Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

3A REVISION > PSYCHIATRY > Flashcards

PSYCHIATRY Flashcards

(225 cards)

Start Studying
1
Q

What is dementia?

A

A clinical syndrome of acquired, progressive usually irreversible global deterioration of higher cortical function in clear consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name 5 areas of cortical deterioration that can occur in dementia

A 
Memory
Orientation
Language
Comprehension
Judgement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name 3 coexisting conditions often present with dementia

A

Behavioural problems
Depression/anxiety
Psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does dementia present?

A

Can be months/years after onset

25% have dementia over 90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cutoff for early onset dementia?

A

Under 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common type of dementia?

A

Alzheimer’s dementia, 55% of dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the onset of Alzheimer’s disease?

A

Gradual with memory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name 3 changes observed in the brain in Alzheimer’s disease

A

Shrunken brain with sulcal widening and enlarged ventricles
Neuronal loss
Neurofibrillary tangles and amyloid plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the amyloid cascade hypothesis? (4)

A

Alzheimer’s is caused by too much beta amyloid protein production and not enough clearance
Beta amyloid forms amyloid plaques, cleaved from amyloid precursor protein by secretase
Build up also causes Tau dysfunction and neurofibrillary tangle formation
Leads to toxicity, inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What neurotransmitters are deficit in Alzheimers? (3)

A

Acetylcholine
Noradrenaline
Serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What gene mutation is associated with early onset Alzheimer’s?

A

Amyloid precursor protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes Alzheimers? (7)

A 
Age
Low education
Obesity
Depression
Social/physical inactivity
Genes
Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give 4 typical symptoms of Alzheimer’s

A

Memory impairment
Dysphasia
Visuo-spatial impairment
Problem solving/reasoning deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of Alzheimer’s?

A

Acetylcholinesterase inhibitors compensate for loss of acetylcholine
NMDA (glutamate) receptor antagonist prevents excitatory neurotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 3 acetylcholinesterase inhibitors

A

Galantamine, donepezil, rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name a NMDA receptor antagonist

A

Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

General management of Alzheimer’s? (4)

A

Treat other causes such as infection
Manage psychosis, aggression
Social support/nursing care
Group cognitive stimulation or behaviour management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is vascular dementia?

A

Focal neurological symptoms appearing in a stepwise manner after strokes, associated with more patchy cognitive impairment than Alzheimer’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is mixed dementia?

A

Vascular and Alzheimer’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the pathophysiology of vascular dementia?

A

At least one area of the brain infarcted on CT

9 times risk of dementia in year after stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risk factors for vascular dementia? (4)

A

Hypertension
High cholesterol
Diabetes
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Symptoms of vascular dementia? (4)

A

Depends on area of brain affected
Stepwise cognitive impairment, memory decline
Behavioural and affective changes
Motor changes - hemiparesis, bradykinesia, ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is dementia with Lewy bodies?

A

Dementia associated with the presence of Lewy bodies and neurites in the basal ganglia and cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptoms of dementia with Lewy bodies? (5)

