Biological Bases of Behavior

Question 1

CNS vs. PNS nervous system

Answer 1

The central nervous system (CNS) consists of the brain and the spinal cord

The peripheral nervous system consists of the nerves that go to and from the brain and the spinal cord

Question 2

Autonomic vs. Somatic nervous system

Answer 2

The peripheral nervous system had 2 main subdivisions: the autonomic nervous system (ANS) and the somatic nervous system.

The ANS controls automatic or involuntary bodily functions of smooth muscles and glands, includes digestion, heart rate, and breathing, The ANS is primarily responsible for maintaining homeostasis and has 2 subdivisions.

The somatic nervous system sends and receives sensory messages that control the voluntary motor movement of skeletal (striated or lined) muscles.

Question 3

Sympathetic vs. Parasympathetic nervous system

Answer 3

The ANS consist of the sympathetic and parasympathetic nervous systems.

The sympathetic nervous system (SNS) is the body’s mobilizing system, aka the flight or fight system. When activated, hormones are released into the bloodstream and result in increased respiration, heart rate, and blood pressure, and decrease the processes of digestion and elimination.

The parasympathetic nervous system (PNS) is the energy-conserving system and it is dominant when the person is relaxed. The main function of the PNS is basic body maintenance via decreasing heart rate, blood pressure, and respiration while increasing digestion and elimination.

Question 4

Spinal cord injuries

Answer 4

Quadriplegia- severing the spinal cord anywhere between C1- C5 results in paralysis in all 4 limbs

Paraplegia- severing the spinal cord T1 or below results in paraplegia in the legs. While damage at C6 or C7 results in paraplegia in the legs and partial paralysis of the arms

Paresis- the incomplete severing of the spinal cord may result in muscle weakness. Strokes can also cause paresis.

Question 5

Left vs. right hemisphere

Answer 5

The left hemisphere controls the right side of the body, while the right hemisphere controls the left side of the body.

The left hemisphere is dominant in 97% of all people and controls language, verbal memory, thinking (rational, analytical, and abstract).

The right hemisphere focus on nonverbal abilities such as perceptual, visuospatial, musical, intuitive activities, maintenance of body image, and the comprehension and expression of visual, facial, and verbal emotion.

Question 6

Types of aphasia- the loss of language abilities due to damages in the brain.

Answer 6

1. Broca’s aphasia- results from lesions to the left frontal lobe and leads to speech productions and articulation (dysarthria). It is considered an expressive or motor aphasia. Broken or choppy speech. They are aware of their problem. Also have problems with word finding, naming objects, and repeating verbal phrases.
2. Wernicke’s aphasia is caused by lesions to the left temporal lobe and results in having no language comprehension. They cannot follow verbal commands or repeat phrases, they can speak fluently, but it makes no sense, and are unaware of their problems. It is considered receptive or sensory aphasia. “Garbage in, garbage out”
3. Conduction aphasia is rare and is caused by a lesion to the arcuate fasciculus- a connective pathway between the expressive and receptive speech areas. The person speaks fluently and comprehends speech but cannot repeat what he or she has heard
4. Global aphasia results from widespread damage to much of the language regions of the cortex. Most language functions are impaired, including fluency, comprehension, repetition, and naming.

Question 7

Parietal lobes

Answer 7

The parietal lobes are located just behind the frontal lobes, contain the primary sensory areas that process somatosensory information. The parietal lobes integrate sensations of touch such as shape, size, weight, and texture; process sensations of pain, hear, proprioception (ability to sense position, location, and movement of the body)

The right parietal lobe plays a key role in directing attention, as well and in visual and spatial skills.

The left parietal lobe is involved in overlearning motor routines and linguistic skills such as reading, writing, and naming objects.

Damage to partial lobes most often caused by a stroke and results in anomia, agraphia, alexia, acalculia, difficulty drawing objects, difficulty distinguishing right from left, lack of awareness of certain body parts that leads to difficulty with self-care, problems with eye-hand coordination, and problems with attending to more than one object at a time.

