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MBChB Final Exam Essentials > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are mood disorders?

A

Disorders of mental status and function where altered mood is the major feature

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2
Q

List three important mood disorders

A

Depression
Mania
Bipolar disorder

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3
Q

A useful mnemonic for the diagnosis of depression is DEADSWAMP. It outlines the major depression criteria.

A 
Depression
Energy (low)/Fatigue  
Anhedonia
Death thoughts (self-harm or suicide) 
Sleep (insomnia or hypersomnia
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4
Q

Depression can be transient (not abnormal) or it can be the principal sign of an abnormal mood disorder. How do psychiatrists determine abnormal depression from normal variation in emotion?

A

Psychiatry emphasises:

  1. Persistence of symptoms
  2. Pervasiveness of symptoms
  3. Degree of impairment
  4. Presence of specific symptoms or signs ( other diagnostic features)
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5
Q

Symptoms of depression occur in three distinct categories. List some psychological symptoms

A

Change in mood: Depression, anxiety, perplexity, anhedonia

Change in thought content: guilt, hopelessness, worthlessness, delusions/hallucinations

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6
Q

Symptoms of depression occur in three distinct categories. List some physical symptoms

A

Change in bodily function: energy, sleep, appetite, libido, constipation, pain

Change in psychomotor function: agitation, retardation

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7
Q

Symptoms of depression occur in three distinct categories. List some social symptoms

A 
Loss of interests 
Irritability 
Apathy 
Withdrawal 
Loss of confidence 
Indecisiveness 
Loss of concentration/memory
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8
Q

What is the definition of agitation?

A

A state of restless overactivity, aimless ineffective

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9
Q

What is the definition of anhedonia?

A

Loss of ability to derive pleasure from experience

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10
Q

What is the definition of apathy?

A

Loss of interest in own surroundings

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11
Q

What is the definition of anxiety?

A

An unpleasant emotion in which thoughts of apprehension or fear predominate

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12
Q

What is the definition of depression?

A

An unpleasant emotion in which sadness or unhappiness predominates

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13
Q

What is the definition of retardation?

A

A slowing of motor responses including speech

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14
Q

What is the definition of stupor?

A

A state of extreme retardation in which consciousness is intact.

The patient stops moving, speaking, eating and drinking.

On recovery can describe clearly events which occurred whilst
stuporous

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15
Q

Outline the general criteria for the diagnosis of depression

A

Symptoms lasting for at least two weeks

No episodes of mania/hypomania in lifetime

Not attributable to psychoactive substance or organic mental disorder

Exclusion of psychotic disorders e.g. schizophrenia

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16
Q

What is somatic syndrome?

A

A form of depression with a predominance of physical symptoms (e.g. loss of appetite, weight loss, loss of libido, anhedonia, psychomotor retardation/agitation

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17
Q

How is the severity of depression characterised?

A

General criteria with additional major and minor criteria

Mild depression requires general criteria, two major criteria and four minor ones.

Moderate requires additional two more criteria

Severe requires all criteria to be met

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18
Q

List some differential diagnoses of depression

A 
Normal reaction to life event
Bipolar
Hypothyroidism
Addison's disease
Infections (infectious mononucleosis, hepatitis, HIV/AIDS)
Drugs
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19
Q

How is depression treated?

A

Antidepressants - SSRIs, TCAs, MAOIs
Psychological treatments - CBT, IPT
Physical treatments - ECT, Psychosurgery, DBS

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20
Q

List some tools for measuring/screening for depression

A

SCID (Structured interview for DSM Disorders)

SCAN (Schedules for clinical assessment in neuropsychiatry)

HDRS (Hamilton Depression Rating Scale)

BDI-II (Beck Depression Inventory-II)

HADS (Hospital anxiety and depression scale)

PHQ-9 (Patient health questionaire-9)

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21
Q

What is mania?

A

A term used to describe a state of feeling, or mood, that can range from near-normal to severe and life-threatening illness

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22
Q

How is mania measured?

A

SCID (Structured interview for DSM Disorders)

SCAN (Schedules for clinical assessment in neuropsychiatry)

YMRS (Young Mania Rating Scale)

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23
Q

How is mania treated?

A

Antipsychotics (olanzapine, risperidone, quetipine)

Mood stabilisers (sodium valproate, lamotrigine, carbamazepine)

Lithium

ECT

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24
Q

What is bipolar disorder?

A

A disorder consisting of repeated episodes of depression and mania/hypomania

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25
Q

How long does the typical major depression episode last for?

A

4-6 months

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26
Q

What percentage of major depressive patients recover at 26 weeks?