A 
Fluctuating cognition and alertness
Vivid visual hallucinations
Spontaneous Parkinsonism
Sensitivity to antipsychotics
Sleep disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the link between dementia and Parkinson's?
25% of people with Parkinson's will develop dementia | 80% still alive after 20 years will have dementia
26
How is Parkinsons dementia differentiated from dementia with Lewy bodies?
If Parkinson's precedes the dementia by >1 year, it is Parkinson's dementia - i.e. motor symptoms first
27
What are the two types of Lewy body dementia?
Dementia with Lewy bodies | Parkinson's dementia
28
How is dementia with Lewy bodies treated?
Cholinesterase inhibitors (rivastigmine) Possibly memantine Caution with antipsychotics as high sensitivity Social care, therapy
29
What is frontotemporal dementia?
Characterised by early personality changes and relative intellectual changes, with a younger mean age of onset
30
Pathological changes in frontotemporal dementia?
Affects frontal and temporal lobes Loss of spindle neurons Ubuquitin or tau positive inclusions
31
Symptoms of frontotemporal dementia? (5)
``` Changes in behaviour and conduct Loss of social awareness Poor impulse control Impaired comprehension Difficulty with speech production ```
32
Treatment of frontotemporal dementia?
Cholinergic systems not affected so can't use AD drugs SSRIs may help disinhibition/impulses Social care/therapy
33
What is normal pressure hydrocephalus?
Excess fluid accumulation in the ventricles without much increase in pressure overall, but may have local pressure effects
34
What causes normal pressure hydrocephalus? (4)
``` Idiopathic Subarachnoid haemorrhage Head injury Meningitis all cause expansion of lateral cerebral ventricles ```
35
Symptoms of normal pressure hydrocephalus? (4)
Marked mental slowness Apathy Wide based gait Urinary incontinence
36
Name a local affect of increased pressure in normal pressure hydrocephalus
Traction on frontal and limbic fibres surrounding the ventricles
37
Treatment of normal pressure hydrocephalus?
Ventriculoperitoneal shunt to drain fluid into abdomen | May only improve symptoms in some, has complications
38
What is Creutzfeldt-Jakob disease?
Fatal brain disorder - 90% die in 1 year, onset around 60
39
What causes Creutzfeldt-Jakob disease?
Prion proteins - misfolded proteins that can disrupt normal proteins, causing cell disruption and death Mostly spontaneous
40
What is a non spontaneous cause of Creutzfeldt-Jakob disease?
Eating beef infected with bovine spongiform encephalopathy, mainly affects younger people
41
Early symptoms of Creutzfeldt-Jakob disease? (3)
Minor lapses of memory Mood changes Apathy
42
Later symptoms of Creutzfeldt-Jakob disease? (8)
``` Clumsiness Decreased coordination Slurred speech Jerky, involuntary movements Weakness Dementia Incontinence Coma ```
43
Treatment for Creutzfeldt-Jakob disease?
None, opioids for pain, clonazepam for movement
44
What is Huntington's disease dementia?
Dementia occurring at any stage of the progressive, inherited Huntington's disease
45
Symptoms of Huntington's disease dementia? (7)
``` Abnormal movements and coordination (Huntington's) Mood problems Cognitive impairment Difficulty with planning/organisation Difficulty concentrating Short term memory loss Obsessive behaviour ```
46
How does Huntington's disease dementia differ from Alzheimer's dementia?
Recognition of people and places is intact until the very late stages
47
Treatment for Huntington's disease dementia?
None for the dementia | Anti-depressants
48
What is HAND?
HIV Associated Neurocognitive Disorder, affects up to 50% of HIV patients
49
What causes HAND?
Either by HIV directly damaging the brain or the weakened immune system enabling other infections to damage to brain
50
(5) Symptoms of HAND?
``` Difficulties with memory Thinking and reasoning difficulties Decision making difficulties Learning difficulties Mood problems ```
51
Treatment of HAND?
At least 3 antiretrovirals, prevents cognitive impairment worsening - may reverse it Rehabilitation
52
What is neurosyphilis?
Infection of the brain/spinal cord caused by Treponema pallidum, usually occurs in chronic untreated syphilis 10-20 years after first infection
53
Symptoms of neurosyphilis? (8)
``` Blindness Confusion Personality change Memory loss Depression Mood disturbance Psychosis, visual disturbance Seizures ```
54
How is neurosyphilis treated?
Penicillin - early diagnosis critical
55
What is Wilson's disease?
Genetic disease where copper builds up in the body, symptoms related to liver and brain begin anytime from 5-35
56
Symptoms of Wilson's disease? (7)
``` Itching, vomiting, oedema (liver) Dysarthria Personality changes Tremors Visual/auditory hallucinations KAISER FLEISCHER RINGS - dark rings circling iris Impaired judgement Mild cognitive deterioration - slow thinking, memory loss ```
