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Psychiatric Disease Flashcards

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1
Q

Factors affecting risk of developing a psychiatric disease?

A 
Genetics
Life events eg divorce, bereavement
Individual personality
Coping skills
Social support
Environmental influences such as viruses, toxins and other diseases
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2
Q

What would be a biological predisposing, precipitating and perpetuating factor?

A

Predisposing - genetics
Precipitating - cannabis use
Perpetuating - not complying with medication

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3
Q

What does depression present with?

A

2 of the 3 core symptoms

  • low mood
  • anhedonia (lack pleasure in anything)
  • decreased energy

Associated symptoms

  • loss of concentration
  • decreased appetite
  • sleep disturbance
  • irritability
  • suicidal thoughts
  • self harm
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4
Q

What is thought to be the underlying pathology in depression?

A

Monoamine neurotransmitters eg noradrenaline and serotonin are deficient

Or…

Depletion of or abnormalities in receptors for the monoamine transmitters at the post-synaptic membrane, despite adequate neurotransmitter levels

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5
Q

Name the four classes of anti-depressants and give an example of each

A

Selective serotonin reuptake inhibitors

  • fluoxetine
  • citalopram
  • paroxetine
  • sertraline

Tricyclic anti-depressants

  • amitryptiline
  • imipramine
  • clomipramine

Serotonin-noradrenaline re-uptake inhibitors

  • venlafaxine
  • duloxetine

Monoamine oxidase inhibitors

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6
Q

Mechanism of action of selective serotonin reuptake inhibitors

A

Prevent reuptake of serotonin by the pre-synaptic membrane

Increases 5-HT concentration in the synaptic cleft

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7
Q

Absorption, metabolism and elimination of selective serotonin re-uptake inhibitors?

A

Absorbed from the gut
Metabolised by the liver
Long elimination - once daily dose

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8
Q

ADRs of selective serotonin reuptake inhibitors?

A

Anorexia
Nausea
Diarrhoea

Mania
Increased social ideation
Tremor
Extra-pyramidal syndromes

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9
Q

When are selective serotonin reuptake inhibitors used?

A

Moderate to severe depression

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10
Q

What is an important ADR of citalopram?

A

Torsades de Pointes

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11
Q

How do tricyclics antidepressants (TCAs) work?

A

Block re-uptake of 5-HT and NA by the pre-synaptic membrane

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12
Q

Absorption, metabolism and half-life of TCAs?

A

Absorbed in the gut
(Lipid soluble)

Metabolised by the liver
Long half-life

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13
Q

ADRs of TCAs?

A

CNS:

  • sedation
  • impaired psychomotor function
  • lower seizure threshold

ANS

  • reduced glandular secretions
  • eye accommodation block

GI
-constipation

CVS

  • tachycardia
  • postural hypotension
  • impaired myocardial contractility
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14
Q

When are TCAs used?

A

Not a lot

  • have many side effects
  • can block α-1 adrenoceptors, suppressing NA transmission
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15
Q

Mechanism of action of serotonin-noradrenaline re-uptake inhibitors (SNRIs)?

A

At low doses, affect 5HT only

At higher doses, block reuptake of noradrenaline also

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16
Q

Absorption and half life of SNRIs?

A

GI absorption

Short half-life

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17
Q

ADRs of SNRIs?

A

Same as SSRIs

  • anorexia, nausea, diarrhoea
  • mania, increased suicidal ideation, tremor, extra-pyramidal syndromes

Plus

  • sleep disturbances
  • raised BP
  • dry mouth
  • hyponatraemia
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18
Q

When are SNRIs used?

A

As second or third line drugs

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19
Q

Mechanism of action of monoamine oxidase inhibitors?

A

Block degradation of neurotransmitters

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20
Q

When are monoamine oxidase inhibitors used?

A

Rarely - highly toxic

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21
Q

Which class of anti-depressants can cause withdrawal syndrome if suddenly stopped?

A

SNRIs (eg venlafaxine, duloxetine)

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22
Q

Define psychosis

A

When patients are not in touch with reality

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23
Q

What are the positive symptoms in paranoid schizophrenia?

A

Hallucinations
Disturbances of thinking
Delusions
Behavioural change

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24
Q

What are the negative symptoms seen in paranoid schizophrenia?

