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Phase 3A Medicine > Psychiatry - Affective disorder and anxiety > Flashcards

Psychiatry - Affective disorder and anxiety Flashcards

1
Q

What are the core symptoms of depression?

A
  1. Anhedonia
  2. Anergia
  3. Low mood
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2
Q

For how long do the symptoms of depression have to persist, to diagnose it?

A

2 weeks

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3
Q

How many of the core symptoms of depression are required to diagnose it?

A

2 of 3

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4
Q

What are the three types of symptoms seen in depression?

A
  1. Cognitive
  2. Biological
  3. Psychotic
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5
Q

Give 3 examples of cognitive symptoms seen in depression

A
  1. Feelings of guilt
  2. Feelings of worthlessness
  3. Unable to see future
  4. Poor concentration and memory
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6
Q

Give 3 examples of biological symptoms seen in depression

A
  1. Altered sleep pattern (insomnia or early morning waking)
  2. Hypersomnia
  3. Reduced appetite
  4. Reduced libido
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7
Q

Give 3 examples of psychotic symptoms seen in depression

Tend to be seen in severe depression

A
  1. Auditory hallucinations (often derogatory)

2. Nihilistic or persecutory delusions

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8
Q

Grades of depression

A

Mild
Moderate
Severe
Severe with psychotic symptoms

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9
Q

Red flag symptoms in depression

A
  1. Suicidality
  2. Psychotic symptoms
  3. Severe self-neglect
  4. Ceasing to eat or drink
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10
Q

Give 3 differential diagnoses of depression

A
  1. Physical e.g. hypothyroidism, head injury, delirium
  2. Adjustment disorder - unpleasant but mild affective symptoms following a life event but not severe enough to diagnose depression
  3. Normal sadness
  4. Bereavement
  5. BPAD/ schizoaffective disorder/schizophrenia
  6. Substance misuse
  7. Postnatal depression
  8. Dementia - if depression affects memory can appear that the patient has dementia
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11
Q

What are the normal stages of grief

A
  1. Numbness
  2. Pining
  3. Depression
  4. Recovery
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12
Q

What investigations would you do in a patient with suspected depression

A
  1. Blood tests - TFT (exclude hypothyroidism), FBC (exclude anaemia), HBa1c (exclude lethargy caused by diabetes)
  2. Rating scales e.g. Beck Depression Inventory (BDI) or Hospital Anxiety and Depression Scale (HADS)
  3. CT or MRI if suspected cerebral pathology
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13
Q

Give 2 examples of rating scales that can be used in patients with suspected depression to measure severity or monitor treatment

A
  1. Beck Depression Inventory (BDI)

2. Hospital Anxiety and Depression Scale (HADS)

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14
Q

What are the 3 steps of depression management

A
  1. Psychological treatment
  2. Pharmacological treatment
  3. Non -drug options
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15
Q

Give three examples of psychological treatments used in depression

A
  1. CBT
  2. Psychodynamic psychotherapy
  3. Interpersonal therapy
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16
Q

How do antidepressants work?

A

Increase the overall level of monamines in the synaptic cleft by either decreasing uptake or breakdown

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17
Q

Antidepressants are typically indicated for what types of depression?

A

Moderate/severe

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18
Q

What antidepressants are first line and why?

A

SSRI’s because they have relatively fewer side effects and safety in overdose

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19
Q

How long should antidepressants be prescribed for?

A

Until the patient is no longer depressed and then a further six months to prevent relapse

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20
Q

Give 3 side effects of antidepressants

A
  1. Hyponatraemia
  2. Sexual dysfunction
  3. Most reduce seizure threshold (be aware in epilepsy)
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21
Q

How long to antidepressants typically take to work and why?

A

4-6 weeks

Serotonin and central beta-adrenergic receptors decrease in number over time

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22
Q

How do SSRI’s work?

A

Reduce uptake of serotonin in pre-synaptic nerve terminal so enhance serotoninergic neurotransmission

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23
Q

How to TCA’s work?

A

Inhibit the reuptake of NA and 5-HT (serotonin)

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24
Q

Why aren’t TCA’s used as first line?

A

Cardiotoxicity in overdose can be lethal

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25
Q

How do MAOI’s work?

A

Inhibit the metabolism of monoamines so increase their synaptic levels.

26
Q

Why aren’t MAOI’s used as first line in depression?

A

Dangers of hypertensive crisis due to a build-up of NA when eating tyramine rich foods e.g. mature cheese, yeast, fermented soya beans. Do not combine with other antidepressants

27
Q

Give 3 examples of SSRI’s

A

Fluoxetine, sertraline, paroxetine, citalopram, escitalopram

28
Q

Give an example of a serotonin and NA reuptake inhibitor (SNRI)

A

Duloxetine

29
Q

Give three examples of TCA’s

A
  1. Amitriptyline
  2. Clomipramine
  3. Imipramine
  4. Lofepramine
30
Q

Give two examples of MAOI’s

A
  1. Phenelzine

2. Tranylcypromine

31
Q

Give 5 side effects of SSRIs

A
  1. Nausea and vomiting
  2. Appetite and weight change
  3. Blurred vision
  4. Insomnia, tremor, dizziness
  5. Headache
  6. Sweating
32
Q

Give 5 side effects of TCA’s

A
  1. Tachycardia
  2. Arrhythmia
  3. Dry mouth
  4. Blurred vision
  5. Constipation
  6. Urinary retention
  7. Postural hypotension
  8. Sedation
  9. Nausea, weight gain
33
Q

What is the side effect of St. John’s wort and how does it work?

