Session 12

Question 1

How does depression present?

Answer 1

Low mood, anhedonia and decreased energy. Must have symptoms for 2 weeks.

Question 2

What is unipolar depression?

Answer 2

Where the mood swing is always in the same direction. Mostly due to external triggers such as life events. Often familial.

Question 3

Describe the monoamine hypothesis of depression.

Answer 3

Depression is caused by a reduction in monoamine neurotransmitters in the brain, and mania is due to an excess, e.g. noradrenaline and serotonin.

Question 4

Describe the neurotransmitter receptor hypothesis.

Answer 4

An abnormality in the receptors for monoamine transmission leads to depression. Depletion of neurotransmitter causes compensatory up-regulation of post-synaptic receptors.

Question 5

Describe the monoamine hypothesis of gene expression.

Answer 5

Deficiency in molecular functioning. Problem within the molecular events distal to the receptor.

Question 6

Describe the role of tricyclic antidepressants.

Answer 6

Block the re-uptake of serotonin and noradrenaline. E.g. Amitriptyline. Also shown to block muscarinic cholinoceptors and alpha-1 adrenoceptors.

Question 7

Give three ADRs of TCAs.

Answer 7

Sedation, impaired psychomotor function, reduced glandular secretions, tachycardia, postural hypotension, sudden cardiac death, constipation.

Question 8

Describe the role of SSRIs as antidepressants.

Answer 8

E.g. Fluoxetine, and citalopram. Prevent the re-uptake of serotonin by the presynaptic membrane, used to treat moderate to severe depression.

Question 9

Describe the role of SNRIs as antidepressants.

Answer 9

Cause re-uptake of noradrenaline too, e.g. Duloxetine. Commonly used as second/third line therapy.

Question 10

Describe the characteristics of schizophrenia.

Answer 10

Positive: hallucinations, delusions, abnormal behaviour.
Negative: social withdrawal, blunted effect.
Cognitive: selective attention, poor memory, reduced abstract thought.
Affective: anxiety and depression.

Question 11

What is a delusion?

Answer 11

A fixed false belief that is out of keeping with someone’s culture or religious beliefs.

Question 12

Describe the dopamine hypothesis of schizophrenia.

Answer 12

Excess of dopamine released by the brain. Dopamine antagonists are the best treatment.

Question 13

What are the main dopamine pathways in the CNS?

Answer 13

Meso-limbic: emotion and behaviour
Meso-cortical: arousal and mood
Nigrostriatal: control of movement
Tuberoinfundibular: pituitary and hypothalamus function.

Question 14

What are typical anti-psychotics?

Answer 14

Increased dopamine antagonism producing extra-pyramidal side-effects. E.g. Haliperidol. Used in acute emergency setting for sedation and tranquilization.

Question 15

Give 2 side-effects of typical anti-psychotics.

Answer 15

Postural hypotension, weight gain, prolactinaemia and pigmentation.

Question 16

Describe the features of neuroleptic malignant syndrome.

Answer 16

Severe rigidity, hyperthermia, increased CPK and autonomic lability.

Question 17

What are atypical anti-psychotics?

Answer 17

Still D2 antagonists, but cause less extrapyramidal symptoms. Often the first-line treatment for new onset schizophrenia. E.g. Risperidone, Olanzipine.

Question 18

What is third line treatment of schizophrenia?

Answer 18

Clozapine (atypical anti-psychotic). The most effective anti-psychotic. Causes severe constipation, sedation, hypersalivation and weight gain.

Question 19

Give two extrapyramidal side-effects.

Answer 19

Parkinsonism, acute dystonic, akathasia and tardive dyskinesia.

Question 20

What is anxiety?

Answer 20

Fear out of proportion of the situation, so individuals undergo avoidance of certain scenarios. Can include physical symptoms such as light-headedness, shortness of breath and hot/cold flushes.

Question 21

What is the first line treatment of anxiety?

Answer 21

CBT

Question 22

Give three side-effects of benzodiazepines.

Answer 22

Dependence, drowsiness, dizziness, psychomotor impairment, dry mouth, blurred vision, GI upset, ataxia, headache, hypotension.

Question 23

Give four symptoms of dependency.

Answer 23

Hallucinations
Paranoia
Dilated pupils
Chills and sweating
Involuntary shaking
Behavioural changes
Muscle cramping and teeth clenching
Reduced inhibitions.

Question 24

What is bipolar disorder?

Answer 24

Episodes of both mania and depression, associated with poor concentration, poor sleep, rapid speech, poor judgement.

Question 25

Give three symptoms of mania.

Answer 25

Unusually happy, overactive, poor concentration, poor sleep, rapid speech, poor judgement, increased interest in sex, hallucinations.

Question 26

What is the treatment of bipolar?

Answer 26

Mood stabilisers, including lithium, sodium valproate, lamotrigine and carbamezepine.

Question 27

Give three side-effects of lithium.

Answer 27

Memory problems, thirst, polyuria, tremor, drowsiness and weight gain.

Question 28

Give two toxic effects of lithium.

Answer 28

Vomiting, diarrhoea, coarse tremor, dysarthria, cognitive impairment, restlessness, agitation.

Question 29

What is the treatment for lithium toxicity?

Answer 29

Supportive measures, anticonvulsants, increase fluid intake, haemodialysis.

Question 30

What are the two main treatments for dementia?

Answer 30

1) Acetyl cholinesterase inhibitors, e.g. Donepezil.

2) NMDA antagonist, e.g. memantine.