psychiatry

Question 1

Depression can be classed into two major categories

Answer 1

Major depression
- depressed mood
- loss of interest or enjoyment
- low self esteem
- reduced appetite
- interrupted sleep
- lack of libido
Severe depression
- guilt, worthlessness
- bleak outlook of life
- self-harm and suicidal ideology
- psychotic states - self harm voices

Question 2

How is depression treated

Answer 2

GOLD standard:

psychotherapy and antidepressant medications

Question 3

Depression is associated with low basal levels of which neurotransmitter

Answer 3

Serotonin (5-HT) which is produced by raphe nuclei in the brainstem it controls

• sleep
• mood
• anxiety

Question 4

Psychotherapy can take many forms

Answer 4

Just to name a few:
1. psychoanalysis
appropriate for people with insight and who want to take responsibility for their condition
2. behavioural therapy
- teaching, conditioning and desensitisation
3. CBT - cognitive behavioural therapy
involves education and adjusting automatic negative thoughts
4. Counselling (takes many forms)

Question 5

What is the main predictive factor fro success in psychotherapy

Answer 5

Success is dependant not on type or form of therapy but by who delivers it

Question 6

Describe various antidepressants

Answer 6

SSRIs - most commonly used, very safe and prevents serotonin reuptake and the synaptic membrane
MAO inhibitors - blocks the enzyme MAO which inactivates 5HT and DA
Mirtazepine - enhances 5HT
Selective noradrenaline reuptake inhibitors
Tricyclic antidepressants (amitriptoline) are not used now (5HT and NE reuptake inhibitors) - they are cardiotoxic and anti-muscarinic

Question 7

Anxiety

Answer 7

is the most common mental health disorder
(it can appear in all types of mental illness - but not a true manifestation)
- panic disorder
associated with panic attacks and chest pain
- agoraphobia
fear of going into public
- social phobia
fear of social situations
- generalised anxiety disorder
excessive worrying about daily things
- obcessive compulsive disorder
uncontrollable compulsive rituals
- other phobias
irrational or persistent fear of objects or situations

Question 8

What treatments are available for anxiety disorders

Answer 8

CBT is gold standard in conjunction with:

• educations
• relaxation
• structured problem solving

Medications are not recommended but can be used for sort term tension relief:

benzodiazepines (highly addictive and dependant drug) or SSRIs

Question 9

Describe benzodiazepines

Answer 9

they are GABA agonists (midazolam = loss of memory, diazepam - insomnia)

• sedative
• hypnotic
• anxiolytic
• anticonvulsant
• muscle relaxant

indications

• ETOH dependance
• anxiety
• seizure
• agitation

short term side effects - depression
long term “ = cognitive impairment

use with care as it can reduce consciousness

Question 10

Schizophrenia

Answer 10

• low prevalence disorder
• related to dopamine
  features:
• disturbed thoughts
• disturbed interpersonal relationships
• hallucinations
• progressive functional decline
• symptoms need to be present for 6 months for a diagnosis
• reduced life expectancy

Question 11

Schizophrenias

Answer 11

• have auditory hallucinations in the third person
• delusions and bizarre ideas
• thought disorder
• they have no insight

Question 12

Describe the coarse of schizophrenia

Answer 12

1. prodrome
   depressed mood with odd behaviours
2. active
   psychotic symptoms, behavioural disturbance, catatonia (paralysis can occur)
3. residual
   negative symptoms, blunted affect, impaired function, some psychosis

Question 13

Treatment of schizophrenia

Answer 13

1. atypical antidepressants
(if all fail - then use clozapine)
typical antidepressants are avoided as they have extrapyramidal symptoms (tardive dyskinesia, parkinsonism)
2. ECT (catatonia or no response)
3. mood stabilisers
4. antidepressants
5. benzodiazepines
6. psychosocial - low stress and stimulation with support

Question 14

Describe bipolar disorder

Answer 14

• low prevalance
• commonly underdiagnosed/misdiagnosed
• associated with depression, mania (1 week with functional decline) or hypomania (4 days no functional decline)

mania = irritability, expansive or elevated mood

Question 15

Bipolar I and Bipolar II

Answer 15

I - one or more episodes of mania + depression

II - one of more episodes of depression + mania (F>M)

Question 16

Treatment of bipolar disorder

Answer 16

1. mood stabilisers (lithium)
2. sodium valporate (anticonvulsant, Na channel blocker, teratogen (beware in pregnancy)
3. antidepressants (beware in depressed state)
4. antianxiety
5. antipsychotics
6. psychotherapy
7. ECT

Question 17

Suicide is the most common cause of death for people with bipolar what are the indicators for suicide

Answer 17

• impulsivity
• concurrent substance abuse
• depression
• child abuse Hx
• incorrect Tx