A

Appears to work similarly to SSRI

Makes the oral contraceptive pill ineffective

34
Q

What symptoms do patients get if they stop antidepressants quickly?

A

Discontinuation symptoms

eg. flu-like symptoms, electric shock sensation, headaches, vertigo, irritability

35
Q

How long should antidepressants be withdrawn over?

A

A few weeks

36
Q

What is the big risk in prescribing two antidepressants at once?

A

SEROTONIN SYNDROME
Excess serotonin - potentially life threatening and symptoms include restlessness, sweating, myoclonus, confusion and fits

37
Q

Define refractory depression

A

Failure to respond to two adequate trials of different classes of antidepressants at adequate doses and for a period of 6-8 weeks

38
Q

What percentage of patients actually have refractory depression?

A

30%

39
Q

Give 3 augmentation strategies that may be used in refractory depression and prescribed by psychiatrists

A
  1. Lithium
  2. Tri-iodothyronine (t3) or levothyroxine (t4)
  3. Buspirone (anxiolytic drug acting on 5-HT receptors)
40
Q

Give two examples of non-drug therapy that can be used as third line management of depression

A
  1. ECT (electroconvulsive therapy)

2. Light therapy in SAD

41
Q

How long must symptoms persist in order to diagnose a manic episode?

A

1 week

42
Q

What are the criteria for diagnosing a manic episode?

A

Symptoms last at least a week

Prevent work and ordinary social activities

43
Q

If patients report manic symptoms but not to the degree that their ability to function is completely disrupted, what is the diagnosis?

A

Hypomania

44
Q

Anxiety disorders affect which gender more commonly?

A

Female 2:1

45
Q

Give 3 contributing factors to the aetiology of anxiety disorders

A
  1. Genetics
  2. Early experiences and life events
  3. Neurochemical abnormalities
  4. Behavioural and cognitive causes e.g. attachment theory and classical conditioning
46
Q

Give 4 behavioural and cognitive causes of anxiety disorder

A
  1. Classical conditioning - frightening stimulus and neutral stimulus associated with fear
  2. Negative reinforcement
  3. Cognitive theory - worrying thoughts repeated in an automatic way that induces and maintains the anxiety response
  4. Attachment theory - quality of attachment between parent and children affects their confidence as adults
47
Q

What are the 3 neurotransmitters that are the targets of drugs that successfully combat anxiety and which drugs target which neurotransmitters

A
  1. GABA - benzodiazepines are GABA agonists
  2. Serotonin - SSRI
  3. Noradrenaline - TCA
48
Q

What is Generalised Anxiety Disorder?

A

Anxiety isn’t triggered by a specific stimulus, but is continuous and generalised. Past mistakes and future catastrophes occupy the mind ceaselessly

49
Q

Give 3 psychological symptoms of GAD

A

Worries, poor concentration, irritability, difficulty getting to sleep, insomnia, feelings of unreality

50
Q

Give 3 motor symptoms of GAD

A

Restlessness, fidgeting, feeling on edge

51
Q

Give 3 neuromuscular symptoms of GAD

A

Tension headache, tremor and muscle aches, tinnitus

52
Q

Give 3 GI symptoms of GAD

A

Nausea, butterflies, loose stools, indigestion, dry mouth and difficulty swallowing

53
Q

Give 2 CV/resp symptoms of GAD

A

Palpitations, tight chest

54
Q

Give 3 GU symptoms of GAD

A

Urinary frequency, ED, amennorhoea

55
Q

Give three differential diagnoses of GAD

A 
Hyperthyroidism
Substance misuse
Excess caffeine
Depression
Anxious personality disorder 
Dementia
Schizophrenia
56
Q

What is the definition of a phobia

A

Intermittent anxiety that occurs in a specific but ordinary circumstance

57
Q

What is social phobia?

A

Fear of being criticised or scrutinised by other people and patients often worried about embarrassing themselves in public. Often onsets in late teens and equal in men and women. Can be about specific things e.g. eating in public

58
Q

What is a panic disorder?

A

Intermittent anxiety but with no trigger

59
Q

What physical symptoms are typically seen in a panic attack?

A
  1. Breathing difficulties
  2. Chest tightness and palpitations
  3. Pins needles in hands, feet and around the mouth
  4. Depersonalisation
  5. Shaking/dizziness/faints/sweating
60
Q

How long do panic attacks typically last?

A

30 mins

61
Q

What are typically safety behaviours that people with panic attacks usually react to?

A

Things like calling an ambulance or taking aspirin. The panic attack tends to provoke until individual engages in the safety behaviour

62
Q

How is panic disorder diagnosed?

A

Recurrent panic attacks (several within the month) and in between episodes person is relatively free of anxiety

Phase 3A Medicine (12 decks)

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