Mental Health

Question 1

What are the three core symptoms of depression?

Answer 1

Low mood
Anhedonia
Anergia

Question 2

What are the five physical symptoms of depression?

Answer 2

Sleep disturbances
Lack of motivation and concentration
Self Harm and Pain

Question 3

Which antidepressant has the greatest number of side-effects?

Answer 3

Amitryptiline (TCA)

Question 4

How long do you need to take antidepressants for?

Answer 4

6-9 months

Question 5

What are the six withdrawal symptoms when stopping antidepressants?

Answer 5

FINISH
F-Flu like symptoms
I- Insomnia
N- Nausea
I- Instability
S- Sensory Disturbances
H- Hyperarousal

Question 6

List four positive symptoms of schizophrenia

Answer 6

Paranoia, Hallucinations, Delusions and Thought disorder

Question 7

List four negative symptoms of schizophrenia

Answer 7

Lack of motivation, Social withdrawal, Apathy, Anhedonia

Question 8

Name the four pathways anti psychotics interfere with

Answer 8

Mesolimbic pathway - Positive symptoms
Mesocortical - Negative symptoms
Nigrostriatal Pathway - EPSE
Tuberoinfundibular Pathway - Prolactin

Question 9

Name the four EPSEs, symptoms, onset duration and treatment

Answer 9

• Dystonia, Oculogyric crisis, Hours or years, Switch Anticholinergic
• Tardive dyskinesia, Orofacial dyskinesias, Months - years, Stop anticholinergic, Reduce dose, Switch
• Pseudoparkinsonism, Tremor, Days - weeks, Reduce dose Switch
• Akathisia, Restlessness, Hours - weeks, Reduce dose
Switch, Something unlicensed

Question 10

Describe what monitoring is required for patients for clozapine. Give the name of the enzyme which metabolizes clozapine and an example of a clozapine inducer and an inhibitor

Answer 10

Aim for 0.35-0.5 mg/L, if the concentration exceeds 0.6mg/L, then it is likely the patient may have seizures so seizure prophylaxis should be given.
CYP450 1A2- Inducer - Tobacco, Inhibitor - Fluvoxamine

Question 11

What side-effects should be monitored when using clozapine? List any healthy - dangerous ranges for any of them

Answer 11

PANCYTOPENIA- check WBCs, neutrophils and platelets. Orange Range- WBC - 3.0-3.510^9/L, Platelets 1.5-2.010^9/L. Red range- WBC < 310^9/L, Platelets < 1.510^9/L
Constipation, Mycoarditis (inflammation of the heart), Seizures and Pneumonia

Question 12

Define Bipolar Affective Disorder

Answer 12

Fluctations between mania and major depression

Question 13

Why is lithium dosing problematic for those with bipolar disorder?

Answer 13

Lithium concentrations are inflenced by dehydration, sodium levels, Addison’s disease. Lithium interacts with NSAIDs and different brands of lithium have different properties. Prescribing should include the brand and strength in mg. Lithium patients should have a purple book.

Question 14

When advising a woman taking valproate, what other drug(s) may you recommend?

Answer 14

A contraceptive and 5 mg of Folic Acid

Question 15

What is the ideal option for treating bipolar?

Answer 15

Fluoxetine + olanzapine or quetiapine

Question 16

What are the different treatments for depression? Which are 1st, 2nd and 3rd line?

Answer 16

1) SSRIs- Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine
2) TCAs- Amitriptyline, Imipramine, Dosulepin, Lofepramine
3) MAOIs (reverisibile for MAOa- moclobemide), (irreversible phenelzine, isocarboxazid)
SNRIs- Reboxetine, Venlafaxine
Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) - Mirtazapine

Question 17

What are the MOA of all the different antidepressants?

Answer 17

1) SSRIs- Inhibits the selective serotonin reuptake proteins in the synapse - increases duration of neurotransmitter in the synapse
2) TCAs- inhibits the reuptake of noradrenaline and serotonin
3) MAOIs- inhibits MAO-a which would break down biological amines
SNRIs- Inhibits the selective noradrenaline reuptake proteins in the synapse - increases duration of neurotransmitter in the synapse
Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) - Mirtazapine