Drugs used in Psychiatric Disease

Question 1

What are the core and secondary symptoms of depression and how to they relate to making a diagnosis?

Answer 1

Core symptoms: (need 2 of 3 of these)

Low mood

Anhedonia

Decreased energy

Secondary symptoms:

Sleep disturbance, Hopelesness, Reduced concentration, Irritibility, Self-harm/suicidal thoughts

Question 2

Explain what is meant by the “monoamine hypothesis” of depression

What are the other 2 theories for the pathophysiology of depression?

Answer 2

Depression thought to be due to deficiency of monoamine neurotransmitters (NA and serotonin)

Neurotransmitter Receptor Hypothesis

The Monoamine Hypothesis of Gene Expression

Question 3

What are the 4 types of antidepressant that can be used clinically?

Answer 3

Tricyclic antibiotics (TCAs)

Serotonin and Noradrenaline reuptake inhibitors (SNRIs)

Noradrenaline reuptake inhibitors (NARIs)

Selective Serotonin reuptake inhibitors (SSRIs)

Question 4

Give some examples of SSRIs

Answer 4

Sertraline

Fluoxetine

Citalopram

Question 5

How are SSRIs absorbed?

Where are they metabolised?

Answer 5

In the gut

Metabolised in the liver

Question 6

List some common and some rare side effects of SSRIs

Answer 6

Common: anorexia, nausea, diarrhoea

Rare: precipitation of mania, increased sucicidal intention

Question 7

How to TCAs work?

Answer 7

Inhibit the reuptake of NA at the nerve terminals

Question 8

Give some examples of TCAs

Answer 8

Amitriptyline

Clomipramine

Question 9

How are TCAs absorbed?

Where are they metabolised?

Answer 9

The gut

Metabolised in the liver

Question 10

List some of the side effects of TCAs

Answer 10

CNS: sedation, lowering of seizure threshold

CVS: tachycardia, postural hypotension

GI: constipation

Question 11

What would be some of the consequences of a TCA overdose?

Answer 11

Hypotension

Seizure

Arrhythmias

Tachycardia

Question 12

Give some named examples of SNRIs

Answer 12

Duloxetine

Venlafaxine

Question 13

What is the definition of psychosis?

Answer 13

Lack of contact with reality

Question 14

What are the symtoms of paranoid schizophrenia?

Answer 14

Disturbances in thinking

Hallucinations

Delusions

Unusual speech

Lack of insight

Question 15

What is the definition of a “hallucination”?

Answer 15

A perception in the absence of an external stimulus

(auditory, olfactory, visual, gustatory, tactile)

Question 16

What is the definition of a “delusion”

Answer 16

A fixed false belief that is out of keeping with someones culute or religious belief

Question 17

Briefly explain the dopamine theory of schizophrenia

Answer 17

Theory of disturbed and hyperactive dopaminergic signal transduction leading to schizophrenia

Question 18

What is the evidence that supports the dopamine hypothesis of schizophrenia?

Answer 18

Amphetamine (increases dopamine) causes very similar symptoms to + schizophrenia symptoms

Parkinson’s disease treatment that do the same can induce schizophrenia like symptoms

Dopamine antagonists are used in the treatment of schizophrenia

Question 19

What are the main dopamine pathways and what are they each responsible for?

Answer 19

Mesolimbic: emotional response and behaviour

Meso-cortical: important in arousal and mood

Nigrostriatal: key pathway damaged in PD

Tuberoinfundibular: in hypothalamus and pituitary gland

Question 20

Name some first generation or “typical” antipsychotics

Answer 20

Haloperidol

Chloropromazine

Question 21

Name some atypical antipsychotics

Answer 21

Olanzapine
Risperidone
Quetiapine

Clozapine

Question 22

What is the definition of bipolar disorder?

Answer 22

A mental illness that is assoicated with periodic episodes of depression and hypomania/mania

Question 23

What kind of things might you notice in a patient with mania?

