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Theme 3: Modulatory systems in psychiatry > Affective disorders: neurobiology and treatment > Flashcards

Affective disorders: neurobiology and treatment Flashcards

1
Q

Aetiology of depression

A

Multifactorial

Incompletely understood

Interactions of genetic factors, childhood adversities, past history of mood disorders, psychological predisposition

Often precipitated by stressful life events

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2
Q

Monoamine dysfunction in depression

A

All traditional antidepressants affect 5-HT/NA systems

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3
Q

Serotonin dysfunction in depression

A

All traditional antidepressants affect 5HT/NA systems

Decrease 5-HT concentrations

Reduced 5-HT transporter in post mortem suicide studies

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4
Q

1st generation antidepressants

A

Monoamine oxidase inhibitors

Tricyclic antidepressants

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5
Q

Monoamine oxidase inhibitors

A

Non-selectively inhibit enzymes involved in the breakdown of monoamines, including serotonin, dopamine and norepinephrine

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6
Q

Tricyclic antidepressants

A

Non-selectively inhibit the reuptake of monoamines, including serotonin, dopamine and noreepinephrine

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7
Q

2nd generation antidepressants

A

SSRI

SNRI

Alpha2 and 5HT2C antagonist

Dopamine- noradrenaline reuptake inhibitor

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8
Q

SSRI examples

A

Sertraline

Citalopram

Escitalpram

Fluoxetine

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9
Q

SNRI

A

Venlafaxine

Duloxetine

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10
Q

Alpha2 and 5-HT2C antagonist

A

Modulate serotonin and Na release

Mirtazapine

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11
Q

Dopamine-noradrenaline reuptake inhibitor

A

Bupropion

Not approved as antidepressant in UK

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12
Q

SSRI

A

Efficacy equal to tricyclics in outpatients

Large spectrum of action

Low toxicity and safe in overdose

Initial treatment phase is most delicate due to prevalence of side effects over benefits

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13
Q

SSRI side effects

A

GI symptoms (nausea and diarrhoea)

Headache

Irritability

Anxiety

Reduction of libido

Sexual dysfunction

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14
Q

Side effects of tricyclics

A

Constipation

Orthostatic hypotension

Dry mouth

Drowsiness

Cardiac toxicity in overdose

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15
Q

MAOi side effects

A

Dry mouth

GI side effects

Headache

Drowsiness

Insomnia

Dizziness

Food interactions

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16
Q

Venlafaxine side effects

A

Nausea

Vertigo

Headache

Insomnia

17
Q

Mirtazapine

A

Drowsiness

Sedation

Hypotension

Increased appetite

Weight gain

18
Q

HPA dysfunction in mood disorders

A

Lack of dexamethasone suppression

Glucocorticoid receptor alterations

Depression in Cushing’s disease

19
Q

Inflammation and depression

A

Raised plasma cytokine levels (IL6, TNFa) and inflammatory markers

High comorbidity between chronic inflammation and depression

Administration of cytokines provokes depressive symptoms

Microglial activation in brain of depressed patients

20
Q

Neural systems involved in depression

A

Increased activity to negative emotional stimuli

Decreased activity to positive emotional stimuli and during receipt and anticipation of reward

Bias of attention towards negative emotional stimuli, and away from positive emotional and reward-related stimuli

21
Q

Short term treatment of bipolar disorder

A

To reduce the severity and shorten the duration of the acute episodes and achieve remission of symptoms

22
Q

Long term treatment of bipolar disorder

A

Prevention of new episodes and to achieve adequate inter-episode control of residual or chronic mood symptoms

23
Q

Drug categories for bipolar disorder treatment

A

Antipsychotics

Lithium

Anticonvulsants

Antidepressants

24
Q

Antipsychotics

A

D2/3 antagonists
DA partial agonists

Rapid anti-manic effect

Often used long term to maintain same treatment effective in acute episodes

Long term adverse effects on weight, glucose regulation and lipids

Full D2 antagonism may cause EPSEs

25
Q

D2/3 antagonists

A

1st generation: haloperidol

2nd generation: olanzapine, risperidone, quetiapine, lurasidone, asenapine, amisulpride, clozapine

26
Q

Lithium

A

Multiple mechanisms of action

  • multiple neurotransmitters
  • cellular signalling
  • neurotrophic factors

Anti suicidial effects

Possible efficacy on impulsive and violent behaviours

Strongest evidence for prevention of relapses

Narrow therapeutic index

Blood tests every 3 months for 1st year

Adverse long term effects on kidney function

Risk of lithium toxicity

27
Q

Anticonvulsants

A

Valproate

Lamotrigine

Carbamazepine

28
Q

Valproate

A

Actions via GABA, intracellular signalling, Na+ channel blockade, epigenetic modulation

Anti-manic and effective in prevention of mania

Useful in combination but potential pharmacokinetic interactions

Not to be used for women of child bearing potential due to teratogenesis

29
Q

Latmotrigine

A

Actions via GABA, glutamate and Na+ channel blockade

Mostly effective in prevention of depressive relapses

Ineffective as anti-manic agent

30
Q

Carbamazepine

A

Less effective in maintenance treatment than lithium but may be used as monotherapy if lithium ineffective

Almost exclusively effective against manic relapse

Pharmacokinetic interactions

31
Q

Treatment of depressive episodes

A

Antipsychotics (quetiapine, lurasidone)

Fluoexetine/ olanzapine combinations

Antidepressants to be co-prescribed with an anti-manic drug

Consider lamotrigine

32
Q

Treatment of acute manic episodes

A

Dopamine antagonists (haloperidol, olanzapine, risperidone, quetiapine)

Valproate

Discontinue any antidepressant treatment

33
Q

Long term treatment: prevention of new episodes

A

Consider long term treatment following a single severe manic episode

Lithium as initial monotherapy

Alternatives:

  • valproate
  • dopamine antagonists/ partial agonists
  • carbamazepine
34
Q

Adverse effects of long term pharmacological treatments

A

WEight gain

Metabolic syndrome

Hyperprolactinemia

Tardive dyskinesia

Liver damage

Kidney and thyroid dysfunction

Theme 3: Modulatory systems in psychiatry (8 decks)

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