Gerstmann’s syndrome involves lesions of the left parietal lobe results in agraphia, acalculia, right-left disorientation, and finger agnosia.

Question 8

Frontal lobes

Answer 8

The frontal lobes are located at the top front portion of each hemisphere and occupy the largest portion of the brain (about 1/3). The frontal lobe consists of the prefrontal cortex, the primary motor cortex, and the premotor cortex. It is involved in orientation to time, place, person; and control motor functioning, language expression, higher-level cognitive processes (e.g. abstract thinking, planning, shift set, etc), and emotions/personality.

Broca’s area is located in the left frontal lobe and controls the muscles that produce speech.

Damage to the frontal lobes is most often caused by traumatic brain injury, a stroke, or a tumor, and may result in loss of movement of various body parts, changes in personality, emotional lability, perseveration, inattention, difficulty with problem-solving, and an inability to express language (Broca’s Aphasia)

Question 9

Occipital lobe

Answer 9

The occipital lobes are located at the back of the brain, houses the primary visual cortex, and are involved in sight, reading, and visual images.

Damage to the occipital lobe is not very common but may result from a stroke or tumor. Damage may lead to difficulty recognizing drawn objects, difficulty identifying colors, hallucinations, and illusions, inability to recognize words (word blindness), and problems with reading and writing.

Question 10

Temporal lobes

Answer 10

The temporal lobes are found around the temples, contain the primary auditory cortex, and are connected to the limbic system (e.g. amygdala and hippocampus). the temporal lobes are also involved in emotional behavior and memory.

The left temporal lobe is involved in verbal memory and language comprehension (Wernicke’s area).

The right temporal lobe is involved in visual memory.

Damage to the temporal lobe most ofter results from TBI, a stroke, or encephalitis. Temporal lobe damage may result in increased aggressive behavior, increased or decreased interest in sexual behavior, interference with memory, and problems understanding speech (Wernicke’s Aphasia).

The temporal lobes have to do with hearing and emotions and aggression “temper, temper”

Question 11

Corpus Callosum

Answer 11

The corpus callosum is a bundle of nerve fibers that connects the right and left hemispheres and makes it possible for the 2 hemispheres to communicate.

Split-brain patients have their corpus callosum severed to reduce severe epileptic seizures. Severing the corpus callosum results in information not being shared. When the word “HE ART” was shown, the person could only read the word “Art” because it appears in the right visual field that is processed by the left hemisphere which controls language.

Question 12

Parts of the Limbic System: Thalamus vs. Hypothalamus

Answer 12

The thalamus lies below the corpus callosum and serves as a major sensory relay center for the brain, receiving input from all our senses except olfaction (smell).

The hypothalamus is just below the thalamus and it is connected to the endocrine system and autonomic nervous system. It serves as a major role in homeostasis: regulating temperature, hunger, thirst, sex, cyclic sex hormone secretion, aggression, and the sleep-wake cycle.

Question 13

Kluver-Bucy Syndrome vs, Septal Rage Syndrome

Answer 13

The Kluver-Bucy syndrome was 1st describe by monkeys who had bilateral temporal lobectomies with complete removal of the amygdala. The amygdala attaches emotional significance to sensory input, it controls fear response, aggression, and emotional memory. When the amygdala is removed or destroyed, aggression is diminished. Kluver-Bucy syndrome results in placidity, apathy, hypersexuality, hyperphagia (excessive eating), and agnosia (problems with recognition).

The septum moderate or decreases aggression. It allows you to simmer down. Damage to the septum can result in septal rage syndrome.

Question 14

The cerebellum

Answer 14

The cerebellum is the 2nd largest structure in the brain ansi slocated at the base of the brain, behind the brain stem. It is responsible for maintinag balance, controlling posture, and coorinatin movements.

Injury to the cerebellum can cause ataxia- a conditon that involues loss of balance, slurred speech, and severe tremors.

