WK 2: mental health

Question 1

SSRIs (4)

Answer 1

citalopram
fluoxetine
paroxetine
sertraline

Question 2

SNRI (2)

Answer 2

duloxetine

venlafaxine

Question 3

selective noradrenaline reuptake inhibitor (NRI)

Answer 3

reboxetine

Question 4

serotonin receptor blocker

Answer 4

trazodone

Question 5

TCAs (4)

Answer 5

amitriptyline
imipramine
lofepramine
mirtazapine

Question 6

classic non sedative MAOI (2)

Answer 6

phenelzine

tranylcypromine

Question 7

melatonin receptor agonist and serotonin receptor antagonist

Answer 7

agomelatine

Question 8

reversible MAOI

Answer 8

moclobemide

Question 9

what is released from the hypothalamus in response to stress

Answer 9

Corticotropin releasing hormone (CRH)

Question 10

what is released from the anterior pituitary in response to CRH

Answer 10

corticotropin

Question 11

cortisol in depression:

Answer 11

• elevated cortisol levels
• reduced suppression of cortisol by exogenous corticosteroids
• increased anterior pituitary and adrenal cortez
• CRH levels increased in cerebrospinal fluid and in limbic brain regions

Question 12

in depression apoptosis occurs in the

Answer 12

hippocampus and prefrontal cortex

Question 13

Brain derived neurotrophic factor (BDNF) role in depression

Answer 13

links stress, neurogenesis and hippocampal atrophy

Question 14

what receptors do monoamines (NA and 5-HT) work on

Answer 14

G protein-coupled receptors

Question 15

what receptors does BDNF work on

Answer 15

kinase-linked receptor

Question 16

why aren’t TCAs and MAOI used first line

Answer 16

safety concerns / adverse effects

Question 17

SSRI that can cause antimuscarinic side effects

Answer 17

Paroxetine

Question 18

why do SSRIs cause hyponatraemia

Answer 18

inappropriate secretion of ADH

Question 19

dry mouth and constipation common with

Answer 19

paroxetine

Question 20

are seizures more common with SSRIs

Answer 20

yes -they lower threshold

Question 21

what SSRI is most troublesome with withdrawal

Answer 21

paroxetine

Question 22

when do withdrawal symptoms start with SSRI

Answer 22

24-72 hrs after stopping treatment

Question 23

how often should patients starting antidepressants be reviewed

Answer 23

every 1-2 weeks

Question 24

how long before swithcing depressant due to lack of efficacy

Answer 24

4 weeks (6 in elderly)

Question 25

following remission how long should antidepressants be continued for

Answer 25

6 months (12 in elderly)

Question 26

following remission how long should antidepressant be continued for in GAD

Answer 26

12 months -high risk of relapse

Question 27

following remission how long should antidepressants be continued for in recurrent depression

Answer 27

2 years

Question 28

goal of treating mania and hypomania

Answer 28

remission -resolution of mood symptoms or improvement to the point that only one/ two symptoms are midly present

Question 29

mainstay treatments of bipolar (3)

Answer 29

lithium anticonvulsants antipyschotics

Question 30

carbamazepine=

Answer 30

anticonvulsant

Question 31

lithium=

Answer 31

mood stabiliser

Question 32

lithium contraindicated in (4)

Answer 32

- significant renal impairment - sodium depletion - dehydration - significant cardiovascular disease

Question 33

SE of lithium (4)

Answer 33

- Nausea and diarrhoea - CNS effects -tremor, giddiness, ataxia, dysarthria, memory impairment - hypothyroidism (long-term) - diabetes insipidus

Question 34

severe toxicity of lithium can cause (3)

Answer 34

coma convulsions profound hypertension with oliguria

Question 35

why diabetes insipidus with lithium

Answer 35

reduced distal renal tubule response to ADH

Question 36

when in bipolar should a antidepressant be avoided (3)

Answer 36

- rapid-cylcing bipolar disorder - recent history of hypomania - rapid mood fluctuations

Question 37

long-term treatment of bipolar should carry on for

Answer 37

at least 2 years from last manic episode

Question 38

serum lithium monitoring should be taken

Answer 38

12 hours after first dose and then weekly until concentrations stable and then every 3 months

Question 39

target lithium serum concentrations for acute mania or subsyndromal symptoms

Answer 39

0.8-1 mmol/litre

Question 40

renal function, cardiac and thyroid function monitoring with lithium

Answer 40

baseline and every 6 months

Question 41

non-pharmacological choices for bipolar

Answer 41

ECT with severe symptoms

Question 42

psychosis associated with psychiatric disorder if (5)

Answer 42

``` family history present insidious onset onset teens to mid-thirties variable presentation auditory hallucinations ```

Question 43

psychosis associated with medical condition if (4)

Answer 43

- acute onset - onset in forties or older - presents in general medical or intensive care - non-auditory hallucinations (tactile, visual, olfactory)

Question 44

what is used to sedate severely agitated potentially violent patients with psychosis

Answer 44

1st gen antipsychotic | rapidly acting BDZ

Question 45

first line treatment in shcizophrenia

Answer 45

antipsychotic drugs

Question 46

role of antipsychotic drugs

Answer 46

they eliminate or reduce positive symptoms to tolerable level

Question 47

antipsychotics causing weight gain/ diabetes mellitus

Answer 47

``` chlorpromazine clozapine + olanzapine paloperidone quetiapine risperidone ```

Question 48

antipsychotics causing anticholinergic SE and orthostatic hypotension

Answer 48

chlopromazine thioridazine Clozapine

Question 49

type of antipsychotics mainly causing prolactin elevation

Answer 49

1st gen | +2nd gen risperidone, paliperidone

Question 50

clozapine causes (5)

Answer 50

``` weight gain/ diabetes hypercholesterolemia sedation anticholinergic SE orthostatic hypotension ```

Question 51

baseline investigations before starting antipsychotic (8)

Answer 51

- weight - waist circumference - pulse and Bp - fasting glucose, HBA1c - lipid profile - prolactin levels - movement disorders - nutritional and physical activity status

Question 52

when is an ECG required before antipsychotic started (3)

Answer 52

- product characteristics - history of CV disease - inpatient

Question 53

how long in psychosis should you trial a medication at optimum dosage for

Answer 53

4-6 weeks