A

54%

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27
Q

What percentage of major depression patients don’t recover?

A

12%

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28
Q

What percentage of major depression patients go on to have another episode?

A

> 80%

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29
Q

What percentage of major depressive patients die y suicide?

A

15%

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30
Q

Outline cognitive behavioural therapy

A

Short-term, problem-based and goal orientated therapy which looks at the relationship between thoughts and feelings and how these affect behaviour.

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31
Q

Outline behavioural activation therapy

A

Focuses on avoided activities. Patients are taught to analyse unintended consequences of their way of responding.

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32
Q

Outline interpersonal therapy

A

Useful for the treatment of depression and anxiety

Focuses on an area(s) where the depressive symptoms link to an interpersonal event(s) - works to reduce symptomology

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33
Q

Outline motivational interviewing

A

Promotes behaviour change in a wide range of healthcare settings

Used where behaviour change is being considered, when a patient may be unmotivated or ambivalent to change

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34
Q

Outline the five stages of change

A
  1. Pre-contemplation - no desire to change
  2. Contemplation - thinking about change
  3. Planning/determination - options for change/building confidence
  4. Action - implement strategies
  5. Maintenance - coping strategies, address weak points etc.
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35
Q

List some indications for the prescription of antidepressants

(5)

A 
Unipolar/bipolar depression
Organic mood disorders
Schizoaffective disorders
Anxiety disorders (OCD, panic, social phobia) 
Premenstrual dysphoric disorder
36
Q

How long does it take for antidepressants to improve symptoms?

A

Delay of two to four weeks after the therapeutic dose is achieved before symptoms improve

37
Q

What is the indicated course of antidepressants after a first depressive episodes?

A

6 months to a year

38
Q

What is the indicated course of antidepressants after a second depressive episodes?

A

2 years

39
Q

What is the indicated course of antidepressants after a third depressive episodes?

A

Lifelong

40
Q

List the classes of antidepressants

A

Tricyclics (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Selective Serotonin Reuptake Inhibitor (SSRIs)
Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
Novel agents

41
Q

Why are tricyclic antidepressants not first line?

A

Unacceptable side effect profile (long QT) and can overdose lethally with a one week supply

42
Q

What are the two different types of tricyclic antidepressant?

A

Tertiary and secondary TCAs

43
Q

What is the action of monoamine oxidase inhibitors?

A

Bind irreversibly to monoamine oxidase. Thereby preventing the activation of amines such as norepinephrine and dopamine.

44
Q

What are MAOIs particularly useful for?

A

Treating resistant depression

45
Q

List some side effects of MAOIs

A 
Orthostatic hypotension 
Weight gain
Dry mouth 
Sexual dysfunction 
Sleep disturbance
46
Q

What can occur if MAOIs are taken concurrently with tyramine rich foods/sympathomimetics

A

Cheese reaction - a hypertensive crisis

47
Q

What is serotonin syndrome?

A

A reaction that can occur when taking multiple serotinergic drugs (e.g. MAOIs) causing abdominal pain, diarrhoea, tachycardia and hypertension.

Can ultimately lead to CVS shock, hyperpyrexia and death

48
Q

What is the action of SSRIs?

A

Block the presynaptic serotonin reuptake

49
Q

List some side effects of SSRIs

A 
GI upset
Sexual dysfunction
Anxiety
Restlessness
Nervousness
Insomnia
50
Q

What is it important to warn a patient of before they start SSRIs?

A

Activation syndrome (acute increase in serotonin)

Lasts 2-10 days

Causes nausea, increased anxiety, panic and agitation

51
Q

What is the risk when stopping SSRIs?

A

Discontinuation Syndrome - causes agitation, nausea, disequilibrium and dysphoria

More common in shorter half life drugs

52
Q

List some examples of SSRIs

A

Fluoxetine
Citalopram/escitalopram
Sertraline
Fluvoxamine

53
Q

What are the pros and cons of choosing fluoxetine in the treatment of depression?

A

Pro - long half-life therefore low risk of discontinuation syndrome

Con - contraindicated in liver disease due to active metabolites and P450 interactions

54
Q

What are the pros and cons of choosing citalopram in the treatment of depression?

A

Pro - low P450 inhibition, therefore, fewer drug interactions

Con - QT prolongation and both sedating/GI side effects

55
Q

What are the pros and cons of choosing sertraline in the treatment of depression?

A

Pro - short half-life

Con - commonly causes GI upset

56
Q

What are the pros and cons of choosing escitalopram in the treatment of depression?

A

Pro - more effective than citalopram in acute response and remission induction

Con - QT prolongation

57
Q

What are the pros and cons of choosing fluvoxamine in the treatment of depression?