Question 15

Brain Stem

Answer 15

The brain stem lies below the subcortical regions and in front of the cerebellum. It is the most primitive part of the brain and is an extension of the spinal cord. 10 of the 12 cranial nerves begin in the brain stem. The major brain stem areas are the pons, medulla, and reticular formation.

The pones, the upper portion of the brain stem, and the medulla, found at the bottom of the brain stems just above the spinal cord , are involved in sleep, respiration, movement, and cardiovascular activity.

Damage to the medulla or pons can lead to failure of bodily functions and death.

The reticular formation is a set of interconnected nuclei in the brain stem and is important in awareness, attention, and sleep. Part of the reticular formation is the reticular activating system (RAS), that projects to the thalamus. the RAS in involved in the sleep-wake cycle, serves as a filter for incoming sensory information, an mediate alertness.

Question 16

Action Potential

Answer 16

At rest, the outside of the cell contains an excess of sodium ions (Na+) and the inside of the cell contains an excess of potassium ions (K+). When stimulus of sufficient charge reaches a resting neuron, Na+ moves into the cell and K+ moves outside the cell.

Question 17

All or none principle/law

Answer 17

Neuronal firing is guided by the all or non principle. If sufficiently stimulated the neuron will fire to the fullest extent, if it is not sufficiently stimulated, it will not fire at all. After firing, there is an absolute refractory period, during which the neuron cannot fire, regardless of the strength of stimulation. During the refractory period Na+ and K+ are returned to their original sides: Na+ outside the cell and K+ inside the cell.

Question 18

Neurotransmitters

Answer 18

Neurotransmitters are chemical messengers manufactured by a neuron. They are released at the synaptic vesicles, which are time sacs located in the axon terminals.

Neurotransmitters are classified as either agonist or antagonist or excitatory or inhibitory.

The term agonist is applied to any substance that enhances the effect of the neurotransmitters, while antagonist refers to any substance that inhibits the neurotransmitter effect.

Neurotransmitters are also classified as either excitatory (e.g. acetylcholine, norepinephrine, or glutamate) if the increase the likelihood of an action potential, or as inhibitory (e.g. GABA and endorphins), if the decrease the likelihood of a action potential

Question 19

Classical Neurotransmitters

Answer 19

Acetylcholine (Ach)- it is involved in voluntary movement and memory and cognition. Significant deficiencies in Ach = Alzheimer’s disease

Catecholamines- are Dopamine (DA) and Norepinephrine (NE)

1. Dopamine (DA)- involved in thought, movement, an emotion. It is linked to the reward system in the brain.

According to dopamine hypothesis of schizophrenia the psychotic symptoms of schizophrenia result for excess dopamine or hyperactivity of the dopaminergic system

Decreased dopamine results in Parkinson’s Disease. L-Dopa (Levodopa) which is a precursor to dopamine, is used to treat the movement components of Parkinson’s

2. Norepinephrine (NE) also called noradrenalin is involved in mood. Decreased NE leads to depression and Increase NE leads to mania

NE also plays a role in pain perception as well as sleep, when it is released as a hormone in the bloodstream is causes the blood vessels to contract and the heart rate to increase

Serotonin (5-HT) is involved in mood, sleep, appetite, aggression, sexual activity, and pain perception

Question 20

The role of dopamine in schizophrenia and Parkinson’s

Answer 20

According to dopamine hypothesis of schizophrenia the psychotic symptoms of schizophrenia result for excess dopamine or hyperactivity of the dopaminergic system

Decreased dopamine results in Parkinson’s Disease. L-Dopa (Levodopa) which is a precursor to dopamine, is used to treat the movement components of Parkinson’s

Question 21

The role of serotonin and norepinephrine in depression and mania

Answer 21

low serotonin and low norepinephrine = depression

low serotonin and high norepinephrine = mania

Question 22

Role of GABA in anxiety

Answer 22

GABA (Gamma-Aminobutyric Acid) is an amino acid is one of the major inhibitory neurotransmitters in the CNS (the other is glycine). They have a calming effect. Low levels of GABA are related to anxiety and epileptic seizures.