57
What causes Wilson's disease?
Autosomal recessive disorder caused by mutation in the Wilson disease protein gene (ATP7B)
58
Treatment of Wilson's disease? (4)
Low copper diet, avoid copper cookware Chelating agents - trientine, d-penicillamine Zinc supplements Liver transplant if severe
59
What are the two types of dementia?
Cortical and subcortical
60
Where to cortical and subcortical dementias affect?
Cortical - cerebral cortex | Subcortical - basal ganglia, thalamus
61
Types of cortical and subcortical dementias?
Cortical - Alzheimer's, frontotemporal, possibly vascular | Subcortical - Parkinson's, Huntington's, AIDS dementia, alcohol related dementia
62
Symptoms of cortical dementias? (4)
Memory impairment Dysphasia Visuospatial impairment Problem solving and reasoning deficits
63
Symptoms of subcortical dementias? (7)
``` Psychomotor slowing Impaired memory retrieval Depression Apathy Executive dysfunction Personality change ```
64
What is delirium?
Acute confusional state characterised by the rapid onset of a global but fluctuating dysfunction of the CNS due to an underlying infectious, vascular, epileptic or metabolic cause
65
How common is delirium?
Occurs in 1/3 of patients admitted to hospital, increases mortality and morbidity
66
Diagnosis of delirium? (5)
Impaired consciousness and attention + perceptual disturbance + cognitive disturbance + acute onset and fluctuating + evidence of physical cause
67
Types of delirium?
Hypo and hyperactive
68
Symptoms of delirium? (9)
``` Fluctuating mood Irritability, confusion, distraction Apathy and depression Transient persecutory, self referential delusions Sweating, tachycardia, dilated pupils Visual hallucinations Memory loss Incoherent speech Day drowsiness, evening alertness ```
69
Risk factors for delirium? (7)
``` Over 65 Dementia or Parkinson's Hip fracture Illness Infection Hypoxia Low B12/folate ```
70
Differences between delirium and dementia? (4)
Delirium is more rapid onset Delirium is more fluctuating course Delirium has clouded consciousness Delirium has vivid, complex thoughts and hallucinations
71
Investigations of delirium? (6)
``` Ask about premorbid personality Drugs/alcohol screen Look for trauma Bloods - FBC, inflammatory markers, U+E, LFT, TFT, calcium, B12/folate MSU CXR, Head CT/MRI ```
72
Management of delirium? (5)
``` Identify and treat underlying pathology Short term antipsychotic or benzodiazepine Maximise orientation and hydration Reduce constipation Reduce polypharmacy ```
73
What is frontal lobe syndrome?
Damage to the prefrontal regions of the frontal lobe, characterised by deterioration of behaviour and personality
74
Cause of frontal lobe syndrome? (6)
``` Head injury Stroke Infection Tumour Frontotemporal dementia Genetics ```
75
Symptoms of frontal lobe syndrome? (6)
``` Lack of spontaneous activity Trouble with speech Loss of concentration Preserved memory but apathy Loss of abstract thought Perseveration Can be withdrawn or uninhibited - mood change ```
76
Investigations of frontal lobe syndrome?
To find cause - e.g. brain imaging, inflammatory markers
77
Management of frontal lobe syndrome? (4)
Supportive care Supervision if risky Respite care Therapy e.g. speech and language
78
What are complex partial seizures?
Focal onset seizures, most common type in adult epilepsy, begin in one side of the brain - often frontal or temporal - and may produce impaired awareness
79
How is depression related to complex partial seizures?
Can occur in pre-ictal and ictal phases More common post-ictal Very common inter-ictal
80
How is psychosis related to complex partial seizures?
Rare pre-ictal Can occur during a seizure or post ictal Can develop inter-ictally, especially if temporal lobe
81
Symptoms of psychosis in complex partial seizures?
Similar to schizophrenia - delusions, depressive/manic psychosis, visual hallucinations
82
How are psychotic features of epileptic seizures treated?
Antipsychotics with least effect on seizure threshold - haloperidol
83
How is cognitive impairment related to epileptic seizures?
Common due to medication or persistent abnormal brain supply
84
What psychiatric symptoms can occur in hyperthyroidism? (3)
Depression and anxiety Irritability, apathy Psychotic depression
85
What psychiatric symptoms can occur in hypercortisolaemia (Cushing's)? (2)
Depression | Mania
86
What psychiatric symptoms can occur in hypocortisolaemia (Addison's)? (2)
Depression | Apathy
87
What psychiatric symptoms can occur in hypopituitarism? (3)
Depression Irritability Impaired memory
88
What psychiatric symptoms can occur in phaeochromocytoma?
Episodic anxiety
89
What psychiatric symptoms can occur in hypothyroidism, hyperparathyroidism, and primary hypoparathyroidism? (6)