Answer 23

Unusal excitement, happiness or optimism

Overactivity

Poor concentration and short attention span

Poor sleep

Rapid, disordered, caotic speech

Poor judgement

Increased interest in sex

Psychotic symptoms

Question 24

Give some examples of mood stabilisers that might be used in the treatment of bipolar disorder

Answer 24

Lithium - most effective

Sodium valporate - antiepileptic

Carbamazepine- antiepileptic

Lamotrigine - antiepileptic

Question 25

How does Lithium work?

Answer 25

May compete with magnesium and calcium ions Increases 5HT and possibily their receptor sites in long term use Attenuates the effect of neurotransmitters

Question 26

Where is Lithium excreted? What needs to be checked before starting Lithium and every 6 months after?

Answer 26

Via the kidneys Renal function

Question 27

List some of the side effects of Lithium

Answer 27

Memory problems Thirst Polyuria Tremor Weight gain Drowsiness Hair loss Rashes

Question 28

What are the toxic effects of Litihum and how can they be treated?

Answer 28

Vomiting, diarrhoea, coarse tremor, cognitive impairment Treat supportively, anticonvulsants, increase fluid intake, haemodialysis

Question 29

What are the two types of drug used to slow the progression of dementia, give examples of each

Answer 29

Acetyl Cholinesterase Inhibitors: - Donepezil - Galantamine - Rivastigmine NMDA antagonist: -Memantine

Question 30

What is the mechanism of action of Acetyl-cholinesterase inhibitors?

Answer 30

Prevents the production of acetyl-cholinesterase which would normally break down acetylcholine Acetylcholine plays a role in arousal, memory, attention and mood

Question 31

According to NICE Acetyl Cholinesterase inhibitors can be used to treat what?

Answer 31

Mild- moderate dementia

Question 32

According to NICE Memantine can be used to treat what?

Answer 32

Moderate- severe dementia

Question 33

What are the actions of all antipsychotics overtime?

Answer 33

Hours: sedation Hours: tranquilisation Days-weeks: antipsychotic Weeks: activation of negative symptoms Hours/days: extrapyramidal side effects

Question 34

Why might an atypical antipsychotic be more acceptibe to patients that a "typical" antipsychotic such as Haloperidol?

Answer 34

Less extrapyramidal side effects Can be taken once daily Can get as dissolvable preparations

Question 35

List some extrapyramidal side effects (EPSEs)?

Answer 35

Parkinsonism Acute dystonia Akathisia Tardive dyskinesia

Question 36

List some of the things you might see in typical antipsychotic toxicity

Answer 36

CNS depression Cardiac toxicity Risk of sudden death

Question 37

List some of the behavioural, psychological and physical symptoms of anxiety

Answer 37

Behavioural: avoidance Psychological: fear of dying, going crazy Physical symptoms: light headedness, hot/cold flushes, SOB, numbness, nausea

Question 38

What is the first line treatment for anxiety?

Answer 38

Non-pharmacological approaches e.g. CBT

Question 39

Give some examples of benzodiazepines

Answer 39

Diazepam Lorazepam

Question 40

How do benzodiazepines work?

Answer 40

Full agonist of GABA receptor site which leads to enhancement of GABA effects This has inhibitory effects on the brain

Question 41

What property of benzodiazepines means that they diffuse into the CNS rapidly?

Answer 41

They are highly lipid soluble

Question 42

When prescribing benzodiazepines, you should be aware that they can cause the need for an increased dose to have the same effect, known as \_\_\_\_\_\_\_\_\_. Discontinuation of treatment can cause withdrawl, known as \_\_\_\_\_\_\_\_\_\_\_.

Answer 42

Tolerance Dependence

Question 43

List some common, occassional and rare side effects of Benzodiazapines

Answer 43

Common: Drowsiness, dizziness, psychomotor impairment Occassional: dry mouth, blurred vision, GI upset, ataxia, headache Rare: amnesia, restlessness, rash

Question 44

Why should benzodiazapines not be used in pregnancy?

Answer 44

They can cause cleft lip and palate Late in pregnancy: respiratory depression, feeding difficulties in baby

Question 45

Which drug might be useful in reversing the effects of benzodiazapine overdose?

Answer 45

Flumazenil