Benzodiazepines are GABA agonists and increase the levels of GABA and thereby reducing levels of overarousal.

Question 23

Peptide Neurotransmitters for Pain

Answer 23

Enkephalins and Endorphins are also known as endogenous opioids and help to regulate stress and pain.

Substance P is another peptide and is involved in pain regulation

Question 24

Thyroid Disorders

Answer 24

Hyperthyroidism- excessive secretion of thyroxin which results in weight loss despite increased appetite, heat sensitivity, sweating, diarrhea, tremor, palpitations, fatigue, agitated depression, insomnia, impaired memory and judgment, and hallucinations and delusions. Most common form of hyperthyroidism is Grave’s disease. Hyperthyroidism mimics anxiety or a manic episode.

Hypothyroidism - under secretion of thyroxin which results in unexplained weight gain, sluggishness, fatigue, impaired memory and intellectual functioning, and sensitivity to cold. Hypothyroidism mimics depression.

Question 25

Disease of the Adrenal Cortex and amounts of Corticosteroid secreted

Answer 25

1. Addison’s disease = under secretion of corticosteroid results in apathy, weakness, irritability, depression, and gastrointestinal disturbance.
2. Cushing’s disease = over secretion of corticosteroid results in agitated depression, irritation and emotional lability, difficulties with memory and concentration and even suicide.

Question 26

Pituitary Growth Hormone disease

Answer 26

1. Hyperpituitarism = over secretion of pituitary growth hormones results in gigantism or acromegaly.
2. Hypopituitarism = under secretion of pituitary growth hormones results in dwarfism and pubertal delay in children and in adults can cause infertility and other disorders such as as hypothyroidism, diabetes and Addison’s disease.

Question 27

Neurocognitive Disorders (NCD)

Answer 27

Neurocognitive disorders include a decline in 1 or more of 6 cognitive domains: complex attention, executive function, learning and memory, expressive and receptive language, perceptual-motor, and social cognition.

1. Delirium- a disturbance in attention and awareness. The onset is rapid (acute) and the course tends to fluctuate, but the disease is reversible. Delirium is sometimes referred to as an acute confusional state.

Antipsychotics (e.g. Haldol) are commonly given as well as Benzodiazepines to help manage withdrawal delirium.

2. Mild and major NCD- the distinction between mild and major NCD is based on the extent to which the cognitive symptoms interfere with daily functioning. If the cognitive deficits interfere with independence in everyday activities, the diagnosis is Major NCD. If the deficits don’t interfere with independence, the diagnosis is Mild NCD.

Question 28

Alzheimer’s vs Vascular Neurocognitive Disorder

Answer 28

Alzheimer’s disease (AD) is the most commonly occurring major NCD (80% of all cases in older adults) and more prevalent in women. Early clinical symptoms include memory problems, apathy and depression. Later symptoms include disorientation, confusion, problems with judgment, behavior changes, and gait and motor problems. In the final states patients loose their ability to communicate, fail to recognize loved ones, and become bedridden.

The hallmark of AD include amyloid plaques and neurofibrillary tangles. There is also damage to hippocampus, amygdala, and decrease levels in Ach, these changes affect learning, memory, and emotions.

AD was initially diagnosed by confirming histopathological evidence found on a biopsy or autopsy; but now PET scans can be used to an agent called Amyvid that stick to beta amyloid plaques and emitting radioactivity. Proton MR spectroscopy is also being used to detect abnormalities in several bain metabolites.

Currently there is no treatment that slows or stops AD, but medications such as Ariceppt (donepezil) and Cognex (tacrine) help to temporary improve cognitive functioning.

Vascular NCD is the 2nd most common major NCD (10-15% of all cases in older adults) and occurs 2 times more in men. It is the result of numerous small cerebrovascular accidents (CVAs) or strokes. Initial symptoms include impaired judgment or ability to make plans. Onset is acute, with a course frequently described as “step-wise” to indicate that there are plateaus followed by further degeneration.

