S12: psychiatry 2 Flashcards

1
Q

Describe the clinical features of depressive disorders

A

Must have had symptoms for at least 2 weeks
Core symptoms: low mood, lack of energy & lack of enjoyment and interest
Depressive thoughts – suicidal ideation
Somatic/biological symptoms – lack of appetite & pain
Might have psychotic symptoms in severe cases

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2
Q

Compare an adjustment reaction vs depression

A

Adjustment reaction: symptoms develop suddenly after an event, time limited, energy not low, no particular pattern to sleep disturbance & feelings of anger and frustration more typical
Depression: symptoms develop gradually, low energy, sleep disturbance with typical EMW & low self esteem and feelings of guilt and blame are typical

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3
Q

List features of mania

A
Elated mood
Increased energy 
Pressure of speech
Decreased need for sleep
Normal social inhibitions are lost 
Self esteem is inflated, often grandiose
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4
Q

Describe bipolar affective disorders

A

Can diagnose following two episodes of a mood disorder, one of which must be either mania or hypomania
Fluctuations in mood
Bipolar 1 – episodes of mania or mania & depression
Bipolar 2 – episodes of hypomania or hypomania & depression

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5
Q

List physical differentials for depression

A
Hypothyroidism
B12 deficiency
Chronic disease
Substance misuse
Hypoactive delirium
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6
Q

List physical differentials for mania

A
Hyperthyroidism 
Delirium
Iatrogenic 
Infection
Head injury
Intoxication
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7
Q

Describe the limbic system

A

Important functions in emotion, memory & motivation
Composed of many brain regions, however the main emotion circuit is known as the Papez circuit:
-various cortical areas send input to the hippocampus which projects to the mammillary bodies via the fornix
-mamillary bodies project to the thalamus & hypothalamus, thalamus projects back to the cortex
-hypothalamus projects down to the pituitary and autonomics mediating some of the somatic effects
-amygdala: can be grouped with hippocampus in terms of its connections

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8
Q

Describe serotonin

A

Produced in brainstem (raphe nuclei) and distributed to cortex and limbic system
Important for sleep, impulse control, appetite & mood

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9
Q

Outline the evidence for decreased serotonin in depression

A

Drugs that increase serotonin in the brain treat depression
5HIAA – low in the CSF of patients with depression
Tryptophan – depletion causes depression
NB: not all features of depression are explained by this hypothesis

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10
Q

Describe noradrenaline

A

Produced in the locus coeruleus of the brainstem & distributed to cortex and limbic system
Important for: mood, arousal & memory

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11
Q

Outline the evidence for decreased levels of noradrenaline in depression

A

Drugs that increase levels of noradrenaline treat depression
Patients who have recovered, but still have low levels of noradrenaline are at higher risk of relapse
Post-mortem studies suggest lower levels of noradrenaline in the brains of those with depression

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12
Q

Describe the treatment of depression

A

Biological: antidepressants – SSRIs, consider electroconvulsive therapy for severe or refractory cases
Psychological: CBT
Social: help with social stressors such as isolation & financial worries

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13
Q

Describe the treatment for acute mania

A

Biological: antipsychotics, mood stabilisers (eg. lithium)
Psychological: unlikely to be helpful in acute phase, helpful to educate patients regarding recognising triggers & signs of relapse
Social: patients need to be kept safe, important to think about implications of mania such as finances etc

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14
Q

Describe the treatment for acute bipolar depression

A

Biological: use antidepressant with mood stabiliser cover
Psychological: CBT
Social: help with social stressors such as isolation & financial worries

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15
Q

Describe the treatment for maintaining stability

A

Biological: mood stabiliser eg. lithium/valproate with or without antipsychotic
Psychological: education, CBT
Social: consider effects on employment, family support

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16
Q

Define psychosis

A

A set of symptoms, not a diagnosis itself

Presence of hallucinations or delusions

17
Q

Describe hallucinations

A

A perception without an accompanying stimulus
In any sensory modality
Visual hallucinations are frequently caused by organic pathologies
Hypnogogic – experienced when going to sleep
Hypnopompic – experienced upon waking

18
Q

Describe delusions

A

A fixed, false belief which is unshakeable

Outside of cultural norms

19
Q

Describe the first rank symptoms of schizophrenia

A

Auditory hallucinations – thought echo, running commentary & third person
Passivity experiences – belief that an action/feeling is caused by external force
Thought withdrawal, broadcast or insertion
Delusional perceptions – attribution of a new meaning to a normally perceived object
Somatic hallucinations

20
Q

Outline the positive and negative symptoms in schizophrenia

A

Positive symptoms – delusions, hallucinations, thought disorder & lack of insight
Negative symptoms – underactivity, low motivation, social withdrawal, emotional flattening & self neglect

21
Q

Describe the evidence for involvement of dopamine in schizophrenia

A

Drugs that increase dopamine levels induce psychosis

Drugs that antagonise dopamine treat psychosis

22
Q

Describe the treatment of schizophrenia

A

Typical antipsychotics – block D2 receptors throughout the CNS, antipsychotic actions from inhibition of mesolimbic & mesocortical pathways, side effects come from blocking other pathways
Atypical antipsychotics – lower affinity for D2 receptors than typicals, hence milder side effects; also block 5HT2 receptors

23
Q

Describe side effects of treatment of schizophrenia

A

Can affect movement due to involvement of nigrostriatal pathways
However untreated patients can also develop hypokinetic movement disorders (catatonia) – might be caused by involvement of GABA
Increased prolactin levels: amenorrhea, galactorrhoea, decreased fertility, decreased libido, osteoporosis

24
Q

Outline the challenges in treating schizophrenia

A

Patients lack insight, which can affect compliance

To get around this, medication can be given in different ways (eg. depot injection)

25
Q

List factors associated with good prognosis (schizophrenia)

A
No family history 
Good premorbid function
Acute onset 
Mood disturbance 
Prompt treatment 
Maintenance of motivation
26
Q

List long term complications of schizophrenia

A
All cause mortality twice as high as general population 
Shorter life expectancy
Greater suicide risk 
Greater risk of violent death
Substance misuse