``` Depression and anxiety Acute agitation, emotional lability Apathy Hallucinations after parathyroidectomy Dementia Delirium ```
90
What is psychosis?
Misinterpretation of thoughts and perceptions that arise from the patient's mind as reality, including delusions and hallucinations
91
What are the first rank symptoms of schizophrenia?
Delusional perception Thought interference (insertion, withdrawal, broadcast) Passivity phenomena (inc. somatic) Auditory hallucinations
92
What are the second rank symptoms of schizophrenia? (5)
``` Persecutory delusions Delusions of reference Persistent hallucination of any modality Neologisms or other thought disorder/disorganised speech Negative symptoms ```
93
How is a diagnosis of schizophrenia made?
One first rank symptom or one of persecutory delusions and delusions of reference Or two of the other second rank symptoms Persisting for at least 1 month
94
When is the peak incidence of schizophrenia?
Late teens/early adulthood
95
What are positive symptoms of schizophrenia? (3)
Delusions, hallucinations, formal thought disorder
96
What are negative symptoms of schizophrenia? (5)
``` Poverty of speech Flat affect Poor motivation Social withdrawal Lack of concern for social conventions ```
97
What are cognitive symptoms of schizophrenia? (2)
Poor attention | Memory loss
98
What is paranoid schizophrenia? 2 symptoms
The most common type of schizophrenia with persecutory delusions and auditory hallucinations prominent Often lack of negative symptoms
99
What is hebephrenic schizophrenia? 4 symptoms
Often early onset and poor prognosis Characterised by irresponsible, unpredictable behaviour, innapropriate mood and incongruous affect - giggling, odd mannerisms Incoherent thoughts, fleeting delusions and hallucinations
100
What is residual schizophrenia? 2 symptoms
When there has been a history of another type of schizophrenia and in the current illness, negative and cognitive symptoms predominate
101
What is catatonic schizophrenia? 4 symptoms
Uncommon Psychomotor disturbances prominent, often alternating between stupor and excessive activity Rigidity, posturing, waxy flexibility Echolalia and echopraxia
102
What is simple schizophrenia?
Uncommon | Negative symptoms without overt/preceding psychosis
103
What causes schizophrenia? (4)
Genetics - first degree relative, advanced paternal age Neurodevelopmental problems Social factors Neurochemical changes
104
What is the neurodevelopmental hypothesis?
Factors interfering with early development of the brain increase schizophrenia risk
105
Give 5 examples of the neurodevelopmental hypothesis
``` Winter births (foetus flu exposure) Obstetric complications/perinatal injury Developmental delay/mild neuro symptoms Temporal lobe epilepsy Cannabis use when young Childhood abuse or bullying ```
106
What findings (2) on brain imaging in schizophrenia supports the neurodevelopmental hypothesis?
Increased ventricle size | Loss of grey matter
107
Give 4 examples of social factors predisposing to schizophrenia
Socioeconomic deprivation Urbanity Negative life events e.g. bereavement Family being overbearing
108
What neurochemical changes are present in schizophrenia?
Final common pathway involves dopamine excess (overactivity in mesolimbic dopaminergic pathways), raised serotonin, decreased glutamate
109
What is the treatment of schizophrenia? (4)
Antipsychotics for positive symptoms, to prevent relapse If agitated, IM antipsychotic or benzodiazepine CBT and family therapy Social support and rehabilitation
110
Name 3 typical antipsychotics
Haloperidol Chlorpromazine Supiride
111
What is the major side effect of typical antipsychotics?
Motor problems - extrapyramidal symptoms
112
Name 5 atypical antipsychotics
``` Olanzapine Quietapine Risperidone Amisulpiride Clozapine ```
113
What are 2 side effect of atypical antipsychotics?
Weight gain and diabetes
114
How can adherence of antipsychotics be improved?
Monthly depot injections if do not adhere to oral
115
How long should an antipsychotic be trialled before changing?
4-6 weeks
116
When can clozapine be used?
When at least one typical and one atypical antipsychotic have been used without success
117
What side effects of antipsychotics need to be monitored? (2)
Clozapine - blood tests to check for granulomatosis | Monitor ECG for increased QT syndrome in all
118
How long after a psychotic episode should antipsychotics be continued?
1-2 years 5 years if further episode High risk of relapse if stopped within 6 months
119
What is acute and transient psychosis?
Psychosis lasting less time than needed for schizophrenia diagnosis - <1 month, group of disorders
120
Symptoms of acute/transient psychosis? (5)
``` Acute onset Delusions Hallucinations Perceptual disturbance Disruption of normal behaviour ```