Half of all diagnosed with vascular MCD die within 2 to 3 years of diagnosis and the age of onset is usually younger than in AD.

Although no medications can reverse the effects of a store, aspirin, anticoagulants (blood thinners), and antihypertensive (high blood pressure) can reduce the likelihood of a future stroke.

Question 29

Cortical vs. Subcortical Neurocognitive disorder

Answer 29

Cortical neurocognitive disorders affect the cortex of the brain. The brain’s outer layers play an important role in processing information and in functions such as language and memory. Cortical NCD is typically associated with the brain’s gray matter.

Subcortical neurocognitive disorders affect structures below the cortex and are more associated with the brain’s white matter. Huntington’s disease, Parkinson’s dementia, and AIDS dementia complex are three examples of conditions classified as subcortical dementia. It is more common to see changes in personality and a slowing down of thought processes (e.g. speed of processing and executive functions (planning, organizing, and sequencing) in subcortical NCD.

Question 30

Huntington’s disease

Answer 30

Huntington’s disease (Chorea) is a fatal condition that results from an autosomal-dominant gene. It involves the basal ganglia, specifically the caudate nucleus and putamen. The motor symptoms of the disease are thought to result from a significant reduction of Ach and GABA, which in turn triggers an excess of dopamine.

Early symptoms include non-specific changes in personality and mood, such as irritability, apathy, or disinhibition. All patients with Huntington’s disease experience progressive deterioration of memory loss and lack of reasoning, choreiform movements (frequent discrete, brisk jerking movements of the pelvis, trunk, and limbs), athetosis (slow writhing movements), and facial grimaces.

Question 31

TBI: Closed-head Injures

Answer 31

Concussion-most common head injury, results from a blow to the head that does not result in a bruise (contusion). It may cause a short-term loss of consciousness as well as both anterograde amnesia (inability to remember new information) and retrograde amnesia (loss of memory for information acquired prior to the injury). Brain injuries from concussions are microscopic and widespread, and tend to cause functional rather than structural damage.

Contusion- cerebral bruises are more serious than concussions, and result from a sever blow to the head that leads to bleeding and bruising of the brain. Contusions are localized and macroscopic and tend to cause structural damage.

Frontal lobe syndrome is characterized by a lack of foresight and concern, problems with executive functioning, irresponsibility, and a lack of insight.

Temporal lobe syndrome is characterized by irritability and hostility.

Question 32

Post-concussion syndrome

Answer 32

Post-concussion syndrome is a collection of somatic and psychological symptoms: headache, dizziness, fatigue, diminished concentration, memory deficits, irritability, anxiety, insomnia, hypochondriacal concern, hypersensitivity to noise, and hypersensitivity to light (photophobia). The most common symptoms are irritability, fatigue, headache, and dizziness. Generally, the psychological symptoms heal in about the same period of time as the physical injures do.

Question 33

Open-head vs Closed-head Injuries

Answer 33

Open-head injures (e.g. gunshot wounds) involve penetration of the skull. Many people who have open head injuries do not lose consciousness. Neurological signs are highly specific and the effects of the injuries resemble the surgical removal of a small area of the cortex. While closed-head injures do not result in the skull being pierced or cracked.

Question 34

Neurocognitive disorder vs. Pseudo-dementia

Answer 34

Pseudodementia occurs in older people who are depressed and exhibit cognitive impairments resembling NCD. A key distinguishing feature between people with pseudodementia and those with NCD, is that the patients with pseudodementia tend to complain about their memory loss while those with NCD tend to lack insight into their condition and often deny memory loss. Additionally, people with pseudodementia regain mental function after the depression is treated, while those with NCD do not.

Question 35

Korsakoff’s syndrome

Answer 35

Korsakoff’s syndrome is a common cause of alcohol-induced major NCD and is the of chronic thiamin (Vitamin B1) deficiency and results in anterograde amnesia and retrograde amnesia. These individuals tend to experience confabulation (the replacement of a gap in the patient’s memory with false information that the patient believes is true). Other hallmarks of the disease include lack of insight, limited spontaneous conversation, problems with executive functioning, disorientation, apathy, and labile irritability.

