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PPT > WK 2: mental health > Flashcards

WK 2: mental health Flashcards

1
Q

SSRIs (4)

A

citalopram
fluoxetine
paroxetine
sertraline

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2
Q

SNRI (2)

A

duloxetine

venlafaxine

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3
Q

selective noradrenaline reuptake inhibitor (NRI)

A

reboxetine

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4
Q

serotonin receptor blocker

A

trazodone

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5
Q

TCAs (4)

A

amitriptyline
imipramine
lofepramine
mirtazapine

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6
Q

classic non sedative MAOI (2)

A

phenelzine

tranylcypromine

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7
Q

melatonin receptor agonist and serotonin receptor antagonist

A

agomelatine

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8
Q

reversible MAOI

A

moclobemide

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9
Q

what is released from the hypothalamus in response to stress

A

Corticotropin releasing hormone (CRH)

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10
Q

what is released from the anterior pituitary in response to CRH

A

corticotropin

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11
Q

cortisol in depression:

A
  • 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
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12
Q

in depression apoptosis occurs in the

A

hippocampus and prefrontal cortex

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13
Q

Brain derived neurotrophic factor (BDNF) role in depression

A

links stress, neurogenesis and hippocampal atrophy

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14
Q

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

A

G protein-coupled receptors

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15
Q

what receptors does BDNF work on

A

kinase-linked receptor

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16
Q

why aren’t TCAs and MAOI used first line

A

safety concerns / adverse effects

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17
Q

SSRI that can cause antimuscarinic side effects

A

Paroxetine

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18
Q

why do SSRIs cause hyponatraemia

A

inappropriate secretion of ADH

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19
Q

dry mouth and constipation common with

A

paroxetine

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20
Q

are seizures more common with SSRIs

A

yes -they lower threshold

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21
Q

what SSRI is most troublesome with withdrawal

A

paroxetine

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22
Q

when do withdrawal symptoms start with SSRI

A

24-72 hrs after stopping treatment

23
Q

how often should patients starting antidepressants be reviewed

A

every 1-2 weeks

24
Q

how long before swithcing depressant due to lack of efficacy

A

4 weeks (6 in elderly)

25
Q

following remission how long should antidepressants be continued for

A

6 months (12 in elderly)

26
Q

following remission how long should antidepressant be continued for in GAD

A

12 months -high risk of relapse

27
Q

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

A

2 years

28
Q

goal of treating mania and hypomania

A

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

29
Q

mainstay treatments of bipolar (3)

A

lithium
anticonvulsants
antipyschotics

30
Q

carbamazepine=

A

anticonvulsant

31
Q

lithium=

A

mood stabiliser

32
Q

lithium contraindicated in (4)

A
  • significant renal impairment
  • sodium depletion
  • dehydration
  • significant cardiovascular disease
33
Q

SE of lithium (4)

A
  • Nausea and diarrhoea
  • CNS effects -tremor, giddiness, ataxia, dysarthria, memory impairment
  • hypothyroidism (long-term)
  • diabetes insipidus
34
Q

severe toxicity of lithium can cause (3)

A

coma
convulsions
profound hypertension with oliguria

35
Q

why diabetes insipidus with lithium

A

reduced distal renal tubule response to ADH

36
Q

when in bipolar should a antidepressant be avoided (3)

A
  • rapid-cylcing bipolar disorder
  • recent history of hypomania
  • rapid mood fluctuations
37
Q

long-term treatment of bipolar should carry on for

A

at least 2 years from last manic episode

38
Q

serum lithium monitoring should be taken

A

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

39
Q

target lithium serum concentrations for acute mania or subsyndromal symptoms

A

0.8-1 mmol/litre

40
Q

renal function, cardiac and thyroid function monitoring with lithium

A

baseline and every 6 months

41
Q

non-pharmacological choices for bipolar

A

ECT with severe symptoms

42
Q

psychosis associated with psychiatric disorder if (5)

A 
family history present 
insidious onset 
onset teens to mid-thirties 
variable presentation 
auditory hallucinations
43
Q

psychosis associated with medical condition if (4)

A
  • acute onset
  • onset in forties or older
  • presents in general medical or intensive care
  • non-auditory hallucinations (tactile, visual, olfactory)
44
Q

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

A

1st gen antipsychotic

rapidly acting BDZ

45
Q

first line treatment in shcizophrenia

A

antipsychotic drugs

46
Q

role of antipsychotic drugs

A

they eliminate or reduce positive symptoms to tolerable level

47
Q

antipsychotics causing weight gain/ diabetes mellitus

A 
chlorpromazine 
clozapine + 
olanzapine 
paloperidone 
quetiapine 
risperidone
48
Q

antipsychotics causing anticholinergic SE and orthostatic hypotension

A

chlopromazine
thioridazine
Clozapine

49
Q

type of antipsychotics mainly causing prolactin elevation

A

1st gen

+2nd gen risperidone, paliperidone

50
Q

clozapine causes (5)

A 
weight gain/ diabetes 
hypercholesterolemia 
sedation 
anticholinergic SE 
orthostatic hypotension
51
Q

baseline investigations before starting antipsychotic (8)

A
  • weight
  • waist circumference
  • pulse and Bp
  • fasting glucose, HBA1c
  • lipid profile
  • prolactin levels
  • movement disorders
  • nutritional and physical activity status
52
Q

when is an ECG required before antipsychotic started (3)

A
  • product characteristics
  • history of CV disease
  • inpatient
53
Q

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

A

4-6 weeks

PPT (8 decks)

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