Week 2 Flashcards
(71 cards)
1
Q
What is a psychiatrist?
A
a doctor who assesses, diagnoses and manages mental illness
2
Q
Describe the psychotic sieve
A
psychotic mood anxiety organic substance misuse personality no mental illness
3
Q
What are the three main psychotic symptoms?
A
hallucinations
delusions
thought disorder
4
Q
What is a delusion?
A
a false, unshakeable idea or belief which is out keeping with the person’s educational, cultural and social background; it is held with extraordinary conviction and subjective certainty
5
Q
What are the three core symptoms of depression?
A
low mood
anhedonia
low energy
6
Q
What are the cognitive features of depression
A
slowed speed of thought reduced concentration reduced self esteem ideas of guilt and unworthiness bleak and pessimistic views of the future hoplessness ideas or acts of self-harm or suicide
7
Q
What are the biological symptoms of depression?
A
disturbed sleep diminished appetite weight loss loss of libido low energy constipation amenorrhoea
8
Q
what are the cognitive disorders associated with depression?
A
arbitary inference selective abstraction magnification minimisation over-generalization personalisation
9
Q
Give examples of SSRIs
A
sertaline, fluoxetine
10
Q
WHat are the side effects of SSRIs?
A
nausea, vomiting, agitation, sexual dysfunction, hyponatraemia, sweating
11
Q
Give examples of tricyclic antidepressants
A
amitryptaline
12
Q
give examples of SNRIs
A
venlafaxine
13
Q
Give examples of NASSAs
A
mirtazepine
14
Q
Give examples of NARIs
A
Reboxetine
15
Q
What are the 5 stages of adjustment?
A
denial anger bargaining depression acceptance
16
Q
What are the types of abnormal grief
A
unexpected
ambivalent
chronic
delayed
17
Q
What are the factors associated with abnormal grief reactions?
A
loss of child loss of parent during childhood sudden unexpected death multiple deaths attachment of blame to survivor
18
Q
What is invasion?
A
growth by infiltration and destruction of surrounding tissues
19
Q
WHat is metastasis?
A
spread of tumour to and growth at ectopic sites via blood, lymphatics, intraepithelial route or transcoelomic
20
Q
What is a carcinoma?
A
malignant tumour derived from epithelial cells
21
Q
What is a sarcoma?
A
malignant tumour derived from mesenchymal cells
22
Q
What is melanoma?
A
malignant tumour derived from neural crest cells
23
Q
What is leukaemia?
A
malignant tumour derived from circulating white blood cells
24
Q
What is lymphoma?
A
malignant tumour derived from the lymphatic system
25
What is the metastatic cascade?
```
local invasion
angiogenesis
detachment
intravasation
transport
lodgement / arrest
extravasation
growth at ectopic site
```
26
What are the properties of a metastatic tumour?
```
reduced cell -cell adhesion
altered cell-substratum adhesion
increased motility
increased proteolytic ability
angiogenic ability
ability to intravasate and extravasate
ability to proliferate
```
27
How do carcinomas acquire the ability to escape the "glue" that binds them together?
via mutations in E-cadherin or in the molecules that regulate or interact with it
28
What are the names for the transcription factors that regulate E-cadherin?
snail, slug, twist
29
Describe the action of HGF
mitogen, mitogen and morphogen
Produced by stromal cells of the tumour
binds to c-met on tumour epithelial cells
increased phosphorylation of beta-catenin in tumour epithelial cells which leads to disrupted ECD-mediated adhesion
30
What is the stromal component of Cmet?
HGF
31
Where are chemokines produced in relation to cancer?
stromal cells
32
How are MMPs normally regulated?
transcriptional
synthesis of zymogen
activated by serine proteases
negative regulation by tissue inhibitors of metalloprteinases
33
What are the stages of extravasation?
rolling
activation
adhesion
diapedesis
34
Where do skin melanoma tumours usually spread to?
lungs, brain, skin, liver
35
What are possible mechanisms for organ tropism?
selective adhesion to endothelium to target organs
selective response to GFs at ectopic site
selective migration to CK source
Factors released by tumour cause changes in prospective TMW at secondary sites
balance of local and systemic angiogenic factors
36
WHat is the name of the chromosome mutation in chronic myeloid leukaemia?
the philadelphia gene
37
How does imatinib work?
binds to ATP binding region on Abl kinase and therefore prevent it from functioning properly
38
What drugs are VEGF inhibits?
sunitinib
pazopanib
axitinib
39
What are common mutations in melanoma?