Question 36

Types of memory loss

Answer 36

1. Anterograde amnesia- difficulty forming new memories

2. Retrograde amnesia-involves the loss of pre-existing memory

Question 37

Effects of bilateral vs. unilateral electroconvulsive therapy (ECT)

Answer 37

Electroconvulsive therapy (ECT) is a procedure win which electric currents are pass through the brain to trigger a brief seizure that can immediately reverse symptoms of certain mental illnesses. It is used to treat severe depression, treatment-resistant bipolar disorder, acute psychosis, or catatonia. It is 85% effective for patients who are medication resistant.

Bilateral ECT caused greater memory impairment than unilateral ECT. Some believe that unilateral ECT is less effective than bilateral ECT, and other have stated that if the dose of electricity is adequate, unilateral ECT is as effective as bilateral ECT with fewer adverse effects.

Question 38

Gate Control Theory of Pain

Answer 38

According to Melzak and Wall’s gate control theory, sensations of pain are mediated by neural gates in the spinal cord that allow these signals to continue on to the brain. Pressure stimulation tends to close the gates, which is why rubbing a hurt area may often relieve pain. Psychological factor, such as attitudes and moods also significantly affects the gates. In particular, depression and bereavement may open neural gates and increase experiences of pain.

Question 39

Stages of sleep: REM vs. non-REM

Answer 39

There are 2 types of sleep: Non-Rapid Eye Movement (NREM) sleep and Rapid Eye Movement sleep. There are 4 NREM states followed by REM sleep.

NREM:
1. State 1- a brief transitional stage between wakefulness and sleep. It is the lightest stage of sleep. In Stage 1 Theta waves predominate.

2. State 2- the brain produces sleep spindles (burst of rapid, rhythmic brain wave activity), body temperature starts to decrease and heart rate begins to slow
3. Stages 3- is a transitional period between light and very deep sleep, and is characterized by delta waves
4. Stage 4- is very deep sleep. The heart rate and respiration are slowed, but muscles maintain tone. The stage is also characterized by delta waves.

REM
5. Stage 5- is characterized by rapid eye movement, increased respiration rate, and increased brain activity. This is paradoxical sleep, while the brain and other body system become more active, muscle becomes more relaxed. Most dreams occurs during REM sleep.

The stages of sleep alternate throughout the night. The deeper stages become less frequent in the second half of the night and REM sleep becomes more prominent. As people age the percent of time spent in REM sleep decreases: newborns 50%, 5 year olds 20-25% and older adults 18%.

If awakened during non-REM sleep, people report have dreams 30% of the time and their dreams seem normal and logical. If awakened during REM sleep, most people report bizarre and illogical dreams.

Non-REM sleep appears to have physically restorative function, while REM sleep appears to have psychologically restorative function.

Question 40

Tonic Clonic vs. Petit Mal Seizures

Answer 40

1. Tonic clonic seizures (aka grand mal seizures) start with sudden loss of consciousness and tonic (stiffening) activity followed by clonic activities (rhythmic jerking caused by alternating muscle contractions and relaxation). After the seizures, people tend to experience headache, confusion, fatigue, and amnesia for the seizure.
2. Petti mal seizures (absence seizures) occurs most often in children and begins before the age of five. They last between 1 to 30 seconds and begin with a brief change in level of consciousness followed by blinking or rolling of eyes, a blank stare, and slight mouth movements (e.g. twitching). The person appears to be daydreaming. Posture is retained and pre-seizure activity is returned to without difficulty.

