WK1 Mental health

Question 1

first line medicaiton for GAD

Answer 1

SSRI -Sertraline

Question 2

why are SSRIs and SNRIs used

Answer 2

best combination of efficacy and safety -less serious SE

Question 3

escitalopram=

Answer 3

SSRI

Question 4

paroxetine=

Answer 4

SSRI

Question 5

SNRI=

Answer 5

serotonin and noradrenaline reuptake inhibitor

Question 6

depression treatment with SSRIs initiation –>

Answer 6

start low go slow

Question 7

average clinically meaniful action for SSRI

Answer 7

4 weeks

Question 8

how long should the initial therapeutic SSRI/SNRI dose be continued for

Answer 8

4 - 6 weeks

Question 9

how should an SSRI be increased

Answer 9

in 1-2 week increments until sufficient improvement or maximum dose tolerated

Question 10

how do SSRIs work

Answer 10

inhibit neuronal reuptake of serotonin from synpatic cleft increasing its avalibility for neurotransmission

Question 11

common SSRI side effects (4)

Answer 11

• GI upset
• appetite and weight change
• hypersensitivity reactions incl skin rash
• sexual dysfunction

Question 12

other important SE of SSRIs (6)

Answer 12

• suicidal thoughts
• hyponatraemia
• lower seizure threshold
• prolong OT interval
• serotonin syndrome
• GI bleed

Question 13

how long should a patient experiencing a good clinical response stay on antidepressants for GAD

Answer 13

12 months

Question 14

SSRIs overdose risk compared to TCA and MAOIs

Answer 14

much less

Question 15

venlafaxine=

Answer 15

SNRI

Question 16

SNRI vs SSRI for overdose

Answer 16

SNRI have a greater risk of significant toxicity in overdose

Question 17

symptoms of SSRI overdose

Answer 17

• CNS features (tremor, agitation, fatigue, coma)
• CVS features (tachycardia, hypotension, HTN, prolonged QT etc)
• Rhabdomyolysis
• serotonin syndrome

Question 18

serotonin syndrome=

Answer 18

clinical combination of;

• autonomic instability
• mental status change
• increased neuromuscular tone

Question 19

what typically causes serotonin syndrome

Answer 19

combining two or more serotonergic medications

Question 20

when does serotonin syndrome occur

Answer 20

several days to one week after addition of new agent / dose increase

Question 21

3 most likely to cause serotonin syndrome

Answer 21

sertraline
paroxetine
fluvoamine

Question 22

clinical findings of serotonin syndrome (8)

Answer 22

muscle clonus
ocular clonus 
agitation 
diaphoresis 
tremor 
hyperreflexia 
muscle rigidity 
hyperthermia

Question 23

severe serotonin syndrome can present with (5)

Answer 23

acute hyperthermia 
HTN 
tachycardia 
agitated delirium 
muscle rigidity

Question 24

without intervention serotonin syndrome can result in (7)

Answer 24

rhabdomyolysis
metabolic acidocis, 
renal failure '
seizures 
disseminated intravascular coagulation 
shock

Question 25

treatment of seizures from overdose

Answer 25

benzodiazepines

Question 26

serotonin antagonist (can be used in severe serotonin syndrome)

Answer 26

cyproheptadine

Question 27

prolonged OT interval after SSRI ingestion management

Answer 27

serial ECGs

Question 28

treatment of acute stress disorder

Answer 28

BDZ

Question 29

when does acute stress disorder become PTSD

Answer 29

>4 weeks

Question 30

mirtazapine=

Answer 30

TCA

Question 31

antidepressant treatment for PTSD if

Answer 31

- preference for drug treatment - refusal of specialist psychological therapies - delayed referral

Question 32

main treatment for PTSD

Answer 32

specialist mental health services for trauma focused psychological treatment

Question 33

antidepressants used in PTSD = (2)

Answer 33

paroxetine | mirtazapine

Question 34

prevalence of alcohol dependancy in UK

Answer 34

3.6%

Question 35

% of admitted patients with alcohol use problems

Answer 35

40%

Question 36

pharmacological support for alcoholics

Answer 36

IV thiamine | Chlordiazepoxide

Question 37

which BDZ are preferred in alcohol withdrawal

Answer 37

long-acting BDZ (e.g Diazepam)

Question 38

BDZ effect on GABA-A

Answer 38

increasing opening frequency of GABA-A receptor potentiating neurotransmission

Question 39

what ion does GABA increase the influx of into the neuron

Answer 39

Cl-

Question 40

useful effect of BDZ (6)

Answer 40

``` sedation sleep induction anterograde amnesia anticonvulsant anxiolytic reduces muscle tone ```

Question 41

indication for BDZ

Answer 41

short term relief (2-4 weeks) of anxiety that is disabling or causing unacceptable distress

Question 42

when can BDZ be used to treat insomnia

Answer 42

when its severe, disabling, or causing extreme distress

Question 43

rapid withdrawal of BDZ can be

Answer 43

life threatening

Question 44

symptoms of BDZ withdrawal (6)

Answer 44

``` tremors anxiety perceptual disturbances dysphoria psychosis seizures ```

Question 45

onset of withdrawal from BDZ

Answer 45

24-28 hrs --> 3 weeks (depending on half-life)

Question 46

how long do the symptoms of BDZ withdrawal last

Answer 46

1-2 weeks

Question 47

treatment of BDZ withdrawal

Answer 47

IV diazepam titrated to effect tapered gradually over months once symptoms controlled

Question 48

symptoms of alcohol withdrawal start how long after stopping drinking

Answer 48

6-12 hours

Question 49

peak incidence of seizures after stopping drinking

Answer 49

36 hours

Question 50

peak incidence of delirium tremens after stopping alcohol

Answer 50

48-72