A

Social withdrawal

Unusual speech and though

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25
What are some cognitive symptoms and affective symptoms seen in paranoid schizophrenia?
Cognitive - selective attention - poor memory - reduced abstract though Affective - anxiety - depression
26
What are hallucinations?
A perception in the absence of an external stimulus eg auditory, olfactory, visual, gustatory, tactile
27
What is a delusion?
A fixed false belief that is out of keeping with someone's culture or religious belief
28
What is thought to be the underlying pathophysiology of paranoid schizophrenia?
There is an excess of dopamine being released by the brain
29
What are the main dopamine pathways in the brain and what are they important for?
Meso-limbic: emotional response and behaviour Meso-cortical: arousal and mood Nigrostriatal: control of movement - damaged in Parkinson's Tuberoinfundibular: function of the hypothalamus and pituitary gland
30
Mechanism of action of drugs used to treat paranoid schizophrenia?
D2 antagonism, blocking the dopamine pathways Produce sedation and tranquilisation within first few hours and anti-psychotic effects set in within a few days
31
General ADRs of dopamine antagonists for schizophrenia?
Enhanced negative and cognitive symptoms Potential dyskinesia Hyperprolactinaemia
32
What molecular effects can typical D2 anti-psychotics have?
D2-antagonist in the CNS Anticholinergic effects α-adrenergic blockade Antihistamine effect
33
What extra-pyramidal side effects can typical anti-psychotics cause?
Parkinsonism Acute dystonia Akathasia (constant motion) Tardive dyskinesia
34
What is the really serious side effect that typical anti-psychotics can cause?
Neuroleptic malignant syndrome - severe rigidity, hyperthermia, increased CPK and autonomic lability - fluctuating consciousness and confusion - medical emergency, 10% mortality
35
What are some other ADRs of typical anti-psychotics?
Postural hypotension Weight gain Prolactinaemia Pigmentation
36
What can an overdose of typical anti-psychotics cause?
CNS depression Cardiac toxicity - prolonged QTC Risk of sudden death
37
Name some typical anti-psychotics
Haloperidol | Chloropromazine
38
When else is haloperidol used?
In an acute emergency setting for sedation and tranquilisation
39
Name some atypical anti-psychotics
Olanzipine Risperidone Clozapine Quetiapine
40
ADRs of atypical anti-psychotics
Better than typical because they're newer Excessive weight gain (olanzapine) due to effects on satiety centres, never feel full Increased prolactin secretion (risperidone) Extra-pyramidal side effects (less common) Postural hypotension Cardiac toxicity (long QT syndrome)
41
Advantages of atypical anti-psychotics over typical?
Fewer extrapyramidal side effects so more acceptable to the patient Different preparations eg dissolvable Some can be taken once a day Differing side-effect profiles can be matched to the patient's characteristics
42
What is anxiety?
A fear out of proportion of the situation so that individuals undergo avoidance of the certain scenario May have physical symptoms
43
What are the symptoms of anxiety?
Light-headedness Shortness of breath Hot or cold flushes Fear of dying or going crazy
44
First line treatment of anxiety?
CBT - gradually increase the exposure threshold by working up stage by stage
45
When are pharmacological agents used in anxiety?
As adjuncts in severe cases
46
Which drugs are used for anxiety?
Benzodiazepines (anxiolytics) Anti-depressants Anti-psychotics
47
Mechanism of action of benzodiazepines?
Enhance the effects of GABA by acting on GABA receptors -bind to BZD receptors of which there are two groups, high affinity and low affinity -high affinity group is important for the anxiolytics, hypnotic and anti-convulsants effects
48
Bioavailability of BZDs?
Almost 100% | Reaches max concentrations 30-90 mins after taking them
49
Distribution of BZDs?
Highly lipid soluble so diffuse through the CNS rapidly
50
Excretion and half life of BZDs?
Excreted via kidneys | Long half life
51
ADRs of BZDs?
Drowsiness Dizziness Psychomotor impairment ``` Dry mouth Blurred vision GI upset Ataxia Headache Hypotension Amnesia Restlessness Rash ```
52
Effect of taking BZDs in pregnancy?
Can cause a cleft lip | Respiratory depression and feeding difficulties
53
What are the withdrawal effects of BZDs?
Insomnia Agitation Anxiety -can build up a tolerance
54
How can BZDs cause death?
Overdose - however they are rare | Respiratory depression
55
Treatment of a BZD overdose?
Flumazenil - acts as a BZD antagonist on the GABA receptor Only give if you are sure that no other drug has been taken with the benzodiazepine
56
What is bipolar characterised by?
Episodes of depression and hypomania and then mania
57
Symptoms of mania?
Feeling unusually excited, optimistic, happy or irritable Overactive Poor concentration and attention span Rapid speech, jump from one idea to another Poor judgement eg over-spending Increased interest in sex Psychotic symptoms such as hallucinations, grandiose delusions
58
Which drugs are used in the treatment of bipolar?
``` Lithium Sodium valproate Carbamazepine Lamotrigine Atypical anti-psychotics ```
59
Mechanism of action of lithium?
Theories -affect electrolytes and channels: may compete with magnesium and calcium ions - neurotransmitters: increases 5-HT, chronic lithium can reduce 5-HT a receptor sites - second messenger systems: Li attenuates the effects of certain neurotransmitters on their receptors without altering receptor density
60
How is the dose of lithium decided?
Narrow therapeutic window so dose needs to start low and be gradually titrated upwards Levels are monitored at least 3-monthly
61
What tests need to be checked before starting lithium?
Renal and thyroid function before starting and every six months
62
How is lithium excreted?
Renally | -nephrotoxic
63
Uses of lithium?
Prophylaxis of mania and depression in bipolar disorder Augmentation of anti-depressants in unipolar depression where anti-depressants are not enough Evidence for reducing suicidality Best evidence of all mood-stabilisers
64
ADRs of lithium?
``` Memory problems Thirst and polyuria Tremor Drowsiness Weight gain Hypothyroidism Nephrotoxic Hair loss Rashes ```
65
What can an overdose of lithium cause?
``` Vomiting and diarrhoea Coarse tremor Dysarthria Cognitive impairment Restlessness Agitation Coma and death ```
66
Treatment of a lithium overdose?
Supportive - fluids Anticonvulsants Haemodialysis
67
General mechanisms of action of drugs for psychiatric disease?
Agonists or antagonists of neurotransmitter receptors Inhibit regulatory enzymes

Pharmacology (23 decks)

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