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Medicine 2 > Week 2 - Depression and Anxiety > Flashcards

Week 2 - Depression and Anxiety Flashcards

1
Q

What do you observe in a mental state examination of a patient?

A
  • Appearance
  • Behaviour
  • Speech
  • Mood
  • Thought
  • Hallucinations
  • Cognition
  • Insight
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2
Q

What are the 5 types of depression?

A
  • Atypical depression
  • Seasonal affective disorder
  • Adjustment disorder
  • Bereavement
  • Life stress
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3
Q

What are the main types of anxiety?

A
  • Simple phobias
  • PTSD
  • Generalised anxiety disorder
  • Panic disordser
  • Health anxiety
  • OCD
  • Social anxiety disorder
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4
Q

What are 3 non-pharmacological ways of treating depression and anxiety?

A
  • Electrical
  • Magnetic
  • Psychological treatment
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5
Q

What is involved in electroconvulsive therapy?

A
  • Treatment resistant depression
  • Deep brain stimulation
  • Controlled seizure
  • Vagal nerve stimulation
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6
Q

What things is the limbic system involved in?

A
  • Emotions
  • Reward driven activity
  • Motivation
  • Social behaviours
  • Memory of environment and experience
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7
Q

What is the limbic system?

A
  • Model of brain function
  • Transitional position between subcortical nuclei and neo-cortex
  • Different circuits connect functionally related components
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8
Q

What are the inputs to the hippocampus?

A
  • Sensory information from cortex via entorhinal cortex
  • Performant path to dentate gyrus
  • Modulatory inputs from septal nuclei and brainstem nuclei influence overall function
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9
Q

What are the outputs from the hippocampus?

A
  • Via subiculum and entorhinal cortex to neocortex
  • Via fornix to septal region and mamillary bodies, hypothalamus, and median forebrain bundle
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10
Q

What are properties of working memory?

A
  • Limited capacity
  • Rapid decay
  • Prefrontal cortex
  • Visual and auditory versions of working memory
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11
Q

What are the roles of the hippocampus on episodic memory?

A
  • Long-term potentiation = synaptic plasticity in hippocampus
  • Long-lasting change in synaptic function
  • Increase in AMPA receptors
  • NMDA and Ca dependent
  • Synapse specific
  • Inputs from sensory cortices via entorhinal cortex
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12
Q

What is responsible for emotions and nwhat are its proeprties?

A
  • Amygdala
  • Multiple sub-nuclei
    • sensory and limbic inputs
  • Organise emotional responses to stimuli
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13
Q

What are the amygdala inputs?

A

Subcortical sources of sensory and visual information

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14
Q

What are the amygdala outputs?

A

Stria terminalis - hypothalamus, brainstem, BNST, accumbent

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15
Q

What is labelled?

A

Amygdala

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16
Q

What happens in fear conditioning?

A

Fearful faces activate amygdala

17
Q

What arears of the brain are involved in the reward circuit?

A
  • Midbrain dopaminergic neurons
  • Ventral tegmental area to nucleus accumbens
  • Median forebrain bundle
  • Orbitofrontal and median frontal cortex
  • Ventral striatum
  • Amygdala
18
Q

What are the 2 pleasure hotspots?

A

Nucleus accumbens

Orbitofrontal cortex

19
Q

What happens in Kluver-Bucy syndrome?

A
  • Bilateral temporal lobe resection where amygdala, hippocampus and other are removed
  • No longer aggressive
  • Indiscriminate sexual activity
  • Cannot discriminate visually between edible and non-edible
20
Q

What happens in Urbach-Wiethe disease?

A
  • Normal IQ
  • Recognise familiar faces and emotion
  • Unable to recognise fear face
  • No fear
  • No deficit in other emotions
  • Cannot learn fearful situations
21
Q

What is the role of the cingulate cortex?

A
  • Handling conflicting information
  • Error monitioring
  • Arousal
  • Overactivity in OCD
22
Q

What happens in brain in depression?

A
  • Dysfunction of limbic-striatum-frontal cortex
  • Amygdala = anxiety
  • Hippocampus = memory deficits
  • Reward circuits = anhedonia and motivation
  • Frontal lobe = motivation, decision making
  • Striatum = motor slowing
23
Q

What is the role of the pre-frontal cortex?

A
  • Inputs to and from key limbic structures
  • Important in decisions about reward and appetite
  • Motivation and behaviour regulation
  • Disorders = psychiatric and personality disorders
24
Q

What is the first factor involved in emotion processing?

A

Appraisal

Primary = evaluation of relevance of current istuation ot personal wellbeing

Secondary = evaluation of capacity to deal with situation

25
Q

What is the second factor involved in emotion processing?

A

Arousal

Encounter, bodilt reaction, emotion

26
Q

What is the thrid factor involved in emotion processing?

A

Expression

Duchenne smile = obtained false smile through electrical sitmulation

Voluntary facial movements = controlled by pyramidal motor system

Involuntary = controlled by extrapyramidal motor system

27
Q

What is the fourth factor involved in emotion processing?

A
  • Action readiness
  • Tendency of an emotion to serve as impusle for action specific to emotion
28
Q

What is the role of the amygdala in emotion processing?

A
  • Receives auditory, taste, and smell information
  • Makes quick evaluation of stimulus
  • Involved in automatic, preconscious detection of threat and danger
29
Q

What is the role of the anterior cingulate cortex in emotion processing?

A
  • Attention to regulate cognitive and emotional processing
30
Q

What happens to brain in depression?

A

Hypothalamus, pititary, adrenal cortex hyperactivation

+ cotrisol in saliva, plasma, and urine

+ CRH in CSF
+ size of pituitary and adrenal glands

Impaired negative feedback

31
Q

How do TCAs work?

A
  • Inhibit serotinin and noradrenaline reuptake
  • Sedative
  • Anticholinergic side effects
  • Cardiovascualr effects can be fatal in overdose
32
Q

How do MAOIs work?

A

Tyramine displaces noradrenaline from vesicle storage

33
Q

How does mirtazapine work?

A
  • Enahnces NA and 5HT transmission
  • Blocking of adrenoceptors responsible for noradrenaline release inhibition
  • Blocking of receptors responsible for inhibiting 5HT release
34
Q

What are the properties of benzodiazepines?

A
  • Used in epilepsy, insomnia, alcohol withdrawal, and ST in anxiety
  • Positive allosteric modulators on GABAa receptor complex
  • Allow GABAa to bind
    • Cl- flow into neurone
  • Hyperpolarisation = inhibition
35
Q

What is the therapeutic window of lithium?

A

0.5-1.0 mmol/L

36
Q

What is an MMSE?

A

Mini mental state examination

Max score = 30

Cut-off score = 23

Mild cognitive impairment = 23-26

Medicine 2 (29 decks)

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