Week 2 Flashcards
What is a psychiatrist?
a doctor who assesses, diagnoses and manages mental illness
Describe the psychotic sieve
psychotic mood anxiety organic substance misuse personality no mental illness
What are the three main psychotic symptoms?
hallucinations
delusions
thought disorder
What is a delusion?
a false, unshakeable idea or belief which is out keeping with the person’s educational, cultural and social background; it is held with extraordinary conviction and subjective certainty
What are the three core symptoms of depression?
low mood
anhedonia
low energy
What are the cognitive features of depression
slowed speed of thought reduced concentration reduced self esteem ideas of guilt and unworthiness bleak and pessimistic views of the future hoplessness ideas or acts of self-harm or suicide
What are the biological symptoms of depression?
disturbed sleep diminished appetite weight loss loss of libido low energy constipation amenorrhoea
what are the cognitive disorders associated with depression?
arbitary inference selective abstraction magnification minimisation over-generalization personalisation
Give examples of SSRIs
sertaline, fluoxetine
WHat are the side effects of SSRIs?
nausea, vomiting, agitation, sexual dysfunction, hyponatraemia, sweating
Give examples of tricyclic antidepressants
amitryptaline
give examples of SNRIs
venlafaxine
Give examples of NASSAs
mirtazepine
Give examples of NARIs
Reboxetine
What are the 5 stages of adjustment?
denial anger bargaining depression acceptance
What are the types of abnormal grief
unexpected
ambivalent
chronic
delayed
What are the factors associated with abnormal grief reactions?
loss of child loss of parent during childhood sudden unexpected death multiple deaths attachment of blame to survivor
What is invasion?
growth by infiltration and destruction of surrounding tissues
WHat is metastasis?
spread of tumour to and growth at ectopic sites via blood, lymphatics, intraepithelial route or transcoelomic
What is a carcinoma?
malignant tumour derived from epithelial cells
What is a sarcoma?
malignant tumour derived from mesenchymal cells
What is melanoma?
malignant tumour derived from neural crest cells
What is leukaemia?
malignant tumour derived from circulating white blood cells
What is lymphoma?
malignant tumour derived from the lymphatic system
What is the metastatic cascade?
local invasion angiogenesis detachment intravasation transport lodgement / arrest extravasation growth at ectopic site
What are the properties of a metastatic tumour?
reduced cell -cell adhesion altered cell-substratum adhesion increased motility increased proteolytic ability angiogenic ability ability to intravasate and extravasate ability to proliferate
How do carcinomas acquire the ability to escape the “glue” that binds them together?
via mutations in E-cadherin or in the molecules that regulate or interact with it
What are the names for the transcription factors that regulate E-cadherin?
snail, slug, twist
Describe the action of HGF
mitogen, mitogen and morphogen
Produced by stromal cells of the tumour
binds to c-met on tumour epithelial cells
increased phosphorylation of beta-catenin in tumour epithelial cells which leads to disrupted ECD-mediated adhesion
What is the stromal component of Cmet?
HGF
Where are chemokines produced in relation to cancer?
stromal cells
How are MMPs normally regulated?
transcriptional
synthesis of zymogen
activated by serine proteases
negative regulation by tissue inhibitors of metalloprteinases
What are the stages of extravasation?
rolling
activation
adhesion
diapedesis
Where do skin melanoma tumours usually spread to?
lungs, brain, skin, liver
What are possible mechanisms for organ tropism?
selective adhesion to endothelium to target organs
selective response to GFs at ectopic site
selective migration to CK source
Factors released by tumour cause changes in prospective TMW at secondary sites
balance of local and systemic angiogenic factors
WHat is the name of the chromosome mutation in chronic myeloid leukaemia?
the philadelphia gene
How does imatinib work?
binds to ATP binding region on Abl kinase and therefore prevent it from functioning properly
What drugs are VEGF inhibits?
sunitinib
pazopanib
axitinib
What are common mutations in melanoma?
Raf kinase
MAP kinase
What can be used to chemically castrate a man?
GnRH agonist
GnRH antagonist
oestrogens
AR antagonist
WHat are the advantages of targeted treatments for cancer?
more selective for cancer cells less selective for normal cells less side effects higher doses more anti-cancer effects
Describe drug resistance in targeted therapy
kinase mutations emerge which are no longer sensitive to drug
cancers eventually begin to grow again
Describe predictive markers
predict which patients will benefit from a specific treatment
what drug to use
WHat are prognostic markers?
inform about outcome regardless of treatment
may help choose which patients to treat but not which drugs
Describe the innate immune system mediated tumour control
innate IR recognises tumour cell establishment
NK cells and other effectors recruited to site by chemokines, which also target tumour growth directly
tumour specific T-cells home to tumour site, along with macrophages and other effectors to eliminate tumour cells
What are the three Es of immunoediting?
elimination
equilibrium
escape
Describe IFN a/b treatment
affects MHC class I expression and cell division prolongs survival and stabilises disease in cancers such as RCC
Describe IL-2 treatment
therapy for RCC and metastatic melanoma
expansion of tumour specific T cells
high dose only
must be in hospital
WHat is the problem with single peptide vaccines against cancer?
tumour escape through selection of non-antigen variants
How can preformed antibodies work?
directly target cancer cells and mediate tumour destruction
How can monoclonal antibodies destroy a tumour?
apoptosis induction
complement mediated cytotoxicity
ADCC
conjugated to toxin
What is the target of ipilimumab?
CTLa4
what does biTEs stand for?
bi-specific T cell engager
Give examples of cell therapy
haematopoetic stem cells tumour infiltrating T cells dendritic cell vaccines NK cells gamma-delta T cells virus specific T cells genetically engineered T cells
What are the stages of stem cell therapy?
mobilise patient or donor cells condition patient with radio / chemo manipulate graft re-infuse cells to "clean system" innate immune system reconstitutes adaptive system reconstitutes
Describe receptor engineering in T cell therapy
tumour antigen-specific artificial receptor generated, containing signalling functions
transferred into patient T cells to attack cancer cells
Describe a MSE
an assessment of current state of mind
snapshot during interaction
carried out with psychiatric history
observations and specific questions
What is the format of a MSE?
appearance and behaviour speech mood and affect though form and content perception cognition insight
Describe appearance in MSE
how person looks ethnicity. build, hair colour, clothing biological vs chronological age well kemp? self neglect? unwell or intoxicated?
Describe behaviour in MSE
how they act motor activity eye contact rapport and engagement body language unusual or socially unacceptable behaviour
Describe speech in MSE
how they talk rate and quantity rhythm volume tone spontaeity
What is mood
a person’s emotional state overall
What is affect?
changes in the person’s emotions that you observe moment to moment during the interview
What types of mood are there?
subjective and objective
What types of affect are there?
reactive
flattened
blunted
labile
Give examples of thought disorders
flight of ideas
loosing of associations / knight’s move thinking
What types of delusion are there?
paranoid grandiose nihilistic delusions of reference thought interference
What are over -valued ideas?
a false belief, not totally fixed but causing great disability
What are obsessions?
recurrent, intrusive, distressing ideas, impulses or images that the patient recognises as their own
How is cognition assessed?
alertness
orientation
attention / concentration
memory
WHat is insight?
the patient’s understanding of their presentation and their need of treatment