121
How is acute and transient psychosis treated?
Usual spontaneous resolution, may be associated with acute stress If persists treat as it is schizophrenia
122
What is persistent delusional disorder?
Fixed, unshakeable delusion with other areas of thinking and function preserved
123
What are the symptoms of persistent delusional disorder?
Long standing delusion | No hallucinations etc, no evidence of brain disease
124
Treatment of persistent delusional disorder?
Psychotherapy - challenging beliefs | May be reluctant to medication - try antipsychotics
125
What is schizoaffective disorder?
Affective and schizophrenic symptoms occur together with equal prominence, doesn't justify either schizophrenic or depressive/manic diagnosis
126
What are the types of schizoaffective disorder?
Manic, depressive, mixed
127
How is schizoaffective disorder treated? (5)
``` Antipsychotics - paliperidone Mood stabilisers Antidepressants Psychotherapy and group therapy Possible ECT ```
128
What is puerperal psychosis?
Psychosis affecting women after childbirth, usually within 2 weeks of birth
129
Symptoms of puerperal psychosis? (4)
Hallucinations Delusions Mania/depression Confusion
130
What is the treatment of puerperal psychosis? (CBT)
Antipsychotics Antidepressants Mood stabilisers CBT
131
Cause of puerperal psychosis? (3)
Traumatic pregnancy or birth Family history Previous schizophrenia/mood diagnosis
132
What is bipolar disorder?
Disorder characterised by recurrent episodes of altered mood and activity, involving both upswings and downswings
133
What are the 4 types that individual episodes can be in bipolar disorder?
Manic Hypomanic Depressive Mixed
134
What is hypomania?
Less severe form of mania causing less disruption to life, without psychotic symptoms
135
What is a mixed episode in bipolar disorder?
Both manic and depressive, rapid cycling
136
How is bipolar disorder diagnosed?
After at least 2 episodes, at least one of which is hypomanic/manic
137
What are the 2 main types of bipolar disorder?
I - manic and depressive episodes | II - recurrent depressive episodes and hypomania
138
What is mania?
Alteration in mood, usually elated and expansive but can also be irritable, with increased energy and activity
139
Give 5 symptoms of mania
Distractibility Decreased need for sleep Disinhibited - risky sexual or financial behaviour, dangerous driving Heightened senses Rapid thinking and speech - pressure of speech, flight of ideas
140
What psychotic symptoms can occur in mania?
Mood congruent delusions | Auditory hallucinations
141
When does bipolar usually present?
Peak in early 20s and lesser peak around 50
142
What is the cause of bipolar disorder? (6)
Genetic Hypothalamic-pituitary-adrenal and thyroid axes implicated Psychological stress in childhood inc. abuse Sleep disturbance Postpartum Severe physical illness/bereavement - life event
143
How does psychological stress in childhood increase risk of bipolar?
Psychological stress leads to hypothalamic-pituitary-adrenal dysfunction and hypersensitivity to stress
144
How is mania treated? (5)
``` 1st line haloperidol, olanzapine, quietapine, risperidone 2nd line lithium - better long term Benzodiazepines short term/rapid tranq. Psychotherapy Physical monitoring - renal for lithium ```
145
How is depression in bipolar disorder treated?
Antidepressants but only with a mood stabiliser as may precipitate rapid cycling, stop at start of a manic episode
146
What is cyclothymia?
Chronic mood fluctuations over at least 2 years, with episodes of depression and hypomania of insufficient severity to meet bipolar diagnosis May progress to bipolar
147
How is cyclothymia treated? (2)
Lithium | Psychotherapy
148
What is dysthymia?
Persistent depressive disorder, lasting for over 2 years interfering with daily life, usually does not go away for more than 2 months at a time Major depressive episodes may be concurrent
149
Risk factors for developing dysthymia?
Family history Life trauma Negative personality
150
How is dysthymia treated?
Antidepressants | Psychotherapy
151
What is depression?
Common illness that negatively affects thoughts, feelings and actions Characterised commonly by lowering of mood, loss of energy, loss of enjoyment in activity that was previously enjoyable
152
What is the classic triad of depressive symptoms?
Anhedonia Low mood Anergia
153
How is depression diagnosed?
At least two of anhedonia/anergia/low mood present for 2 weeks
154
Other symptoms of depression apart from the classic triad? (9)
``` Reduced concentration Flat affect Low confidence/self esteem Guilt, worthlessness, hopelessness Decreased sleep Decreased appetite Reduced motor activity Thoughts of self harm Low libido ```
155
How is depression classified?
