3 core symptoms of depression
- persistent low mood
- reduced energy
- anhedonia = loss of interest/enjoyment
mild = 2 core + 2 other moderate = 2 core + 3/4 other severe = 3 cored + 4+ others
what is included in an MSE exam
appearance speech thought (+suicide/harm) cognition perceptions mood and affect insight
psychiatric interview components
- presenting complaint
- history of presenting complaint
- past psychiatric history
- past medical history
- medication history
- family history
- personal history
- social history
- substance use
- premorbid personality
- forensic history
psychiatric interview components
- presenting complaint
- history of presenting complaint
- past psychiatric history
- past medical history
- medication history
- family history
- personal history
- social history
- substance use
- premorbid personality
- forensic history
Agoraphobia
feel safe at home but even going outside to front garden–> anxiety
Therefore the avoid even outdoors, let alone social environments
Fear of being alone at places where escape is difficult
2x more common in women
3 types of stress disorders
- An acute stress reaction (which occurs up to 2 days after trauma)
- Adjustment disorder (where anxiety persists up to one month after trauma)
- more serious = PTSD
anxiolytics and hypnotics
benzodiazepines - BOTH
(-lams/pams)
hypnotics
- Z drugs
- anti histamines
anxiolytics
- 5-HT1A agonists eg. busprione (SSRIs for GAD)
- b-adrenoceptor antagonists
why should you not stop benzodiazepines cold turkey
Benzos stimulate the GABA inhibitory
therefore body adapts and increases excitatory receptors
if you stop cold turkey
excitatory receptors > inhibitory
leads to high activation of excitatory–> seizures
so you should slowly decrease not completely withdraw
how do barbiturates and benzodiazpines work
they are positive allosteric molecules
they bind to GABA -A receptor and help binding of GABA and leave them open for longer
more Cl- into post-synaptic neurone
decreasing excitatory effects–> decreasing anxiety/insomnia
which drugs can lead to tolerance
benzodiazepines / z-drugs
what are z -drugs
act similar to Benzodiazpeines but are hypnotic (slightly different structure)
zolpiDEM
how to 5-HT1A agonists work
+how does SSRIs affect them
when activated we get less release of serotonin
(5-HT1A is auto inhibitory)
body down regulates the pre-synaptic 1a receptors (less inhibition)
leading to more serotonin in cleft
SSRIs can lead to serotonin receptor trafficking
they inhibit reuptake so there is massive activation of both pre/post receptors
body down regulated pre and post synpatic
B1 and B2 stimulation relating to anxiety symptoms
B1 - increases heart rate/renin release
B2 - increases renin release also
why are barbiturates not used anymore
+ but what are they still used for
narrow therapeutic index
(high risk of OD)
+ there is no OD antidote whereas Benzos = flumenazil (an antagonist)
capital punishment
epilepsy
euthanasia
drugs for depression + side effects
MAOis
- only releases the NA/5-HT that was gonna be degraded (not the ones recycled in vesicles)
- usually thymine (cheese/wine) is also broken down by MAO too
- accumulation —-> sympathomimetic effects
- headache/intracrainal haemorrhage/elevated BP/HT
RIMA (reversible) eg. moclobemide
- accumulation of NA displaces RIMA
- allows degradation of excess NA
TCAs
- NA + 5HT reuptake inhibitor
- increased activation on all 5-HT
- downregulation of 5-HT1A and alpha 2 (disinhibition)
- BUT anti-cholinergic/muscarinic activity / CVS effects
SSRI
- 5HT reuptake inhibitor ONLY
- no blockages of NA - less CVS effects
side effects of SSRIs
sexual dysfunction/ insonmia (5-HT2)
Nausea; GI distress; headache (5-HT3)
serotonin syndrome
- confusion
- hyperthemia
- seizures
