Flashcards in Session 12 - Antipsychotics Deck (41)
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1
What is the theory for the cause of depression?
Deficiency of production of the monoamine neurotransmitters serotonin and noradrenaline in the brain. This combined with an environmental trigger such as death, divorce or trauma and possibly a genetic susceptibility leads to depression.
2
What are the core symptoms of depression?
Core symptoms (2 of 3 needed to diagnose depression):
Low mood
Anhedonia
Decreased energy
3
What are the secondary symptoms of depression?
Decreased appetite
Sleep disturbance
Hopelessness
Reduced concentration
Irritability
Self harm or suicidal ideas and acts
Reduced libido
May have psychotic symptoms
4
What tool is used to help diagnose the severity of depression?
Becks depression scale
5
What management is used to treat depression?
1. Assess suicide risk. May need mental health act assessment/sectioning.
2. Psychological therapy e.g. counselling/cognitive behavioural therapy
3. Antidepressants - first line = SSRIs
6
Other than depression, what other indications are there for the use of antidepressants?
Anxiety
Neuropathic pain
7
What are the types of antidepressants?
Serotonin Selective Reuptake Inhibitors (SSRIs) (first line)
Tricyclic Antidepressants (TCAs)
Serotonin/Noradrenergic Reuptake Inhibitors (SNRIs)
Monoamine Oxidase Inhibitors (MAOIs)
8
What is the guidance for changing and stopping antidepressants?
Try one antidepressant for at least 6 weeks before switching to another.
Even if feeling better it is recommended to continue antidepressants for at least a year to reduce relapse risk.
9
Give examples of serotonin selective reuptake inhibitors.
Citalopram
Fluoxetine
10
Explain the mechanism of action of serotonin selective reuptake inhibitors.
Limit reabsorption (reuptake) of serotonin into the presynaptic cell (neurone), which increases the concentration of serotonin in the synaptic cleft. This means there is more serotonin available to bind to the postsynaptic receptors and carry on an action potential.
11
What are the possible side effects of serotonin selective reuptake inhibitors (SSRIs)?
Nausea
Sexual dysfunction
Insomnia
Serotonin syndrome
12
What is serotonin syndrome?
Life threatening presentation which occurs within a few weeks of initiating SSRI or when two SSRIs are used at once.
Symptoms:
Tachycardia
Sweating
Dilated pupils
Myoclonic
Hyperreflexia
Hyperthermia
Can lead to seizures, muscle breakdown and complication of hyperthermia.
13
Give an examples of a tricyclic antidepressant (TCA).
Amitriptyline
14
What are the indications for amitriptyline?
Depression
Neuropathic pain
15
What is the mechanism of action of tricyclic antidepressants (TCAs)?
They act largely as serotonin noradrenaline reuptake inhibitors (SNRIs).
16
What are the possible adverse drugs reactions caused by tricyclic antidepressants?
Due to antimuscarinic action:
Dry mouth
Dry nose
Blurry vision
Constipation (lowered GI motility)
Urinary retention
Cognitive and/or memory impairment
Increased body temperature
CARDIOTOXIC - life threatening inhibitors
NEUROTOXIC - seizures, hallucinations, delirium, coma
17
Why should tricyclic antidepressants not be prescribed to patients with suicidal ideation?
Tricyclic are lethal in overdose due to their wide range of toxic effects.
18
Give examples of serotonin noradrenaline reuptake inhibitors (SNRIs).
Venlafaxine
Duloxetine
19
What are the possible adverse drug reactions caused by serotonin noradrenaline reuptake inhibitors (SNRIs)?
Same as SSRIs plus:
Raised blood pressure
Dry mouth
Hyponatraemia
20
Explain the mechanism of action of monoamine oxidase inhibitors (MAOIs).
Monoamine oxidase inhibitors (MAOIs) block the enzyme monoamine oxidase from destroying neurotransmitters.
21
Give examples of illnesses that involve psychosis.
Schizophrenia
Mania
Severe depression with psychosis
Organic syndromes
Delusional disorder
Delirium
Dementia
22
What does psychosis mean?
A lack of contact with reality.
23
What are the symptoms of paranoia schizophrenia?
Disturbances of thinking
Hallucinations
Delusions
Unusual speech-thought disorder
Behavioural changes
Lack of insight
Negative symptoms
24
What is a hallucination?
A perception in the absence of an external stimulus - auditory, olfactory, visual, gustatory, tactile.
25
What is a delusion?
A fixed false belief that is out of keeping with someone’s culture or religious beliefs.
26
What are the main dopamine pathways?
Mesolimbic - emotional response and behaviour
Mesocortical - important in arousal and mood
Nigrostriatal - key pathway damaged in Parkinson’s disease
Tuberoinfundibular - in hypothalamus and pituitary gland
27
What are the two types of antipsychotics?
Typical (old generation)
Atypical (new generation)
28
Give examples of typical antipsychotics.
Haloperidol
Chlorpromazine
29
What is the mechanism of action of typical antipsychotics?
Act predominantly as dopamine antagonists.
More likely to cause extrapyramidal side effects.
30