Mild/moderate/severe Depending on how many symptoms, how severe, degree of distress and impact on daily life Depression with psychosis is always severe
156
What is Beck's triad?
Thoughts in depression often include negative thoughts about self, the world and the future
157
What are the biological symptoms of depression? (3)
Decreased sleep Decreased appetite Decreased libido
158
What is the typical sleep pattern in depression?
Early waking, maximal low mood in morning
159
What psychotic features occur in depression? (5)
``` Mood congruent Nihilistic delusions Delusions of guilt Hypochondriacal delusions Auditory, usually 2nd person hallucinations condemning the person or urging them to self harm ```
160
Who is most at risk of depression?
Women, onset usually in 20s
161
Causes of depression? (7)
``` Possibly genetic Monoamine neurotransmitter loss Dysfunctional limbic system and prefrontal cortex Psychosocial factors Treatment with recombinant interferons Severe illness Medications i.e. isotrenoin ```
162
How might antidepressants work on the monoamine neurotransmitters?
Serotonin, noradrenaline levels are reduced in the synaptic cleft in depression Antidepressants increase availability This results in secondary neoplastic changes that bring about antidepressant effect i.e. produce more brain derived neurotrophic factor promoting neurogenesis
163
What are some psychosocial factors implicated in depression? (4)
Recent life trauma Adverse social circumstances Low socioeconomic class Childhood bereavement, abuse
164
How might psychosocial factors lead to depression?
Stress leads to increased cortisol which may cause low mood due to decreased brain derived neurotrophic factor
165
How is mild depression managed? (5)
``` In primary care Treat any physical illness, substance misuse Self help groups Physical activity CBT or IPT if mild ```
166
When are patients with depression referred to psychiatric services? (5)
``` High suicide risk Severe illness Unresponsive to treatment Recurrent depression Bipolar ```
167
How is moderate or severe depression treated?
As mild depression but add antidepressants | At least 6 months, tapered when stopped
168
What are SNRIs? Name 2
Serotonin noradrenergic reuptake inhibitors Venlafaxine Duloxetine
169
What are SSRIs? Name 4
``` Selective serotonin reuptake inhibitors - most common Gluoxetine Citalopram Sertraline Paroxetine ```
170
What is mirtazepine and 3 side effects?
Noradrenergic and specific serotenergic antidepressant | Dry mouth, drowsy, weight gain
171
Name 2 tricylic antidepressants
Amitriptyline | Imipramine
172
What are MAOIs? Name 2
Monoamine oxidase inhibitors Phenelzine Tranylcypromine
173
How do antidepressants generally work?
Increasing neural transmission of monoamines - serotonin, noradrenaline
174
How do SSRIs and SNRIs work?
Inhibit reuptake of neurotransmitters from the synaptic cleft 2nd messengers from monoamine binding to post synapse increase production of BDNF This increases neuroplasticity and neurogenesis in the hippocampus
175
How do MAOIs work?
Inhibit breakdown of neurotransmitters
176
Side effects of tricyclic antidepressants?
Increased CV mortality (arrhythmias) so SSRIs safer in overdose
177
Side effects of SSRIs and SNRIs? (5)
Initial agitation Headache, nausea, anxiety May increase suicidal ideation (except fluoxetine)
178
Management if resistant to antidepressants? (2)
Augment with lithium, atypical antipsychotic or another antidepressant ECT if severe especially with psychosis or stupor
179
Why is effective treatment important in the initial depressive episode?
Recurrent episodes tend to be more severe and shorter disease-free periods if not treated effectively first time
180
What are post partum blues?
Normal low mood, affect 30-50% of women after childbirth
181
Symptoms of post partum blues? (4)
Emotional lability Crying Irritability Worried abot coping
182
Cause of post partum blues?
Elevated prepartum progesterone, big postpartum fall in oestrogen and progesterone implicated
183
How is post partum blues treated?
Self resolving within a few days usually | Reassure and ensure supported
184
How common is postpartum depression and when does it occur?
10-15% of new mothers, mainly first week but can be up to the first year after birth
185
Symptoms of post partum depression? (5)
``` Similar to depression but also: Guilt/anxiety over the baby Feeling inadequate Unreasonable fears Reluctance to feed or bond Possible feelings of harming the baby ```
186
Risk factors for postpartum depression? (5)
``` History of depression Low socioeconomic class Single mother Lack of support Traumatic birth ```
187
How is postpartum depression treated?
Psychotherapy | Antidepressants if needed - risk when breastfeeding to baby
188
Why is it important to recognise and treat postpartum depression?