Raf kinase
| MAP kinase
40
What can be used to chemically castrate a man?
GnRH agonist
GnRH antagonist
oestrogens
AR antagonist
41
WHat are the advantages of targeted treatments for cancer?
```
more selective for cancer cells
less selective for normal cells
less side effects
higher doses
more anti-cancer effects
```
42
Describe drug resistance in targeted therapy
kinase mutations emerge which are no longer sensitive to drug
cancers eventually begin to grow again
43
Describe predictive markers
predict which patients will benefit from a specific treatment
what drug to use
44
WHat are prognostic markers?
inform about outcome regardless of treatment
| may help choose which patients to treat but not which drugs
45
Describe the innate immune system mediated tumour control
innate IR recognises tumour cell establishment
NK cells and other effectors recruited to site by chemokines, which also target tumour growth directly
tumour specific T-cells home to tumour site, along with macrophages and other effectors to eliminate tumour cells
46
What are the three Es of immunoediting?
elimination
equilibrium
escape
47
Describe IFN a/b treatment
```
affects MHC class I expression and cell division
prolongs survival and stabilises disease in cancers such as RCC
```
48
Describe IL-2 treatment
therapy for RCC and metastatic melanoma
expansion of tumour specific T cells
high dose only
must be in hospital
49
WHat is the problem with single peptide vaccines against cancer?
tumour escape through selection of non-antigen variants
50
How can preformed antibodies work?
directly target cancer cells and mediate tumour destruction
51
How can monoclonal antibodies destroy a tumour?
apoptosis induction
complement mediated cytotoxicity
ADCC
conjugated to toxin
52
What is the target of ipilimumab?
CTLa4
53
what does biTEs stand for?
bi-specific T cell engager
54
Give examples of cell therapy
```
haematopoetic stem cells
tumour infiltrating T cells
dendritic cell vaccines
NK cells
gamma-delta T cells
virus specific T cells
genetically engineered T cells
```
55
What are the stages of stem cell therapy?
```
mobilise patient or donor cells
condition patient with radio / chemo
manipulate graft
re-infuse cells to "clean system"
innate immune system reconstitutes
adaptive system reconstitutes
```
56
Describe receptor engineering in T cell therapy
tumour antigen-specific artificial receptor generated, containing signalling functions
transferred into patient T cells to attack cancer cells
57
Describe a MSE
an assessment of current state of mind
snapshot during interaction
carried out with psychiatric history
observations and specific questions
58
What is the format of a MSE?
```
appearance and behaviour
speech
mood and affect
though form and content
perception
cognition
insight
```
59
Describe appearance in MSE
```
how person looks
ethnicity. build, hair colour, clothing
biological vs chronological age
well kemp?
self neglect?
unwell or intoxicated?
```
60
Describe behaviour in MSE
```
how they act
motor activity
eye contact
rapport and engagement
body language
unusual or socially unacceptable behaviour
```
61
Describe speech in MSE
```
how they talk
rate and quantity
rhythm
volume
tone
spontaeity
```
62
What is mood
a person's emotional state overall
63
What is affect?
changes in the person's emotions that you observe moment to moment during the interview
64
What types of mood are there?
subjective and objective
65
What types of affect are there?
reactive
flattened
blunted
labile
66
Give examples of thought disorders
flight of ideas
| loosing of associations / knight's move thinking
67
What types of delusion are there?
```
paranoid
grandiose
nihilistic
delusions of reference
thought interference
```
68
What are over -valued ideas?
a false belief, not totally fixed but causing great disability
69
What are obsessions?
recurrent, intrusive, distressing ideas, impulses or images that the patient recognises as their own
70
How is cognition assessed?
alertness
orientation
attention / concentration
memory
71
WHat is insight?
the patient's understanding of their presentation and their need of treatment