A

Pro - shortest half-life (can be pro or con)

Con - GI distress, headaches, sedating

58
Q

What is the action of SNRIs?

A

Inhibit both serotonin and noradrenaline reuptake (like TCAs) but dont have any anti-histamine, androgenic and cholinergic effects

59
Q

Give two examples of SNRIs

A

Venlafaxine

Duloxetine

60
Q

List some examples of novel antidepressant agents

A

Mirtazapine

Buproprion

61
Q

What are the current indications for novel antidepressant agents?

A

Good for augmentation adjunct to SSRI/SNRI therapy

62
Q

Treatment-resistant depression is common. What therapies are indicated in this case?

A

Combination of SSRI/SNRI with mirtazapine
Adjunctive treatment with lithium
Adjunctive treatment with atypical antipsychotic e.g. olanzapine
ECT (Electro-convulsive therapy)

63
Q

What classes of drugs are categorised as mood stabilisers?

A

Lithium
Anti-convulsants
Anti-psychotics
Anxiolytics

64
Q

List some indications for mood stabilisers

A

Bipolar
Cyclothymia
Schizoaffective disorders

65
Q

What is the main indication for the use of lithium?

A

Effective in long term prophylaxis of both mania and depressive episodes in over 70% of cases

66
Q

What factors predict a positive response to lithium?

A

Prior long-term response or family member with good response
Classic pure mania
Mania followed by depression

67
Q

What baseline investigations need to be done before commencing lithium therapy

A

Baseline U/Es and TSH

Pregnancy check (association with Ebstein’s anomaly)

68
Q

What monitoring is required for patients on long term lithium therapy?

A

Steady-state achieved after 5 days

TSH checked at three months
Creatinine levels at six months

Blood level between 0.6-1.2mmol\L

69
Q

List some common side effects of lithium

A 
Common GI upset 
Thyroid abnormalities 
Interstitial renal fibrosis (polyuria/polydipsia)
Reduces seizure threshold 
Cognitive slowing
70
Q

Lithium toxicity can be either mild, moderate or severe.

Outline the symptoms and signs of each

A

Mild - vomiting, diarrhoea, ataxia, nystagmus
Moderate - clonic limb movements, delirium
Severe - convulsions, oliguria and renal failure

71
Q

List some commonly used anticonvulsants

A

Lamotrigine
Valproic acid
Carbemazapine

72
Q

What are the indications of the use of valproic acid?

A

Effective in mania prophylaxis (not for depression) and has better tolerance than lithium

73
Q

What investigations are required before valproic acid is commenced?

A

LFTs and pregnancy test

74
Q

What is the side effect profile of valproic acid?

A 
Thrombocytopenia
Sedation
Tremor 
Increased risk of NTD
Alopecia
75
Q

What are the indications of carbamazepine?

A

First-line agent for acute mania and mania prophylaxis

76
Q

What is the action of typical anti-psychotics?

A

D2 dopamine receptor antagonist

77
Q

List some typical antipsychotics (list both high potency and low potency types)

A

High potency - haloperidol, fluphenazine, pimozide

Low potency - chlorpromazine, thioridazine

78
Q

What is the difference between high and low potency typical antipsychotics

A

High potency typical antipsychotics bind to D2 with high affinity. Low potency have low affinity

79
Q

Outline the action of atypical antipsychotics

A

Serotonin-dopamine 2 antagonists

80
Q

Give examples of commonly used atypical antipsychotics

A

Risperidone
Clozapine
Aripiprazole
Olanzapine

81
Q

What are the three main adverse effects of antipsychoitcs?

A

Tardive dyskinesia
Neuroleptic malignant syndrome
Extrapyramidal side effects

82
Q

Outline the presentation of tardive dyskinesia

A

Involuntary muscle movements

83
Q

Outline the presentation of neuroleptic malignant syndrome

A

Muscle rigidity, fever, altered mental status, elevated white cell count

84
Q

What are three examples of extrapyramidal side effects?

A

Acute dystonia
Parkinsons syndrome
Akathisia

85
Q

What agents may be prescribed to treat extrapyramidal side effects?

A

Amantadine (dopamine facilitators)

Propranolol (beta-blocker)

86
Q

What are anxiolytics and what are they used to treat?

A

Drugs used, often in conjunction with SSRIs/SNRIs to treat many diagnoses including panic disorder, generalised anxiety, substance-related disorders and their withdrawal etc.

87
Q

Give two examples of anxiolytics

A

Buspirone

Benzodiazepines

MBChB Final Exam Essentials (18 decks)

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