per subunit

72
Q

in order for the GABA receptor to be BDZ sensitive, what combination of GABA subunit isoforms is needed?

A

alpha 1-3
any form of beta
gamma 2-3

73
Q

what is the function of GABA a receptors with alpha 1 subunits?

A

found in brain regions that regulate sleep

74
Q

what is the function of GABA a receptors with alpha 2-3 subunits?

A

found in brain regions that regulate anxiety

75
Q

what is meant by the following description ‘BDZ’s are PAM’s of the GABA a receptor’

A

benzos are positive allosteric modulators of GABA receptor.

In the presence of GABA their binding keeps the chloride channel open for longer and at increased frequencies

76
Q

between which two subunits on the BDZ insensitive GABA A receptor does alcohol bind?

A

alpha 4-6

DELTA

77
Q

where do barbiturates bind the GABA-A receptor?

A

multiple sites across the receptor- very potent

78
Q

what is alogia?

A

inability to speak due to mental illness

79
Q

what delusions are most common in Scz?

A

delusion of reference

delusion of persecution, control, impossibility

80
Q

what delusions are most common in bipolar?

A

delusion of grandiosity

81
Q

what delusions are most common in depression?

A

somatic
nihilistic
guilt

82
Q

what criteria is used to diagnose Scz?

A

ICD10

83
Q

what is catatonic behaviour?

A

psycho-motor inability to move

84
Q

name the 4 main dopamine pathways in the brain

A

associative + sensorimotor = nigrostriatal pathway
tuberoinfundibular
mesolimbic
mesocortical

85
Q

where is the nucleus accumbens found?

A

ventral striatum of basal ganglia

86
Q

where are the ventral tegmental area and substantia niagra located?

A

midbrain

87
Q

which dopamine receptors are found in the entirety of the striatum?

A

D1 and D2(l+s)

88
Q

which dopamine receptors are in the D1 family?

A

D1 and D5

89
Q

which dopamine receptors are in the D2 family?

A

D2(l+s), D3, D4

90
Q

what is the correlation between dopamine levels in the striatum and risk of Scz?

A

direct correlation- the higher the Da, the higher the risk

91
Q

what is the minimum receptor occupancy needed for D2 antagonists?

A

65%

92
Q

what D2 receptor occupancy produces hyperprolactinaemia?

A

72%

93
Q

what D2 receptor occupancy produces parkinsonian symptoms?

A

80%

94
Q

what is the only true D2 antagonist used to treat scz?

A

Amisulpride

95
Q

which 2 antipsychotics don’t tend to produce EPSE at high doses?

A

Clozapine
Olanzapine

both bind M1 muscarinic Ach receptor, balancing GABA input to the thalamus

96
Q

what is the prevelence of scz?

A

0.4%

97
Q

what is the lifetime risk of Scz?

A

1%

98
Q

what are the chances of monozygotic twins developing Scz?

A

45%

99
Q

what are the chances of developing Scz if both parents have Scz?

A

50%

100
Q

what is the median age of onset for males and females in Scz?

A

26 and 29

101
Q

by how much does Scz risk increase if a first degree relative suffers from it?

A

7%

102
Q

what drugs should be used to treat depressive episodes inbetween psychotic episodes of schizophrenia?

A

Antidepressants e.g. citalopram

103
Q

what is akathisia?

A

feeling of inner restlessness and inability to remain still

antipsychotic side effect

104
Q

how long after taking an antipsychotic would you expect the symptoms to alleviate?

A

2 weeks

105
Q

agranulocytosis is a side effect associated with which antipsychotic?

A

clozapine

106
Q

what percentage of scz patients relapse after their first episode of psychosis?

A

80%

107
Q

what are the three stages of psychosis?

A

prodromal
acute
recovery

SEM3 BIOSCIENCE (13 decks)

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