PSYCHIATRY

Question 1

how is depression diagnosed?

Answer 1

patient health questionnaire 9 based on DSM IV criteria for MDD

5 positive responses = diagnosis of MDD

Question 2

a positive response to which question on the PHQ-9 triggers an automatic diagnosis of MDD?

Answer 2

suicidal ideation

Question 3

according to the PHQ-9, which two symptoms have to be present (out of 5 in total) to diagnose MDD?

Answer 3

anhedonia

depressed mood

Question 4

what things should be ruled out before reaching an MDD diagnosis?

Answer 4

no psychosis (hence bipolar)
not due to a physiological effects of a substance
not accounted for by bereavement

Question 5

what are the most severe symptoms of depression?

Answer 5

psychosis (guilt)
loss of colour vision
catatonic retardation (inability to move)
suicide

Question 6

are men or women more likely to get depression?

Answer 6

women are twice as likely to be depressed than men

Question 7

from what molecule are catecholamines such as dopamine and noradrenaline synthesised from?

Answer 7

tyrosine

Question 8

from what molecule are indolamines such as serotonin synthesised from?

Answer 8

tryphophan

Question 9

in which region of the brain is noradrenaline synthesised in?

Answer 9

locus cerulus of the pons

Question 10

which region of the brain is serotonin synthesised in?

Answer 10

raphe nuclei (brainstem)

Question 11

which enzyme catalyses the conversion of tyrosine to l-dopa?

Answer 11

tyrosine hydroxylase

Question 12

which enzyme catalyses the conversion of tryptophan to 5-hydroxytryptophan?

Answer 12

tryptophan hydroxylase

Question 13

which enzyme catalyses the conversion of l-dopa and 5-hydroxytryphan to dopamine and 5-hydroxytryptamine (5-HT) respectively?

Answer 13

l-aromatic amino acid decarboxylase

Question 14

what enzymes cause reuptake and degradation of serotonin at the synapse? (2)

Answer 14

SERT

MAO-A

Question 15

what enzymes cause reuptake and degradation of noradrenaline at the synapse? (3)

Answer 15

NET
MAO-A
COMT

Question 16

COMT functions to promote reuptake of which neurotransmitter?

Answer 16

noradrenaline

Question 17

what is the precise function of MAO-A?

Answer 17

degrades noradrenaline and serotonin after reuptake in synaptic terminal

n.b. some degradation occurs in synapse

Question 18

what is the precise function of the NET/SERT proteins?

Answer 18

reuptake of noradrenaline and serotonin for recycling/degradation

Question 19

which subtype of noradrenergic receptor is of most clinical importance in psychiatry? Why?

Answer 19

a2 adrenoreceptor

acts through inhibitory G proteins to supress noradrenaline release via negative feedback loop

Question 20

which antidepressant drug is a a2 adrenoreceptor antagonist?

Answer 20

mirtazapine

Question 21

what is the relationship between synaptic noradrenaline release and synaptic 5-HT release?

Answer 21

noradrenaline release causes more 5-HT release

Question 22

what effect on 5-HT does a1 adrenoreceptor activation have?

Answer 22

INCREASES 5-HT

Question 23

what are the effects of a2 autoreceptor activation on naradrenaline?

Answer 23

DECREASES NORADRENALINE

Question 24

what are the effects of a2 heteroreceptor activation on 5-HT release?

Answer 24

DECREASES 5-HT

Question 25

what are MOA-A inhibitors used to treat?

Answer 25

MDD MAO-A degrades 5HT and NA

Question 26

what are MOA-B inhibitors used to treat?

Answer 26

Parkinsons MOA-B degrades DOPAMINE

Question 27

name 1 REVERSIBLE MAO-A inhibitors...

Answer 27

Moclobomide

Question 28

name 2 IRREVERSIBLE MAO-A inhibitors...

Answer 28

Phenelzine | Tranylcypromine

Question 29

name one specific side effect of MAO-A inhibitors

Answer 29

Hypertension patients can't metabolise monoamines, can lead to hypertensive crisis

Question 30

How does antidepressant doseage effect drug efficiacy?

Answer 30

the higher the dose, the greater the affinity of binding to ALL receptors at the synapse

Question 31

what is the kindling hypothesis?

Answer 31

depressive episodes become more easily triggered over time. At first, huge stresses will trigger a depressive episode. With time, this stimuli will be need to be smaller in order to trigger

Question 32

what is considered to be the gold standard of MDD management?

Answer 32

effective, individualised ADx treatment | talking therapies/CBT

Question 33

what is negative cognitive bias?

Answer 33

processing of sensory stimuli which negatively impacts sense of self, world view and emotions (aka clinical pessimism)

Question 34

which neural system is underactive in MDD?

Answer 34

DORSAL neural system

Question 35

which neural system is overactive in MDD?

Answer 35

VENTRAL neural system

Question 36

which region of the brain is responsible for the recognition of facial expression?

Answer 36

Amygdala

Question 37

in depression, the amygdala is ............ and the hippocampus is .............

Answer 37

LARGE SMALL

Question 38

low levels of what factor is thought to be responsible for the decrease in hippocampal size in depression?

Answer 38

BDNF

Question 39

according to DSM5 diagnostic criteria, what are the criteria that differentiate BP1 and BP2?

Answer 39

psychosis 7 or more days severely effects work/life requires hospitilisation

Question 40

what is the 12 month prevalence of BP1?

Answer 40

0.5-1%

Question 41

what is the 12 month prevalence of MDD?

Answer 41

4-5%

Question 42

what is the mean age of first mood onset for BP1 and BP2?

Answer 42

18 | mid 20's

Question 43

what is the mean age of first mood onset for MDD?

Answer 43

late 20's

Question 44

by how many years is life expectancy reduced in BP?

Answer 44

9-20 years (mental!!!) lifetime suicide risk of bipolar is 15 times that of general population

Question 45

what comorbid conditions are common in BP?

Answer 45

anxiety ADHD impulse control drug or alcohol abuse

Question 46

which 3 psychiatric disorders have the highest degree of heritability?

Answer 46

bipolar schizophrenia autism

Question 47

what would you expect to see after giving MAO-A inhibitors / TCA to a patient with undiagnosed bipolar disorder?

Answer 47

precipitation of a manic episode

Question 48

BP1 is genetically linked with which other psychiatric disorder?

Answer 48

Schizophrenia

Question 49

BP2 is genetically linked with which of psychiatric disorder?

Answer 49

MDD

Question 50

what type of drug should be prescribed is if a patient is experiencing psychotic symptoms associated with a manic bipolar episode?

Answer 50

Dopamine D2 receptor antagonists | antipsychotics

Question 51

in terms of dopamine levels in the striatum, what is the difference between bipolar psychosis and SCZ psychosis?

Answer 51

BP - Da elevated throughout the striatum SCZ - Da elevated ONLY in associative striatum

Question 52

What is the role of dopamine dysfunction in psychosis?

Answer 52

Da dysfunction is apparent in all forms of psychosis within different disorders

Question 53

what are the three phases of bipolar disorder?

Answer 53

mania/hypomania depression maintenence (between the two)

Question 54

which drug is effective at treating all three phases of bipolar disorder?

Answer 54

Lithium

Question 55

which drugs are effective at treating manic bipolar episodes?

Answer 55

lithium valproate carbemazepine

Question 56

which drugs should be used to treat depression associated with bipolar disorder?

Answer 56

LOW DOSE quetiapine lithium lamatrogine

Question 57

which drug is the gold standard for treatment of the maintenance phase of BP?

Answer 57

LITHIUM

Question 58

what are the three mechanisms by which valproate is teratogenic?

Answer 58

Potent inhibitor of histone deacetylase Induces oxidative stress Interference with folate metabolism

Question 59

excluding valproate, which other antipsychotic is unsafe for use in pregnancy?

Answer 59

carbemazepine Increases risk of NTD but DOESN'T increase risk of developmental delay

Question 60

what is the shape of the graph that relates anxiety and arousal?

Answer 60

Yerkes-Dodson law Bell shaped curv

Question 61

what are the 5 symptoms that make up the anxiety diagnostic criteria?

Answer 61

``` poor concentration insomnia muscle tension fatigue restlessness ``` have to have 3 of them for GAD diagnosis

Question 62

what is the diiference between generalised and specific anxiety disorders?

Answer 62

generalised anxiety has no environmental cues

Question 63

the symptoms of anxiety are as a result of overstimulation in which endocrine system?

Answer 63

autonomic excessive sympathetic arousal

Question 64

what is the lifetime risk of one suffering from GAD?

Answer 64

1 in 20

Question 65

tension headaches are a cardinal sign of GAD. In which muscle is the tension coming from?

Answer 65

Frontalis portion of occiptiofrontalis

Question 66

how is GABA synthesised?

Answer 66

decarboxylation of glutamic acid catalysed by glutamic acid decarboxylase

Question 67

what is the mechanism of action of baclofen?

Answer 67

GABA B agonist Used clinically as a muscle relaxant

Question 68

how many GABA molecules bind each GABA receptor? Where do they bind?

Answer 68

between alpha and beta subunits 2

Question 69

which is the only 5HT receptor that is not metabotrophic?

Answer 69

5-HT3

Question 70

the most common form of the GABA A receptor has how many subunits?

Answer 70

2 x alpha 2 x beta 1 x gamma

Question 71

how many transmembrane domains does each of the GABA A receptor subunits have?

Answer 71

4 TM domains per subunit

Question 72

in order for the GABA receptor to be BDZ sensitive, what combination of GABA subunit isoforms is needed?

Answer 72

alpha 1-3 any form of beta gamma 2-3

Question 73

what is the function of GABA a receptors with alpha 1 subunits?

Answer 73

found in brain regions that regulate sleep

Question 74

what is the function of GABA a receptors with alpha 2-3 subunits?

Answer 74

found in brain regions that regulate anxiety

Question 75

what is meant by the following description 'BDZ's are PAM's of the GABA a receptor'

Answer 75

benzos are positive allosteric modulators of GABA receptor. In the presence of GABA their binding keeps the chloride channel open for longer and at increased frequencies

Question 76

between which two subunits on the BDZ insensitive GABA A receptor does alcohol bind?

Answer 76

alpha 4-6 | DELTA

Question 77

where do barbiturates bind the GABA-A receptor?

Answer 77

multiple sites across the receptor- very potent

Question 78

what is alogia?

Answer 78

inability to speak due to mental illness

Question 79

what delusions are most common in Scz?

Answer 79

delusion of reference | delusion of persecution, control, impossibility

Question 80

what delusions are most common in bipolar?

Answer 80

delusion of grandiosity

Question 81

what delusions are most common in depression?

Answer 81

somatic nihilistic guilt

Question 82

what criteria is used to diagnose Scz?

Answer 82

ICD10

Question 83

what is catatonic behaviour?

Answer 83

psycho-motor inability to move

Question 84

name the 4 main dopamine pathways in the brain

Answer 84

associative + sensorimotor = nigrostriatal pathway tuberoinfundibular mesolimbic mesocortical

Question 85

where is the nucleus accumbens found?

Answer 85

ventral striatum of basal ganglia

Question 86

where are the ventral tegmental area and substantia niagra located?

Answer 86

midbrain

Question 87

which dopamine receptors are found in the entirety of the striatum?

Answer 87

D1 and D2(l+s)

Question 88

which dopamine receptors are in the D1 family?

Answer 88

D1 and D5

Question 89

which dopamine receptors are in the D2 family?

Answer 89

D2(l+s), D3, D4

Question 90

what is the correlation between dopamine levels in the striatum and risk of Scz?

Answer 90

direct correlation- the higher the Da, the higher the risk

Question 91

what is the minimum receptor occupancy needed for D2 antagonists?

Answer 91

65%

Question 92

what D2 receptor occupancy produces hyperprolactinaemia?

Answer 92

72%

Question 93

what D2 receptor occupancy produces parkinsonian symptoms?

Answer 93

80%

Question 94

what is the only true D2 antagonist used to treat scz?

Answer 94

Amisulpride

Question 95

which 2 antipsychotics don't tend to produce EPSE at high doses?

Answer 95

Clozapine Olanzapine both bind M1 muscarinic Ach receptor, balancing GABA input to the thalamus

Question 96

what is the prevelence of scz?

Answer 96

0.4%

Question 97

what is the lifetime risk of Scz?

Answer 97

1%

Question 98

what are the chances of monozygotic twins developing Scz?

Answer 98

45%

Question 99

what are the chances of developing Scz if both parents have Scz?

Answer 99

50%

Question 100

what is the median age of onset for males and females in Scz?

Answer 100

26 and 29

Question 101

by how much does Scz risk increase if a first degree relative suffers from it?

Answer 101

7%

Question 102

what drugs should be used to treat depressive episodes inbetween psychotic episodes of schizophrenia?

Answer 102

Antidepressants e.g. citalopram

Question 103

what is akathisia?

Answer 103

feeling of inner restlessness and inability to remain still antipsychotic side effect

Question 104

how long after taking an antipsychotic would you expect the symptoms to alleviate?

Answer 104

2 weeks

Question 105

agranulocytosis is a side effect associated with which antipsychotic?

Answer 105

clozapine

Question 106

what percentage of scz patients relapse after their first episode of psychosis?

Answer 106

80%

Question 107

what are the three stages of psychosis?

Answer 107

prodromal acute recovery