Year 3: Psychiatry Flashcards Preview

Finals Club (Dundee Medicine Master Summary Deck) > Year 3: Psychiatry > Flashcards

Flashcards in Year 3: Psychiatry Deck (187)
Loading flashcards...
1

Depression is due to

Decreased Serotonin (5-HT)

But also due to decreased Dopamine

2

What 3 dopamine pathways are affected in depression

Nigrostriatal 

Mesolimbic 

Anterior Cingulate 

 

Hence side effects like anhedonia etc

3

 3 core symptoms of Depression

  • Persistent low mood (2 weeks+)
  • Anhedonia
  • Decreased energy, increased fatigue

4

F32 Criteria

(Severity of Depression)

  • Mild: 1/3 core features
  • Moderate: 2/3 core features + 3 additional symptoms
  • Severe: 3/3 core features + 5 additional symptoms

5

Depression immediately becomes BPAD when

there are any manic symptoms 

6

First line treatment for depression

Escitalopram (SSRI)

7

An SSRI that is to be used in pregnancy, cardio patients and anxiety patients

Sertraline (SSRI)

"As you are certain that it's okay in pregnancy etc"

8

Anti-depressant that increases weight gain (appetite) and is good for sleep

Mirtazipine (Tetracycline)

9

Anti-depressant used for resistant depression 

- Tried many drugs and they don't work

Venlafaxine (SNRI)

10

Side effect of Citalopram (SSRI)

Can cause long QT syndrome

11

An anti-depressant with little side effects

Can be used in kids

Fluoxetine (SSRI)

12

Why are tricyclic anti-depressants bad in patients with suicidal risk

They are cardiotoxic, and so are easy to overdose on 

13

Contraindications of Monoamine Oxidase Inhibitors

A tyramine rich diet 

  • Cheese
  • Red wine
  • Cured/processed meats
  • Sauces and gravy

14

Why are tyramine rich food avoided in MAOIs

Can cause a hypertensive crisis

15

Contraindications with SSRIs

NSAIDs

Elderly (can cause hyponatraemia)

16

What is seen in Direct Self Harm?

Decreased activity in the pre-frontal cortex 

17

 Hallucinations seen in Psychotic Depression

Second person hallucinations 

 

"You are fucking crazy son, kill yourself"

18

DSM-V Criteria for BPAD

(Subtypes of Bipolar Affective Disorder)

Type 1: More manic than depressed

Type 2: More depressed than manic

Type 3: Hypomanic due to chronic use of antidepressants

19

Examples of Type 1 BPAD

The "classic Bipolar person"

  • Have a manic episode lasting 1 week+
  • Has been depressed in the past
  • Flight of ideas, grandiosity, increased activity etc
  • On an absolute high 

 

High 15% of the time

20

Examples of Type 2 BPAD

Most common form of BPAD

  • Hypomania lasting 4 days 
  • Has been depressed in the past
  • Reckless behaviour (spending money rashly)
  • Increased libido

High 5% of the time

21

ICD-10 Criteria for BPAD shows 

 

 

The severity of Bipolar Affective Disorder

22

ICD-10 Criteria for a hypomanic episode

Increased mood sustained for 4 consecutive days 

Need 3/6 symptoms 

23

ICD-10 Criteria for a manic episode

Increased mood sustained for 1 week

3/9 Symptoms 

Symptoms are a bit more mental

 

24

If a BPAD patient is manic and on an antidepressant then

Take them off the antidepressant 

25

1st line drug for BPAD

Lithium carbonate

To stabilise long term mood 

26

If a patient is on lithium you should

  • 12-hour monitoring when first started
  • U&Es - as nephrotoxic
  • TFTs- as thyrotoxic 

27

Main rule for 2nd line prescribing in BPAD

  • If you prescribe an antidepressant then you must also prescribe an antimanic drug 
  • If you prescribe an antimanic drug you must also prescribe an antidepressant drug 

 

28

If BPAD patient is mainly manic what is the 2nd line drug combination

Sodium valproate (antiepileptic) and fluoxetine (SSRI)

29

If BPAD patient is mainly depressed what is the 2nd line drug combination

Lamotrigine (antiepileptic) and fluoxetine (SSRI)

30

1st line for acute mania management 

Olanzapine (atypical antipsychotic)