Flashcards in Session 12 Deck (30):
How does depression present?
Low mood, anhedonia and decreased energy. Must have symptoms for 2 weeks.
What is unipolar depression?
Where the mood swing is always in the same direction. Mostly due to external triggers such as life events. Often familial.
Describe the monoamine hypothesis of depression.
Depression is caused by a reduction in monoamine neurotransmitters in the brain, and mania is due to an excess, e.g. noradrenaline and serotonin.
Describe the neurotransmitter receptor hypothesis.
An abnormality in the receptors for monoamine transmission leads to depression. Depletion of neurotransmitter causes compensatory up-regulation of post-synaptic receptors.
Describe the monoamine hypothesis of gene expression.
Deficiency in molecular functioning. Problem within the molecular events distal to the receptor.
Describe the role of tricyclic antidepressants.
Block the re-uptake of serotonin and noradrenaline. E.g. Amitriptyline. Also shown to block muscarinic cholinoceptors and alpha-1 adrenoceptors.
Give three ADRs of TCAs.
Sedation, impaired psychomotor function, reduced glandular secretions, tachycardia, postural hypotension, sudden cardiac death, constipation.
Describe the role of SSRIs as antidepressants.
E.g. Fluoxetine, and citalopram. Prevent the re-uptake of serotonin by the presynaptic membrane, used to treat moderate to severe depression.
Describe the role of SNRIs as antidepressants.
Cause re-uptake of noradrenaline too, e.g. Duloxetine. Commonly used as second/third line therapy.
Describe the characteristics of schizophrenia.
Positive: hallucinations, delusions, abnormal behaviour.
Negative: social withdrawal, blunted effect.
Cognitive: selective attention, poor memory, reduced abstract thought.
Affective: anxiety and depression.
What is a delusion?
A fixed false belief that is out of keeping with someone's culture or religious beliefs.
Describe the dopamine hypothesis of schizophrenia.
Excess of dopamine released by the brain. Dopamine antagonists are the best treatment.
What are the main dopamine pathways in the CNS?
Meso-limbic: emotion and behaviour
Meso-cortical: arousal and mood
Nigrostriatal: control of movement
Tuberoinfundibular: pituitary and hypothalamus function.
What are typical anti-psychotics?
Increased dopamine antagonism producing extra-pyramidal side-effects. E.g. Haliperidol. Used in acute emergency setting for sedation and tranquilization.
Give 2 side-effects of typical anti-psychotics.
Postural hypotension, weight gain, prolactinaemia and pigmentation.
Describe the features of neuroleptic malignant syndrome.
Severe rigidity, hyperthermia, increased CPK and autonomic lability.
What are atypical anti-psychotics?
Still D2 antagonists, but cause less extrapyramidal symptoms. Often the first-line treatment for new onset schizophrenia. E.g. Risperidone, Olanzipine.
What is third line treatment of schizophrenia?
Clozapine (atypical anti-psychotic). The most effective anti-psychotic. Causes severe constipation, sedation, hypersalivation and weight gain.
Give two extrapyramidal side-effects.
Parkinsonism, acute dystonic, akathasia and tardive dyskinesia.
What is anxiety?
Fear out of proportion of the situation, so individuals undergo avoidance of certain scenarios. Can include physical symptoms such as light-headedness, shortness of breath and hot/cold flushes.
What is the first line treatment of anxiety?
Give three side-effects of benzodiazepines.
Dependence, drowsiness, dizziness, psychomotor impairment, dry mouth, blurred vision, GI upset, ataxia, headache, hypotension.
Give four symptoms of dependency.
Chills and sweating
Muscle cramping and teeth clenching
What is bipolar disorder?
Episodes of both mania and depression, associated with poor concentration, poor sleep, rapid speech, poor judgement.
Give three symptoms of mania.
Unusually happy, overactive, poor concentration, poor sleep, rapid speech, poor judgement, increased interest in sex, hallucinations.
What is the treatment of bipolar?
Mood stabilisers, including lithium, sodium valproate, lamotrigine and carbamezepine.
Give three side-effects of lithium.
Memory problems, thirst, polyuria, tremor, drowsiness and weight gain.
Give two toxic effects of lithium.
Vomiting, diarrhoea, coarse tremor, dysarthria, cognitive impairment, restlessness, agitation.
What is the treatment for lithium toxicity?
Supportive measures, anticonvulsants, increase fluid intake, haemodialysis.