Prolonged maternal depression may affect later social and cognitive development of the child
189
What is suicide?
Intentional self inflicted death
190
Epidemiology of suicide?
8/100,000 annually More men than women Especially middle aged men
191
What is self harm?
Intentional non fatal self inflicted harm
192
Epidemiology of self harm?
3/1000 annually More women than men Mostly young women
193
Causes of suicide and self harm? (4)
Availability of means Lack of social support Traumatic life events Mental illness
194
What mental illnesses predispose to self harm/suicide? (5)
``` Depression Schizophrenia Substance misuse Emotionally unstable/antisocial PD Eating disorder ```
195
3 further causes of suicide?
Chronic painful illnesses Family history of suicide Decreased brain derived neurotrophic factor at postmortem
196
3 further causes of self harm?
Unemployed Divorce Socioeconomic deprivation
197
What are the 3 types of suicide?
Altruistic - for the good of society Anomic - reflects a society's disintegration, loss of common values Egoistic - an individual's separation from otherwise cohesive social groups
198
Suicide prevention strategies? (5)
``` Detect and treat psychiatric disorders Respond to risk Prescribe safely Manage self harm well Reduce availability of means ```
199
2 most common types of self harm?
Overdose | Physical self injury - cutting
200
Management of self harm? (6)
``` Medical stabilisation Psych assessment Decrease risk of repitition - address psych illness or social problems Prescribe lower lethality drugs Psych therapy, self help groups Dialectical behaviour therapy ```
201
4 motivators for self harm?
Interruption of a sequence of events Attention Communication attempt Wish to die
202
What needs to be established in a psych assessment of self harm/suicide attempt? (6)
``` Motives Psych illness Planning - leaving a note, will, attempt not to be found Mode of harm Social history History of self harm ```
203
What are the 3 categories of psychological therapy?
Supportive therapies Cognitive and behavioural therapies Psychodynamic psychotherapies
204
What is group therapy?
Emphasises interrelationships within the group where problems are shared
205
What is family therapy?
Systemic or behavioural - improved family functioning will improve patient
206
What is CBT?
Cognitive behavioural therapy, helps to identify and challenge automatic negative thoughts and to modify underlying core beliefs
207
When is CBT used? (5)
``` Depression Anxiety Eating disorders Personality disorders Psychosis ```
208
What are behavioural therapies?
Based on operant conditioning - positive reinforcement of desirable behaviours, withholding reinforcement if negative
209
What are behavioural therapies used for?
Phobias Tourette's Eating disorders
210
What are psychodynamic therapies?
Unstructured, helps with long standing problems, based on psychoanalytic principles - therapist interprets what the patient says and makes links
211
What is transference and counter transference?
Transference - patient experiences strong emotions with the therapist Counter-transference - therapist experiences strong emotions toward the patient
212
What is interpersonal therapy IPT and used for?
For depression, eating disorders | Focusses on interpersonal - close relationships and problems
213
What is dialectical behaviour therapy DBT and used for?
Borderline PD! Esp. self harm | Incorporates CBT, and group skills training for alternative coping strategies
214
What is eye movement desensitisation and reprocessing EMDR and used for?
PTSD Aims to help patients access and process traumatic memories to resolve them Recall the trauma while focussing on an external stimulus
215
What is ECT?
Electroconvulsive therapy, by electric current through electrodes to brain uni or bilaterally temporal
216
How does ECT work? (5)
Induces a modified cerebral seizure, causing neurotransmitter release, hormone secretion, synapto and neurogenesis, increase in blood brain barrier permeability
217
Indications for ECT? (3)
Severe depression Prolonged/severe/unresponsive mania Catatonia When all other treatments failed or if high risk
218
Side effects of ECT?
Cognitive impairment Dysarrhythmias Headache
219
What are the most commonly used anxiolytics?
Benzodiazepines
220
Indications for anxiolytics? (4)
Insomnia Short term for anxiety Alcohol withdrawal Control of violence
221
Effects of anxiolytics? (3)
Sleep inducing Anticonvulsant Muscle relaxant
222
Commonly used hypnotics?
Zopiclone, zolpidem
223
How is benzodiazepine overdose treated?
Flumenazil
224
What is methylphenidate?
Stimulant, used for ADHD (ritalin)
225
Other indications for antidepressants? (5)
``` Phobias PTSD Generalised anxiety Bulimia OCD ```

3A REVISION (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions