Bio

Question 1

What is an agnosia?

Answer 1

A problem with recognition. Eg visual agnosia trouble recognizing a head is a head and a hat is a hat

Question 2

Synesthesia?

Answer 2

When different sensory experiences get mixed eg visions and emotions, numbers have colours

Question 3

Two main divisions of the nervous system and what’s included in each?

Answer 3

1) Central Nervous System - brain stem and spinal cord
2) Peripheral Nervous System - nerves that go to and from the spinal cord (cranial nerves, spinal nerves, peripheral ganglia)

Question 4

Parts of the PNS and the CNS?

Answer 4

Peripheral Nervous System:
A. Somatic Nervous System
B. Autonomic Nervous System - Sympathetic and Parasympathetic

Central Nervous System:
A. Spinal Cord
B. Brain - B1. Cerebrum = cerebral cortex + subcortical areas; B2. Cerebellum; B3. Brainstem

Question 5

Function of the Somatic Nervous System?

Answer 5

Send and receive sensory messages that control voluntary movement of the skeletal muscles

Question 6

Function of the Autonomic Nervous System?

Answer 6

Controls automatic or involuntary bodily functions of the smooth muscles and glands including digestion, heart rate and breathing. Has the sympathetic and parasympathetic nervous systems.

Question 7

What are sensory neurons? What are motor neurons?

Answer 7

Both are related to the CNS - sensory neurons are afferent neurons that bring info INTO the CNS. Motor neurons are efferent neurons that take info OUT of the CNS to the muscles and glands

Question 8

4 regions of the spinal cord?

Answer 8

1) Cervical (neck region); 2) Thoracic (chest region); 3) Lumbar (back region); Sacral

Question 9

Quadriplegia and Paraplegia? Paresis?

Answer 9

Quadriplegia = full paralysis, severed C1-C5. Paraplegia = paralysis of legs only. Severing C6-C7 = paraplegia + partial paralysis of arms. Severing T1 or below = paraplegia only. Paresis = muscle weakness

Question 10

Main differences between left and right hemispheres of the cerebral cortex?

Answer 10

Left hemisphere controls right side of body and vice versa.
Left hemisphere (Language and Logical):
-dominant in most people (meaning it controls language - including reading writing spelling naming and motor control)
-involved in verbal memory
-involved in rational, logical, abstract thinking

Right hemisphere
-perceptual, visuospatial, artistic and intuitive activities
-maintenance of body image
-comprehension and expression of visual, facial and verbal emotion

Question 11

What is aphasia? Apraxia?

Answer 11

Aphasia = speech disorder
Apraxia = movement disorder

Question 12

Three main divisions of frontal lobe and their functions? Remember Broca’s area

Answer 12

Prefrontal cortex, premotor area, motor area
PFC = personality, executive functioning
Premotor = planning movement
Motor = initiates voluntary muscle movement

Broca’s area is in the left frontal lobe - controls muscles that produce speech

Question 13

Function of parietal lobes?

Answer 13

-contain primary sensory areas that process somatosensory information
-integrate sensations of touch such as shape, size, weight, texture
-process sensations pain, heat, and proprioception
-key role in directing attention
-visual and spatial skills
-left parietal lobe - overlearned motor routines and linguistic skills like reading, writing, naming objects

Question 14

Anomia, Agraphia, Alexia, and Acalculia. What are they and what lobe damage do they result from?

Answer 14

Anomia = inability to name objects
Agraphia = inability to write
Alexia = problems with reading
Acalculia = difficulty doing math

Damage to parietal lobes. Other issues include: difficulty drawing objects, distinguishing left from right, awareness of certain body parts –> self care, hand-eye coordination, attending to more than one object at a time

Question 15

Gerstmann’s Syndrome - What brain region is involved and what is it?

Answer 15

Lesions of the left parietal lobe
-results in four primary symptoms: agraphia, acalculia, right-left disorientation, finger agnosia (unable to recognize their fingers as part of their body)

Question 16

What brain systems/cortices are related to the Temporal lobe? Functions of temporal lobe? Wernicke’s area on the left!!

Answer 16

Primary auditory cortex, limbic system
-involved in emotional and behaviour memory
-left temporal lobe involved in verbal memory and language comprehension
-right temporal lobe is involved in visual memory

Question 17

Wernicke’s aphasia? Lobe involved?

Answer 17

Problems understanding speech, temporal lobe

Question 18

Occipital Lobes - function and main cortex?

Answer 18

Primary visual cortex - sight, reading, visual images

Question 19

Name the three subcortical brain areas?

Answer 19

1) corpus callosum; 2) limbic system; 3) basal ganglia

Question 20

Function of corpus callosum? (Subcortical brain area)

Answer 20

Communication between left and right hemispheres. Remember that info is processed on the opposite side of the brain regardless of whether the corpus callosum is intact

Question 21

5 key structures of the limbic system? (Subcortical brain area)

Answer 21

1) thalamus 2) hypothalamus 3) amygdala 4) hippocampus 5) septum

Question 22

Limbic System (Subcortical brain area): Thalamus Functions

Answer 22

Sensory relay center for the brain
-receives input from all senses except olfaction
-integrates and processes this info before sending it to the appropriate cortical areas
-critical in perception of pain
-abnormalities linked to schizophrenia (e.g., misperceptions of sensory input)

Question 23

Limbic System (Subcortical brain area): Hyopthalamus Functions including suprachiasmatic nucleus - five F’s of hypothalamus

Answer 23

-connections to the endocrine system (e.g., pituitary, thyroid, adrenal glands) and autonomic nervous system
-serves major role in homeostasis - regulating temp, hunger, thirst, sex, aggression, sleep-wake

SCN - body’s circadian clock - regulates sleep-wake cycle

-influences pituitary gland by secreting hypothalamic releasing and hypothalamic inhibiting hormones which leads to pituitary gland secreting hormones and activating other endocrine glands

Five Fs: fever, feeding, fighting, falling asleep, f*cking

Question 24

Limbic System (Subcortical brain area): Hippocampus function?

Answer 24

Memory - the consolidation of conscious memories - stores new info and events as lasting memories

Question 25

Limbic System (Subcortical brain area): Amygdala function? -Kluver-Bucy syndrome

Answer 25

-attaches emotional significance to sensory input
-strongly implicated in fear, aggression and emotional memory
-controls the fear response and is involved in memory of fear - linked to PTSD
-related to aggression - Kluver-Bucy Syndrome - removal of amygdala - apathy, hypersexuality, hyperphagia (excessive eating), agnosias (problems with recognition)

Question 26

Limbic System (Subcortical brain area): Septum function? -Septal rage syndrome

Answer 26

-moderates or decreases aggression
-damage to septum = septal rage syndrome

Question 27

Basal Ganglia (Subcortical brain area) functions?

Answer 27

-regulation and coordination of movement
-establishing posture
-send info to premotor cortex and motor cortex
-basal ganglia are INHIBITORY - they put the breaks on movement and release the breaks in order to move voluntarily

Question 28

Five main nuclei of the basal ganglia (Subcortical brain area)?
Huntingtons and Parkinsons? Two other disorders?

Answer 28

1) caudate nucleus 2) putamen 3) substantia nigra 4) globus pallidus 5) subthalamic nucleus

Huntingtons:
-presence of unwanted movements
-degeneration of caudate nucleus and putamen
-continuous thrusting movements of the face and limbs

Parkinsons:
-slow and steady loss of dopaminergic neurons in the substantia nigra
-results in tremor, rigidity, bradykinesia (slowed movements)

Two other disorders: Tourette’s and OCD

Question 29

Cerebellum (Main Brain Structure) functions? Ataxia

Answer 29

-provides EXCITATORY inputs responsible for maintaining smooth movement and coordinating motor activity
-supports our ability to maintain balance
-involved in motor learning

Ataxia - lack of coordination of voluntary movements in the absence of weakness or sensory loss

Question 30

Brainstem (Main Brain Structure) functions? Three main areas and their functions?

Answer 30

-extension of spinal cord, 10 of 12 cranial nerves begin here

1) pons 2) medulla 3) reticular formation

Pons and Medulla
-sleep, respiration, movement, cardiovascular activity

Reticular Formation
-set of nuclei
-awareness, attention, and sleep
-reticular activating system (RAS) - projects to the thalamus- involved in sleep-wake cycle, filter for incoming sensory info, mediates alertness

Question 31

Three parts of a neuron and their functions?

Answer 31

1) Dendrites
-receive info from other neurons by picking up NTS in the synaptic cleft

2) Cell Body (soma)
-integrates info from dendrites
-contains nucleus - regulates cell activity and controls hereditary characteristics eg DNA

3) Axon
-tube-like structure that transmits information

Question 32

Action potential and relevant ions, all or none principal + absolute and relative refractory

Answer 32

-at start, outside cell excess sodium (Na+), inside excess potassium (k+)
-when stimulus of sufficient charge reaches the resting neuron, sodium rushes in, creating an AP
-Potassium then moves out
-AP travels along the axon to the terminal buttons, releases NTs into synaptic cleft
-some NTs then bind to dendrites of next neuron
-also, reuptake occurs- pre-synaptic terminal neurons re-uptake some NTs in synaptic cleft

All or None
-if stimulation is sufficient, neuron files to the full extent. if not, it doesn’t fire at all.

Absolute Refractory
-period after firing where neuron can’t fire regardless of stimulation while Na+ and K+ levels are restored outside and inside neurons

Relative Refractory
-after absolute refractory, where very intense stimulation is required to cause firing

Question 33

Two categories of neurotransmitters, agonist and antagonist, excitatory and inhibitory

Answer 33

1) classical NTs (the basic ones)
2) peptide NTs

Agonist = any substance that enhances the effect of the NT
Antagonist = any substance that inhibits effect of NT

Excitatory NTs = increase likelihood of action potential (e.g., acetylcholine, norepinephrine, glutamate)
Inhibitory NTs = decrease likelihood of AP (e.g., GABA, endorphins)

Question 34

Acetylcholine (ACh - Classical NT) Info - 2 significant functions?

Answer 34

-one of the most common NTs
-involved in 2 significant functions: 1) voluntary movement 2) memory and cognition
-poison of black widow spider affects ACh and causes paralysis
-prevalent in hippocampus
-deficiencies of ACh observed in Alzheimers

Question 35

Chatecholamines (Classic NT) - 2 principal chatecolamines and their function?

Answer 35

1) Dopamine (DA)
-thought, movement, and emotion
-linked to reward system of the brain
-dopamine hypothesis of schizophrenia- psychotic symptoms result from excess dopamine or hyperactivity of dopaminergic system
-parkinsons = degeneration of neurons in substantia nigra (basal ganglia). L-Dopa treats Parkinsons

2) Norepinephrine (NE)
-aka noradrenalin
-significantly involved in mood
-NE deficiency –> depression
-NE excess –> mania
-pain perception
-sleep
-causes blood vessels to contract and HR to increase

Question 36

Serotonin (5HT - Classic NT) - functions

Answer 36

-mood, sleep, appetite, aggression, sexual activity, pain perception
-dysregulation of serotonin –> suicidality and impulsivity
-deficiencies implicated in mood disorders
-low 5HT + low NE = depression
-low 5HT + high NE = mania

Question 37

The Amino Acids (Classic NT) - 3 amino acids and their functions

Answer 37

1) Gaba and 2) Glycine
-major inhibitory NTs in the CNS
-calming effect
-anxiety and epileptic seizures associated with insufficient levels of Gaba
-Benzodiazepines are Gaba agonsits - increase Gaba and reduce overarousal

3) Glutamate
-most common NT
-major mediator of fast excitatory synaptic transmission
-abnormal glutamate transmission suspected in schizophrenia, ASD, OCD and depression

Question 38

Peptide Neurotransmitters - 2 endogenous opioids and Substance P

Answer 38

-long chains of amino acids
-endogenous opioids: 1) enkephalins and endorphins - help regulate stress and pain
-substance P - involved in pain regulation

Question 39

List the three categories of Endocrine Disorders, and the disorders that fall within each category
pituitary is the master endocrine gland and is regulated by hypothalamus

Answer 39

1. Thyroid Disorders
   -hyperthyroidism
   -hypothyroidism
2. Diabetes
   -type 1 diabetes
   -type 2 diabetes
   -gestational diabetes
3. Other Endocrine Disorders
   -hypopituitarism + hyperpituitarism
   -Addison’s disease and Cushing’s disease

Question 40

Thyroid Disorders (Endocrine Disorders) - 2 types and describe

Answer 40

1) Hyperthyroidism
-excessive secretion of thyroxin
-weight loss despite increased appetite, heat sensitivity, sweating, diarrhea, tremor and palpitations, fatigue, agitated depression, insomnia, impaired memory and judgment, can involve hallucinations and delusions
-most common form = Grave’s disease

2) Hypothyroidism
-undersecretion of thyroxin
-unexplained weight gain, sluggishness, fatigue, impaired memory and intellectual functioning, sensitivity to cold

OF NOTE: thyroid disorders are one of the first medical disorders to suspect when psyhiatric symptoms. Hyper mimics anxiety or manic episode. Hypo mimics depression

Question 41

Diabetes (Endocrine Disorders) - general info and hallmarks

Answer 41

-Type 1 = pancreas does not produce insulin
-Type 2 = body develops resistance to insulin
-Gestational = develops during pregnancy
-insulin regulates blood sugar

Hallmark = Hyperglycemia
-excessive glucose or blood sugar levels
-classic symptoms = 3 P’s
1) polyuria = increased urination
2) polydispia = increased thirst
3) polyphagia = increased appetite

-meds treating diabetes can lower blood sugars too much –> hypoglycemia
-symptoms: nervousness, irritability, trembling, cold sweat, fatigue, rapid HR, hunger, headache, confusion

Question 42

Diabetes (Endocrine Disorders) - 3 types and describe

Answer 42

Type 1
-Insulin Dependent Diabetes Mellitus (IDMM)
-develops before age 30
-life-long insulin
-children manage regimen well, become less compliant as adolescents

Type 2
-Non-Independent Diabetes Mellitus (NIDMM)
-can sometimes be controlled by diet and exercise alone
-often requires meds or insulin injections
-major risk factors = obesity and sedentary lifestyle
-rise in type 2 diabetes in kids attributed to increased inactivity and obesity
-African Americans and Hispanics have higher risk

Gestational
-pregnant women develop high glucose level
-may precede Type 2
-1-3% of pregnancies

Question 43

Hypo and Hyperpituitarism (Other Endocrine Disorders)

Answer 43

Hypopituitarism
-undersecretion of pituitary growth hormones
-dwarfism and pubertal delay in children
- in adults: gonadal failure (e.g., impotence, infertility) as well as others (e.g., hypothyroidism, diabetes, adrenocortical insufficiency)

Hyperpituitarism
-oversecretion of pituitary growth hormones
-startling skeletal overgrowth - gigantism or acromegaly

Question 44

Addison’s Disease and Cushing’s Disease (Other Endocrine Disorders)

Answer 44

Corticosteroids - secreted by adrenal cortex - involved in use of energy resources, inhibition of anitbody formation, and inflammation

Addison’s Disease
-undersecretion of corticosteroids (adrenal insufficiency)
-symptoms: apathy, weakness, irritability, depression, GI disturbance

Cushing’s Disease
-oversecretion of corticosteroids
-symptoms: agitated depression, irritability, emotional lability, difficulties with memory and concentration, suicide
-physically- adiposity = swelling of face, neck, trunk

Question 45

Cog Symptoms Related to Stroke, Trauma, Brain Tumors, and Neurocog Disorders - 7 types

Answer 45

1) Aphasia
2) Apraxia
3) Agnosia
4) Agraphia
5) Alexia
6) Amnesia
7) One-Sided Neglect

Question 46

Aphasia - what is it and list the 6 subtypes

Answer 46

Aphasia = loss of language abilities due to damage in the brain (lesion)
-specific location of lesion determines the type of aphasia

1) Broca’s Aphasia; 2) Wernicke’s Aphasia; 3) conduction aphasia; 4) global aphasia; 5) anomic aphasia; 6) transcortical aphasia

Question 47

Broca’s Aphasia- describe

Answer 47

-an expressive or motor aphasia
-lesions to the dominant (left) frontal lobe
-severe problem with speech production and articulation (dysarthria)
-speech is slow and effortful- short phrases and lengthy pauses
-articles (the, an, a), conjunctions and other small words are omitted
-comprehension mostly intact
-difficulty with word finding, naming objects, repeating phrases
-people with this have awareness of it
-broken (broca) or choppy speech

Question 48

Wernicke’s Aphasia - describe

Answer 48

-receptive or sensory aphasia
-lesions in the dominant (left) temporal lobe
-no language comprehension - can’t follow verbal commands or repeat phrases
-speak fluently, but speak nonsense
-unaware of the problem (anosognosia)

Question 49

Conduction Aphasia - describe

Answer 49

-relatively rare
-lesion in connecting pathway between receptive and expressive areas
-intact language comprehension and speak fluently
-cannot repeat verbal phrases
-speak fluently but make no sense
-can execute verbal commands because still comprehend language

Question 50

Global Aphasia - describe

Answer 50

-widespread damage to language regions of the cortex
-most language functions impaired including fluency, comprehension, repetition and naming

Question 51

Anomic Aphasia - describe

Answer 51

-problems recalling words or names
-speak in a round-about way (circumlocution)
-use descriptions to express a word they can’t remember
-damage to parietal or temporal lobe

Question 52

Transcortical Aphasia - describe + 3 types

Answer 52

-caused by damage outside the main language regions
-3 types: transcortical motor aphasia, transcortical sensory aphasia, transcortical mixed aphasia - similar to Broca’s, Wernicke’s, and Global respectively EXCEPT ability to repeat words and phrases remains intact

Question 53

Apraxia - describe

Answer 53

-inability to carry out voluntary or purposeful motor movements
-understands and is willing to perform movements but cannot execute
-many different types:
-difficulty carrying out motor command voluntarily but performing it involuntarily (e.g., scratch nose)
-inability to carry out complex tax in sequence (e.g., socks before shoes)
-no longer being able to perform task with necessary object (e.g., tries to write when given screwdriver)
-difficulty plan + coord movements needed for speech (apraxia of speech)
-difficulty drawing, copying or constructing simple figures (constructional apraxia)

Question 54

Agnosia - describe + 2 types

Answer 54

-loss of ability to recognize sensory stimulus e.g., objects, people, sounds, shapes, smells
-caused by damage in the parietal, temporal, or occipital regions

1) Prosopagnosia
-inability to recognize a familiar face
-retrograde and anterograde
-occurs despite processes being intact e.g., visual perception, alertness, attention
-injuries to areas of the visual association cortex

2) Anosognosia
-lack of awareness of a disability or the nature of one’s illness
-e.g., Wernicke’s not recognizing they’re speaking gibberish
-deficits in frontal or perietal lobes

Question 55

Agraphia - describe

Answer 55

-partial or complete loss of ability to write
-problems with letter formation, spelling, word selection, grammar, or spatial arrangement
-left hemisphere damage eg frontal, temporal or parietal lobes

Question 56

Alexia - describe

Answer 56

-aka word-blindness
-loss of ability to read and/or comprehend meaning of written words and sentences
-most common cause is stroke to dominant (left) hemisphere

Question 57

Amnesia - describe and 2 types

Answer 57

-partial or total memory loss

1) Retrograde
-loss of pre-existing memories
-usually temporally graded - harder to remember recent memories relative to old
-episodic memory more affected than semantic
-can be short (2 years) or extensive (decades)
-even if extensive, memories for facts and events of childhood/adol intact

2) Anterograde
-loss of ability to form new memories
-forget new information, new people, new events within a few seconds
-memory does not transfer from short- to long-term memory

Question 58

One-Sided (Hemispatial) Neglect

Answer 58

-most often result of stroke in right hemisphere
-in this case, no awareness of objects to their left
-may eat from only right side of plate, write on right side of page, shave or put makeup on the right
-may forget to dress the left side of body, walk into furniture on the left

Question 59

Neurocognitive Disorders- brief description of types

Answer 59

-Delirium, Major NCDs, Mild MCDs, and subtypes
-Major NCD: definition is broad- individuals with decline in a single domain cam receive diagnosis
-Mild NCD: less severe levels of cognitive impairment
–> interference with independence in daily activities
-cause of NCD should be stated as part of diagnosis

Question 60

Neurocognitive Disorders: Criteria

Answer 60

Decline in one or more of 6 domains

1) complex attention (sustained, divided attention, processing speed)
2) executive function
3) learning and memory
4) expressive and receptive language
5) perceptual-motor
6) social cognition

Question 61

Neurocognitive Disorders: Specifiers

Answer 61

1) Alzheimer’s disease
2) vascular disease
3) Lewy body disease
4) multiple etiologies
5) Parkinson’s disease
6) Huntington’s disease
7) frontotemporal lobar degeneration
8) HIV infection
9) prion disease (e.g., Creutzfeldt-Jakob disease)
10) another medical condition
11) traumatic brain injury
12) substance/medication use
13) unspecified

Question 62

Delirium

Answer 62

-hallmark: disturbance in attention and awareness
-rapid onset (hours to days)
-course is fluctuating
-includes a cognitive disturbance
-need evidence that symptoms have a physiological cause in order to diagnose (e.g., medical condition, infection, substance intoxication or withdrawal)
-sometimes called an acute confusional state

-different from NCD because acute onset, fluctuating course, and often reversible
-can be superimposed on a major NCD (e.g., major NCD due to Alzheimer’s disease, with delirium)

-can occur at any age, most common with older adults
-most common cause: drugs/meds and infections

-once suspected or diagnosed, look for underlying cause
-reorientation techniques or memory cues e.g., calendar, clock, family photos

-most common meds are antipsychotics (e.g., Haldol)
-benxos used to manage withdrawal delirium

Question 63

Alzheimer’s Disease (AD) - major NCD

Answer 63

-most common major NCD up to 80% of NCDs
-prevalence increases with age
-more prevalent in women because they live longer

Question 64

Alzheimer’s - early and later clinical symptoms

Answer 64

Early symptoms
1) memory problems
2) apathy and depression

Later Symptoms
1) disorientation
2) confusion
3) problems with judgment
4) behaviour changes
5) gait and motor problems

-as it progresses, people need help with basic activities of daily living
-in the final stages, lose ability to communicate, fail to recognize loved ones, become bedridden

Question 65

Alzheimer’s neural abnormalities

Answer 65

-amyloid plaques (deposits of protein fragment beta-amyloid)
-neurofibrillary tangles (twisted strands of the protein tau)
-neuronal damage and death throughout cortex and within brain structures - especially hippocampus and amygdala
-decrease of NT ACh

Question 66

Alzheimer’s: 3 stages

Answer 66

1) pre-clinical - biomarkers indicate early disease but no symptoms
2) mild cognitive impairment (MCI) - mild but noticeable changes in thinking that don’t affect ability to carry out daily activities
3) dementia due to Alzheimer’s disease

-now thought to begin up to 20 years before the presence of symptoms

Question 67

Alzheimer’s etiology, diagnosis, treatment

Answer 67

-agent called Amyvid can help diagnose - picked up in a PET scan
-proton MR spectroscopy also being used

-etiology unclear but evidence for genetic component - particularly first-degree relatives

-progressive disease
-cortical in nature- memory, language and movement most affected

-two principals of management
1) support caregivers
2) treat what is treatable
-drugs: Aricept (donepezil) and Cognex (tacrine) give modest albeit temporary improvements in cog functioning
-no treatment that slows or stops AD

Question 68

Major Vascular Nuerocognitive Disorder - description, initial symptoms, onset and course, prognosis

Answer 68

-second most common NCD
-10-15% of NCD in older adults
-twice as common in males than females
-results from small cerebrovascular accidents (CVAs) or strokes
-location of brain injury determines how functioning is affected

Initial symptoms
-impaired judgment or ability to make plans

-onset is abrupt, course is stepwise - plateaus followed by further degeneration

-half of those diagnosed die within 2-3 years
-age of onset usually younger than Alzheimer’s

-no meds can reverse effects of strokes
-aspirin, anticoagulants and antihyperintensives can reduce risk of future stroke

Question 69

Major Neurocognitive Disorder with Lewy Bodies

Answer 69

-involves abnormal clumps of the protein alpha-synuclein (also found in Parkinson’s Disease)

-symptoms: similar to Alzheimer’s, PLUS visual hallucinations, sleep disturbances, muscle rigidity, other parkinsonian movement features (e.g., shuffling gait)

Question 70

Major Neurocognitive Disorder due to Multiple Etiologies

Answer 70

-most commonly involves Alzheimer’s disease + another disease such as vascular disease or Lewy bodies
-research shows this is more common than previously thought

Question 71

Parkinson’s Disease - 4 markers; co-occurring neuropsych; abnormalities; treatments

Answer 71

-movement disorder marked by tremors, rigidity, and bradykinesia (slowed initiation of movement), and shuffling gait

-commonly co-occuring with neuropsych symptoms like depression or NCD
-depression may precede motor symptoms by several years
-as PD progresses, neurocognitive symptoms are quite common
- prevalence rate of major NCD due to Parkinson’s up to 40%

-subcortical- affects processing speed and EF

-incidence is 1/10th that of Alzheimer’s
-abnormalities include alpha-synuclein aggregates (also found in NCD with Lewy bodies) beginning in substantia nigra of basal ganglia
-aggregates cause degeneration of nerve cells that produce dopamine

-L-Dopa (a precursor to dopamine) is used to treat movement components of Parkinson’s
-does not alter the progression of the disease or decrease symptoms of major NCD

Question 72

Huntington’s Disease (Chorea) - onset, prognosis, early symptoms; brain regions; intervention

Answer 72

-fatal condition
-results from autosomal-dominant gene
-symptoms become apparent between 30- and 50-years old

earliest symptoms
-non-specific changes in personality and mood e.g., irritability, apathy, disinhibition

-all patients experience a progressively deteriorating major NCD (memory loss and lack of reasoning) - slowly develops alongside psychological symptoms

-choreiform movements: frequent, discrete, brisk jerking movements of the pelvis, trunk, and limbs
-athetosis: slow writhing movements
-facial grimaces
-all may begin after 10 years of onset

-involves basal ganglia: caudate nucleus and putamen
-motor symptoms result from significant reduction in ACh and GABA which triggers excess of dopamine

-genetic counselling is an important intervention for those with a family history
-child whose parent has gene for Huntington’s has 50% chance of getting it

Question 73

Major Frontotemporal Neurocognitive Disorder - typical symptoms, 2 examples

Answer 73

-umbrella term - describes a diverse group of rare disorders affecting the frontal and temporal lobes

Typical Symptoms:
-changes in personality and behaviour e.g., problems with judgment, explosive temper, disinhibition, poor impulse control
-difficulty with language

-Pick’s disease and progressive supranuclear palsy are examples

Question 74

Major Neurocognitive Disorder due to HIV Infection - HAART, cog, motor, behaviour/mood symptoms

Answer 74

-prior to highly active antiretroviral therapy (HAART) major NCD was a common source of morbidity and mortality in HIV patients

-AKA Aids Dementia Complex (ADC)

-cognitive symptoms: memory problems (LTM remains intact), attention and concentration, language difficulties

-motor: weakness, lack of coordination, unsteady gait, jerky eye movements

-behaviour/mood: apathy, withdrawal, lack of motivation, personality changes, inappropriate affect, mood swings, hallucinations

Question 75

Creutzfeld-Jakob Disease - cause, symptoms, progression, duration

Answer 75

-rare, degenerative, fatal brain disorder
-results from an infectious misfolded protein (prion) that triggers other proteins throughout the brain to misfold and malfunction

-results in rapidly progressive major NCD

-symptoms: problems with muscular coordination, personality changes, impaired orientation, memory, judgment, thinking, problems with vision

-average duration from onset of symptoms to death is 4-6 months

-one variant is believed to be caused my consumption of products from cattle affected by mad cow

Question 76

Hydrocephalus - what is it, cause, symptoms, prognosis

Answer 76

-accumulation of CSF in the brain’s ventricles causing increased intracranial pressure

-caused by over-production or malabsorption of CFS - mal-absorption more common

-symptoms: urinary incontinence, unsteady gait, NCD

-can sometimes be cured and symptoms reversed with a shunt in the brain to drain excess fluid

Question 77

Neurocognitive Disorder due to TBI - describe, common symptoms, head trauma two types

Answer 77

-involves NCD that results directly from a head trauma
-nature and extent of impairment depends on location and extent of brain injury
-in many cases, posttraumatic amnesia is present + some persisting memory impairment and EF issues
-others: attention, regulating mood, aggression, apathy, changes in personality

-head trauma = leading cause of brain injury in children and young adults

-two types of head trauma: closed- or open-head injuries

Question 78

Closed-Head Injuries (Major NCD due to TBI) - describe, 2 most common types

Answer 78

-skull is not pierced or cracked
-loss of consciousness is common

Types: 1) concussions; 2) contusions

Question 79

Concussions (Closed-Head Injuries (Major NCD due to TBI)) - describe, type of brain injuries, postconcussion syndrome

Answer 79

-most common head injury

-may cause short a short- or long-term loss of consciousness + retrograde and anterograde amnesia
-retrograde amnesia typically includes amnesia for events just before the injury and the incident itself (not for remote events)

-brain injuries are microscopic, widespread, and tend to cause functional (rather than structural) damage

Postconcussion Syndrome
-constellation of somatic and psych symptoms: headaches, dizziness, fatigue, diminished concentration, memory deficit, irritability, anxiety, insomnia, hypochondriacal concern, hypersensitivity to noise and light
-most common symptoms: irritability, fatigue, headache, dizziness
-psych symptoms typically heal in same period of time as physical injuries

Question 80

Contusions (Closed-Head Injuries (Major NCD due to TBI)) - coup-countrecoup, cerebal swelling, frontal lobe syndrome, temporal lobe syndrome

Answer 80

-bruises
-more serious than concussions
-result from severe blow to the head that leads to bleeding and bruising of the brain

Coup-Countrecoup: bruising beneath the point of impact as well as on the opposite side of the brain

-cerebal swelling is common and is potentially life-threatening

-localized, macroscopic, structural damage
-often at the frontal or temporal lobes

-frontal lobe syndrome: lack of foresight and concern, EF problems, irresponsibility, loss of insight

-temporal lobe syndrome: irritability and hostility

Question 81

Open-Head Injuries (Major NCD due to TBI) - neurological signs

Answer 81

-e.g., gunshot wounds

-many with open-head injuries do not lose consciousness

-neurological signs are highly specific: effects of injuries resemble surgical removal of a small area of cortex

Question 82

Recovery from Head Trauma (Major NCD due to TBI)

Answer 82

-may continue for 2-3 years but the bulk of recover is within first 6-9 months

-recovery of memory functions is typically slower than general intelligence
-final level of memory performance is lower than for other cog functions

-as memory recovers, first remember more remote events and then events coming closer and closer to the trauma
-may never remember the event itself or moments leading up - head injury disrupts consolidation

Question 83

Substance/Medication induced Major NCD - cause of alcohol induced + symptom

Answer 83

-impairment persists beyond intoxication and withdrawal

Korsakoff’s Syndrome
-common cause of alcohol-induced major NCD
-results from chronic thiamin (Vitamin B1) deficiency related to longstanding alcohol abuse
-most significant problem: anterograde amnesia
-also retrograde amnesia most often of recent memories

Confabulation
-replacement of a gap in memory with false information that is believed to be true

-also, lack of insight, limited spontaneous conversation, EF problems, disorientation, apathy, labile irritability

Question 84

Pseudodementia

Answer 84

-occurs in people who are depressed and have cog impairments resembling NCD
-in older people, depression symptoms look like NCD

Distinguishing Features:
-those with pseudodementia complain about memory loss, those with NCD often don’t have insight
-those with pseudodementia regain mental functions after depression lifts

Question 85

Pain (Special Topics)- gate control theory, acute and chronic pain, centralization of pain theory

Answer 85

Gate Control Theory
-Melzak and Wall (1965)
-sensations of pain not directly related to activation of pain receptors
-mediated by neural gates in spinal cord that allow signals to move onto the brain
-pressure stimulation closes gates - rubbing hurt area can relieve pain
-psych factors e.g., thoughts and mood sig affect gates - depression and bereavement may open gates

Acute Pain
-begins suddenly
-triggered by clearly defined cause
-resolves when underlying cause is healed

Chronic Pain
-persists after injury is healed
-affects people physically and emotionally
-physical: tense muscles, limited mobility, lack of energy
-emotional: depression, anger, anxiety
-common complaints: headaches, low back pain, cancer pain, arthritic pain, neuropathic pain

Centralization of Pain Theory
-sensitization to pain occurs when brain is exposed to repeated pain signals or nerve stimulation
-bc of neuroplasticity, neurons develop a memory for responding to pain signals
-brain responds more quickly when exposed to same signals in the future
-lowered pain threshold and stronger pain response
-once centralization occurs, takes larger doses of analgesics to overcome it
-some argue for pre-emptive analgesia to prevent or decrease neural plasticity

-recommendation is meds on a time-contingent schedule NOT a pain-contingent schedule re: addiction

Question 86

Sleep (Special Topics) - 2 main types, brain waves, sleep cycle, sleep deprivation

Answer 86

Types of sleep: 1) non-rem; 2) REM

Beta waves = alertness and attention - you beta be awake
Alpha waves = relaxation - “aaaaah”

Sleep Cycle = 4 NREM followed by REM Stage 5

Stage 1) brief transitional stage between wakefulness and sleep - THETA WAVES

Stage 2) sleep spindles - bursts of rapid rhythmic brain activity. body temp and HR start to slow

Stages 3) and 4) - DELTA waves - stage 3 transition between light and very deep sleep, stage 4 is deep sleep - HR slowed but keep muscle tone

Stage 5) REM Sleep - REM, increase respiration rate, increased brain activity- paradoxical sleep - while brain becomes more active, muscles become more relaxed. Most dreaming happens here

-deeper stages less frequent in second half of night and REM more prominent

-time in REM decreases with age: newborns 50%; 4-5 y/o 20-25%; older adults 18%

-waken during NREM - 30% dream, normal and logical dreams
-waken during REM - most have dream that is bizarre and illogical

-NREM = physically restorative
-REM = psychologically restorative

-sleep deprivation: impairs memory, concentration, decision making; disrupts metabolism; increases stress hormones
-long-term deprivation = increased risk car accidents
-dream deprivation (waking during REM episodes) causes REM rebound

Question 87

Electroconvulsive Therapy

Answer 87

-electric currents passed through brain deliberately triggering a seizure
-severe depression, treatment-resistant bipolar, acute psychosis, catatonia
-memory loss - confused and disoriented up to 45 mins after
-anterograde amnesia - typically resolves a few weeks after treatment
-retrograde amnesia - takes longer to resolve - most experience some permanent loss of memory for events during ECT period as well as a few days to a few weeks beforehand
-bilateral ECT = greater memory impairment
-unilateral ECT = less memory impairment and can be as effective if electrical dose is suffucient

Question 88

Tests of Brain Function and Structure

Answer 88

EEG
-electrodes on scalp - electrical activity in cortex
-changes in brain activity
-diagnosis of brain conditions especially seizures
-localizing source of seizure during the event

PET and SPECT Scans
-nuclear imaging
-demonstrate activity or functioning of brain
-small amount of radioactive material injected
-measure metabolism and blood flow
-eg cancer shows up brighter bc have higher metabolism rate

MRI, FMRI and MR Spectroscopy
-uses magnetic fields and radiowaves to create images
-MRI imaging - picks up scars or lesions
-fMRI - brain activity and functioning - how blood flows within brain during specific task - more activity = more blood flow = brighter on scans
-MR spectroscopy - dete4cs metabolic changes that may be consistent with certain disease processes

CT Scan
-test of structure
-combines series of X-ray views and creates cross-sectional images of brain, bones, soft tissues

Question 89

Headaches

Answer 89

Tension
-most common
-band-like tightness, ache or pressure around head
-bilateral pain, dull and steady
-most can function normally
-more common in women

Migraines
-second most common
-often involve unilateral throbbing pain
-moderate to severe intensity
-pain interferes with or is worsened by normal physical activity
-associated features: nausea/vomiting, sensitivity to light and sound
-15-20% of people experience an aura (e.g., visual distortion, hand numbness) prior to headache
-ocular/retinal migraines = visual disturbances like flashing or bright lights, floating geometric shapes, scotomata (blind spots), loss of peripheral vision

Cluster Headaches
-recurring headaches that occur in groups or cycles over a period of days or weeks
-appear suddenly
-severe, debilitating pain in one side of the head
-often accompanied by watery eye/nasal congestion/runny nose on same side of head
-affect 0.1% of population
-more frequent in men

Question 90

Synesthesia

Answer 90

-perceptual condition of mixed sensations
-stimulus in one modality (e.g., vision) elicits a sensation/experience in another modality (e.g., olfaction); or a perception of a form (e.g., letter/number) induces a different perception in the same modality (e.g., colour)
-runs in families
-Vladimir Nabokov and David Hockney have it

Question 91

General Adaptation Syndrome

Answer 91

-Hans Selye
-model of response to long-term stress
-three stages

1) Alarm
-bodily mobilizes resources to cope with stress (fight or flight)
-sympathetic nervous system activated, release of adrenaline and cortisol
-immune functioning is lowered while body on high alert
-physical symptoms: headache, fatigue, diarrhea

2) Resistance
-alarm reaction subsides and body adapts to stressor
-level of resistance to illness above normal

3) Exhaustion
-occurs in response to chronic, unrelenting stress
-body’s resources are exhausted
-immunity is greatly lowered
-can be significant loss of health and death

Question 92

Health Belief Model

Answer 92

-Rosenstock
-multicausal - in addition to psychosocial factors, there are 6 constructs that predict health behaviours

1) perceived susceptibility to disease
2) perceived seriousness of the disease
3) perceived benefits of preventative action
4) perceived barriers to preventative action
5) cues to action e.g., media information
6) self-efficacy

Question 93

Major classes of psychotropic medications? 5

Answer 93

-antipsychotics
-antidepressants
-antianxiety agents
-mood stabilizers
-stimulants

Question 94

Antipsychotics aka neuroleptics or major tranquilizers: First Generation, Conventional, Typical, or Traditional Antipsychotics - list them (11)

Answer 94

Thorazine (chlorpromazine)**
Prolixin (fluphenazine) *
Haldol (haloperidol)
Trilafon (perphanazine) ***
Serentil (mesoridazine)
Navane (thiothixene)
Orap (pimozide)
Loxitane (loxapine)
Moban (molindone)
Stelazine (trifluoperazine)
Mellaril (thioridazine)

Question 95

Antipsychotics aka neuroleptics or major tranquilizers: Second Generation, Atypical, or Novel Antipsychotics - list them (7)

Answer 95

Clozaril (clozapine)*
Risperdal (risperidone)*
Zyprexa (olanzapine)*
Invega (paliperidone)*
Seroquel (quetiapine)*
Geodon (ziprasidone)*
Abilify (ariprazole)***

Question 96

Antipsychotics aka neuroleptics or major tranquilizers - history, mechanism of action

Answer 96

-first-gen 1950s have a long history of effectively reducing positive symptoms of schizophrenia, but are only minimally effective at treating negative symptoms or cognitive symptoms
-second gen 1990s thought would help with negative symptoms but don’t. They have less severe side effects

Mechanism:
-are to some extend dopamine D2 antagonists - lower levels of dopamine by blocking postsynaptic dopamine receptors

Question 97

Antipsychotics aka neuroleptics or major tranquilizers- Disorders Treated

Answer 97

Schizophrenia
-effective in reducing positive symptoms
-no sig effect on negative or cognitive symptoms

Other Psychotic Disorders
-e.g., delusional disorder, brief psychotic disorder, schizoaffective disorder

Bipolar
-atypical antipsychotics in conjunction with mood stabilizers or antidepressant meds to treat mania

Others
-Delirium, Tourette’s, ASD (decrease oppositional behaviour, emotional lability, irritability)
-PTSD and MDD
-NCDs but the FDA says death rates higher for elderly patients

Question 98

Antipsychotics aka neuroleptics or major tranquilizers: Side Effects

Answer 98

-common side effects: sedation and drowsiness, orthostatic hypotension (dizziness when standing up)
-weight gain and sexual dysfunction
-for typical antipsychotics (especially Haldol, Prolixin, and Trilafon, which are higher potency), most sig side effects are extrapyramidal symptoms
-risk of tartive dyskinesia reduced with atypical anyipsychotics

Anticholinergic Effects
-can be cause by both typical and atypical
-dry mouth (most common), constipation, urinary hesitancy or retention, blurred vision, dry eyes, photophobia (light sensitivity), nasal congestion, confusion, decreased memory
-typically diminish in first month but do not fully disappear
-drying out or holding in

Extrapyramidal Symptoms (EPS)
-movement-related symptoms- some of which are the most damaging side effects of antipsychotics
-managed through use of anticholinergic agents (ACAs) like Cogentin (benzotropine) and Artane (trihexyphenidyl)
-far more likely in typical than atypical, especially Haldol, Prolixin and Trilafon which are higher potency
-symptoms include: dystonia (acute and painful muscle spasms), parkinsonism (mask-like face, shuffling gate, drooling, resting tumor, rigidity, bradykinesia), and akathisia (unpleasant restless feeling particularly in legs)

Tardive Dyskinesia
-most commonly involves abnormal movement of the lips, tongue, jaw (e.g., lip smacking, grimacing, chewing, rolling and protruding tongue)
-many involve trunk and arms as well
-generally occurs after longer period of treatment (e.g., 1 year+)
-higher risk of TD with typical antipsychotics - 20-40% of those taking typical antipsychotics get it
-not dangerous, but stigmatizing
-best treated through prevention- monitoring and re-assessing every 6 months to see if med can be discontinued or dosage lowered
-occasionally, symptoms start only once a med has been discontinued or lowered
-no established treatment
-oddly, antipsychotics CAN serve as a short-term treatment for TD
-anticholinergic agents typically exacerbate TB
-may be reversible - 50% experience full remission after stopping antipsychotics

Metabolic Effects
-atypical antipsychotics frequently cause major weight gain and changes in metabolism - increased risk of diabetes/high cholesterol
-regular monitoring of weight, glucose levels and lipid levels

Neuroleptic Malignant Syndrome (NMS)
-rare - less than 1%
-potentially lethal
-severe muscle rigidity, altered consciousness, autonomic instability (e.g., heart rate and blood pressure changes), high fever
-requires emergency medical attention

Agranulocytosis
-potentially lethal side effect of Clozaril (clozapine)
-Clozapine only given to patients who have failed on all other antipsychotics
-sudden drop in the white blood cell (granulocyte) count that results in very high risk of serious infection due to immune suppresion

Question 99

Antipsychotics aka neuroleptics or major tranquilizers: dependence/withdrawal/overdose

Answer 99

-do not cause addiction, dependence, or tolerance
-withdrawal only happens when high dose is suddenly stopped
-symptoms might include GI distress, headaches, insomnia, nightmares
-overdoses not highly lethal unless a full 30-60 day supply taken at one time
-more lethal when combined with another drug e.g., tricyclic antidepressant

Question 100

Antidepressants - 4 classes

Answer 100

SSRI/SNRI, Tricyclic, MAOIs, Other

Question 101

Antidepressants - SSRI/SNRI meds

Answer 101

Prozac, Serafem (fluoxetine)*
Zoloft (sertraline)*
Paxil (paroxetine)*
Effexor (venlafaxine)* [SNRI]
Lexapro (escitalopam)***
Luvox (fluvoxamine)
Celexa (citalopram)
Cymbalta (duloxetine) [SNRI]

Question 102

Antidepressants - Tricyclics (TCAs)

Answer 102

Elavil (amitryptyline)*
Anafranil (clomipramine)*
Tofranil (imipramine)*
Sinequan (doxepin)*
Asendin (amoxapine)
Vivactil (protriptyline)
Surmontil (trimipramine)
Norpramin (desipramine)
Pamelor, Aventyl (nortriptyline)

–> can sometimes be recognized by the ending “amine” or “tyline”

Question 103

Antidepressants - Monoamine-Oxidase Inhibitors (MAOIs)

Answer 103

Nardil (phenelzine)
Marplan (isocarboxazid)
Parnate (tranylcypromine)
Ensam (selegiline) patch

Question 104

Antidepressants - Other Antidepressants

Answer 104

Wellbutrin (bupropion)*
Desyrel (trazadone)*
Ludiomil (maprotiline)
Remeron (mirtazipine)

Question 105

Antidepressants - Overview

Answer 105

-SSRIs newest most widely prescribed, well-tolerated, few side effects, minimal lethality
-TCAs - highly effective but potential side effects are more serious and can be fatal in overdose
-MAOIs - oldest class of antidepressants, especially effective in treating atypical depression (increased appetite and need for sleep), interact dangerously with certain foods and medications

Question 106

Antidepressants - Presumed Mechanism of Action

Answer 106

-block reuptake of serotonin/norepinephrine, increasing their levels in the brain
-Wellbutrin (bupropion) is an anomaly - increases dopamine
-typically takes a couple weeks for meds to take effect

Question 107

Antidepressants - Disorders Treated

Answer 107

Major Depressive Disorder
-all antidepressants equally effective in treating typical depressions
-SSRIs = fewer and less distracting side effects than others, and are safer, first line of treatment

Bipolar Disorder, Depressed
-used in combination with mood stabilizer when treating depression in bipolar - to minimize risk of inducing manic episode
-prozac, paxil, zoloft, and wellbutrin are common

Anxiety/Trauma/OCD
-panic disorder: SSRIs, TCA Tofranil (imipramine), and MAOIs used in addition to antianxiety agents like Xanax and Ativan
-OCD: SSRIs and TCA Anafranil (clomipramine)
-PTSD: SSRIs
-Social Anxiety Disorder: SSRIs
-GAD: SNRI Effexor (venlafaxine) and TCA Tofranil (imipramine)

Chronic Pain
-responds well to many TCAs

Bulimia Nervosa
-antidepressants are common
-only FDA approved is Prozac (fluoxetine)
-studies have also shown efficacy for other SSRIs, TCAs, and MAOIs

Premature Ejaculation
-SSRIs and TCA Anafranil (clomipramine)

Other Uses:
-severe bereavement
-anorexia nervosa
-premenstrual dysphoric disorder
-enuresis
-childhood sleepwalking or night terrors
-persistent depressive disorder (dysthymia)
-borderline personality disorder

Question 108

Antidepressants - Side Effects

Answer 108

SSRIs
-far fewer side effects than TCAs and MAOIs
-headaches, nervousness, restlessness, insomnia, GI distress - fade over time
-if there is sexual dysfunction, may be helped by adjusting the dose or switching to another
-black box warning of potential risk of suicidal thinking or attempts for children and adolescents

TCAs
-may cause severe anticholinergic effects (e.g., dry mouth, blurred vision, constipation, urinary hesitation, confusion, memory problems)
-frequent effects: sedation, orthostatic hypotension, weight gain, nausea, sexual dysfunction
-linked to increased risk of heart disease - contraindicated in patients with heart conditions, high blood pressure or seizures

MAOIs
-frequently cause orthostatic hypotension, weight gain, edema, sexual dysfunction, and insomnia
-tyramine-induced hertensive crisis - can’t eat foods high in tyramine - can trigger dangerous increase in blood pressure requiring immediate medical attn. Symptoms: severe headache, stiff neck, palpitations, sweating, nausea, vomiting
-certain meds should be avoided e.g., MAOIs can react with SSRIs - serotonin syndrome - potentially life threatening

Question 109

Antidepressants - Dependence/Withdrawal/Overdose

Answer 109

-do not cause dependence, tolerance, or addiction
-abruptly stopping can cause non-life-threatening withdrawal symptoms
-TCAs and MAOIs highly lethal when used to attempt suicide via overdose
-lethality further increases when combined with alcohol
-SSRIs and other are not very lethal

Question 110

Benzodiazepines - 4 Types

Answer 110

1) Anxiolytics (BZs)
2) Sedative/Hypnotics (BZs)
3) Non-Benzodiazepine Anxiolytics
4) Non-Benzodiazepine Sedative/Hypnotics

Question 111

Benzodiazepines - Anxiolytics List

Answer 111

Xanax (alprazolam)*
Klonopin (clonazepam)*
Valium (diazepam)*
Ativan (lorazepam)*
Librium (chlordiazepoxide)
Tranxene (clorazepate)
Paxipam (halazepam)
Serax (oxazepam)

Question 112

Benzodiazepines - Sedative/Hypnotics List

Answer 112

Restoril (temazepam)*
Halcion (triazolam)*

Question 113

Non-Benzodiazepine Anxiolytics List

Answer 113

Buspar (buspirone)***

Question 114

Non-Benzodiazepine Sedative/Hypnotics

Answer 114

Ambien (zolpidem)***
Sonata (zaleplon)
Lunesta (eszopiclone)

Question 115

Benzodiazepines etc. - Overview

Answer 115

-divided into two categories: 1) anxiolytics - major function anxiety reduction; 2) sedative/hypnotics - main purpose is to induce sedation and improve sleep

-non-benzo anxioltyics and sedative/hypnotics - eg buspirone - low potential for abuse and dependence, but typically requires 2-4 weeks for clinical response and can’t be taken as needed

-beta-blockers usually used to treat high blood pressure and other heart conditions
-inderal (propranolol) - a beta blocker that can prevent physical symptoms that occur with social phobia

Question 116

Benzodiazepines etc. - Mechanism of Action

Answer 116

-GABA agonist
-increased GABA = reduced anxiety, increased sedation, muscle relaxation, and reduction in seizures

Question 117

Benzodiazepines etc. - Disorders Treated

Answer 117

Anxiety Disorders
-because of high potential for abuse/dependence, benzos should only be prescribed for short periods
-consider underlying cause of anxiety e.g., medical illness, illicit drugs, withdrawal for CNS depressants
-Panic Disorder: Xanax (alprazolam) and Ativan (lorazepam) + SSRIs or TCAs drug of choice in long-term
-GAD: Xanax (alprazolam) and Klonopin (clonazepam). Buspar (buspirone) + antidepressants
-Other anxiety disorders: minor role in treating SAD, Phobias, PTSD, OCD - antidepressants much more common

Sleep Problems
-BZs are best used for short-term (less than 7 days) sleep problems precipitated by acute stress or jet lag
-issues with tolerance and dependence
-rebound insomnia - discontinuing causes insomnia
-disrupt sleep cycle and suppress REM - REM rebound - vivid, disturbing dreams that interfere with sleep

Other Clinical Issues
-Klonopin (clonazepam) sometimes used to treat acute mania
-BZs sometimes used to treat akithesia and alcohol withdrawal
-play a role as antivconsulsants (particularly Klonopin), muscle relaxants, and in anesthesia

Question 118

Benzodiazepines etc. - Side Effects

Answer 118

-most common = drowsiness and dizziness
-others: mild cognitive impairment, impaired coordination, nightmares, headaches, upset stomach, memory problems

-side effects of Buspar: dizziness, headaches, nausea, lightheadedness, excitement and insomnia

-beta-blockers side effects (they are generally well-tolerated): sexual dysfunction (up to 10% males developing impotence), fatigue, dizziness, shortness of breath, angina, cold hands and feet, difficulty sleeping, nightmares

Question 119

Benzodiazepines etc. - Dependence/Tolerance/Withdrawal/Overdose

Answer 119

-physiological and psychological dependence are possible
-BZs vary greatly in how quickly they take effect and how long they last (half-life) - the most addictive are those with rapid onset (= buzz) and short half-life (= mini-withdrawal) - e.g., Xanax
-taking BZs as needed (PRN) encourages dependency

-can develop tolerance to BZs
-BZs and alcohol are cross-tolerant - those who have tolerance to BZs also have increased tolerance to alcohol (hence BZs use to decrease alcohol withdrawal)

-withdrawal syndrome for BZ can be fatal - only gradual taper with doc monitoring - never abrupt stop
-stage 1 symptoms: tremors, sweating, agitation, increased autonomic reactions
-stage 2 symptoms: hallucinations and panic
-stage 3: single or multiple grand mal seizures

-BZs rarely fatal when taken alone, easily fatal when taken with alcohol or other CNS depressants

-BZs should be avoided for older adults - BZ use in older adults = increased risk of falls and fractures, MVAs, cog impairment
-BZ use should be limited in patients with history of alcohol or drug dependence

Question 120

Mood Stabilizers - Two Types

Answer 120

1) Lithium
2) Anticonvulsants

Question 121

Mood Stabilizers - Lithium list

Answer 121

Eskalith (lithium carbonate)
Lithobid (lithium citrate)

Question 122

Mood Stabilizers - Anticonvulsants List

Answer 122

Tegretol (carbamazepine)*
Neurontin (gabapentin)*
Depakote (divalproex)*
Depakene (valproic acid)*
Lamictal (lamotrigine)***
Trileptal (oxcarbazepine)
Topamax (topiramate)

Question 123

Mood Stabilizers - Overview + Presumed Mechanism of Action

Answer 123

-lithium first mood stabilizer - 1970s
-1990s anticonvulsants started to be used as mood stabilizers - were initially meant to treat seizures

-specific mechanism of action is largely unknown

Question 124

Mood Stabilizers - Disorders Treated

Answer 124

Bipolar Disorder
-lithium most often used
-long time to take effect: 1-3 weeks for insomnia, 6-8 weeks for depression - because of this, may be combined with atypical antipsychotic for manic episodes and with an antidepressant for depressive episodes
-after several months, drug has a prophylactic (preventative) effect - cuts in half the number of episodes and reduces severity
-used for schizoaffective disorder, bipolar type
-anticonvulsants are also used, often when lithium doesn’t work or is contraindicated

Other Clinical Uses
-depression - lithium or anticonvulsant may be added if antidepressants alone are ineffective
-impulse control disorders (e.g., intermittent explosive disorders)
-occasionally used as part of treatment of cyclothymic disorder and BPD
-anticonvulsants used for pain relief for some neurological chronic pain disorders like trigeminal neuralgia

Question 125

Mood Stabilizers - Side Effects and Overdose

Answer 125

-lithium side effects: fine hand tremors, gastric distress (e.g., nausea, diarrhea, bloating), weight gain, sedation, hair loss, acne, plyuria (excessive peeing) and polydipsia (excessive thirst)
-period blood tests required when taking lithium to make sure levels are in a therapeutic range + monitor for thyroid or kidney problems
-lithium toxicity - potentially fatal, always a medical emergency. Symptoms may initially mimic the flu - vomiting, abdominal pain, severe diarrhea. Other signs = sever tremor, ataxia, coma, seizures, confusion, irregular heartbeat. Can occur when a patient is on a stable dose and complying with doctor’s orders. Can also occur as result of an overdose

-anticonvulsants side effects: drowsiness, dizziness, headache, diarrhea, nausea, vomiting
-may increase risk of suicidal thoughts and behaviours

Question 126

Mood Stabilizers - Dependence/Tolerance/Withdrawal

Answer 126

-lithium alone does not cause tolerance, addiction, dependence, or withdrawal
-non-compliance is a major issue
-lithium contraindications include pre-existing heart disease, thyroid disease, renal damage, and pregnancy
-always require close monitoring while on lithium because of effects on body symptoms + many drug interactions

-anticonvulsants = no dependence, tolerance, withdrawal

Question 127

Stimulants - List

Answer 127

Ritalin (methylphenidate)*
Adderall (amphetamine)*
Concerta (methylphenidate)*
Dexedrine (dextroamphetamine)*

Strattera (atomoxetine)*** - an SNRI, non-stimulant med that is FDA-approved to treat ADHD but note warning of increased suicidal thoughts in kids and adolescents

Question 128

Stimulants - Mechanism of Action

Answer 128

-increase release of dopamine and norepinephrine (the catecholamines) AND by blocking their reuptake

Question 129

Stimulants - Disorders Treated

Answer 129

ADHD
-response typically occurs within the first two days of administration

Other Clinical Uses
-sometimes used for treatment-resistant depression, treatment-resistant obesity, narcolepsy, and chronic medically debilitating conditions (e.g., AIDS, cancer)

Question 130

Stimulants - Side Effects

Answer 130

-loss of appetite
-insomnia
-headaches
-GI distress (stomach aches or nausea)
-may temporarily suspend growth in children

Other Side Effects
-anxiety, irritability, dysphoria, increases in HR and BP
-can occasionally bring about movement disorders (tics)

Drug Holidays (structured treatment interruptions)
-benefits: relief from side effects
-drawbacks: possible negative impact on social development and peer relations

Question 131

Stimulants - Tolerance/Dependence/Withdrawal/Overdose

Answer 131

-can cause psychological dependence and drug abuse
-street value as uppers
-can cause physical dependence, tolerance (esp when used for narcolepsy), addiction, and withdrawal

-withdrawal: increased appetite, increased weight gain, increased sleep, decreased energy, and uncommonly, paranoid symptoms

-overdose is rarely lethal bc of large discrepancy between therapeutic doses and lethal doses