Question 41

Tests of Brain Function and Structure

Answer 41

1. Electroencephalogram (EEG)- uses electrodes attached to the scalp to measure electrical activity in the cortex. It is used to diagnose seizure disorders and localize the source of a seizure during the event of the seizure.
2. Positron emission tomography (PET) and Single-photon emission computerized tomography (SECT) scans are nuclear imaging techniques used to demonstrate activity or functioning or the brain and other organs. A small amount of radioactive substance is injected into a vein, inhaled, or swallowed and the scans measure metabolism and blood flow which helps detect abnormalities.
3. Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create detailed images of the structure of the brain, other organs, and tissues of the body. It is the most frequently used imaging test of the brain and can pick up scars or lesions.
4. Functional magnetic resonance imaging (fMRI) examines brain activity and functioning. It detects how the blood flows within the brain during a specific task.
5. Magnetic resonance spectroscopy (MR Spectroscopy) is used to detect metabolic changes in the brain that may be consistent with certain disease processes.
6. Computerized tomography (CT) scan- is a structural test that combines a series of X-rays taken at different angles and computer processing to create cross-sectional images of the brain, bones, or soft tissue.

Question 42

Positive vs Negative Symptoms of Schizophrenia

Answer 42

Positive symptoms of schizophrenia includes hallucinations, delusions, disorganized thinking

Negative symptoms of schizophrenia includes affective flattening, lack of motivation, poverty of speech

Question 43

Side effects of Antipsychotics and mechanisms of action

Answer 43

All antipsychotic are to some extent dopamine D2 antagonists, which means that they lower (antagonize) the levels of the neurotransmitter dopamine in the brain by blocking postsynaptic dopamine receptors.

Common side effects of antipsychotics include sedation and drowsiness, orthostatic hypotension (dizziness when standing up), anticholinergic (drying out or retaining fluids), weight gain, sexual dysfunction, extrapyramidal symptoms (EPS), tardive dyskinesia, metabolic adverse effects, and risk of agranulocytosis.

Schizophrenia, delusional disorder, brief psychotic disorder, schizoaffective disorder, bipolar, delirium, Tourette’s disorder, ASD, PTSD, and major depressive disorder are treated by antipsychotics.

Question 44

EPS vs. Tardive dyskinesia vs. Agranulocytosis

Answer 44

Extrapyramidal symptoms (EPS) are movement-related symptoms: dystonia (acute and painful muscle spasms), parkinsonism (a make-like face, shuffling gait, drooling, resting tremor, rigidity, and bradykinesia) and akathisia (an unpleasant, restless feeling particularly in the legs. This side effect occurs when taking Haldol, Prolixin, and Trilafon.

Tardive dyskinesia (TD) most commonly involves abnormal movements of the lips, tongue, and jaw, and may involve trunk and arms as well. It generally occurs after one or more years of treatment of an antipsychotics. All of the antipsychotics can potentially cause tardive dyskinesia, although the risk is reduced with atypical antipsychotics.

Agranulocytosis is a potentially lethal side effect associated with Clozaril (clozapine) and is a sudden drop in the white blood cell count that results in a very high risk of serious infection due to immune suppression.

Question 45

TCAs vs MAOIs vs. SSRIs

Answer 45

There are 3 main classes of antidepressants. Selective Serotonin Reuptake Inhibitors (SSRI ) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are the newest and most widely prescribe antidepressants. SSRIs are generally well tolerated, with few side effects and minimal lethality. Side effects include: headaches, nervousness, restlessness, insomnia, and GI distress. Sometimes it causes sexual dysfunction. There is a risk of suicidal thinking or attempts for children and adolescents.

Tricyclics (TCAs) are highly effective, but their potential side effects are more serious and they can be fatal when taken in overdose. Side effects include: severe anticholinergic effects, sedation, orthostatic hypotension, weight gain, nausea, and sexual dysfunction. They are also linked to increased risk of heart disease and should not be used in patients with heart conditions, high blood pressure, or seizures.

Monoamine-Oxidase Inhibitors (MAOIs) are the oldest class of antidepressants. MAOIs are especially effective in treating atypical depression (increase appetite and need for sleep), however MAOIs interact dangerously with certain foods and medications. The most common side effects include: orthostatic hypotension, weight gain, edema, sexual dysfunction, and insomnia. The most serious side effect is tyramine-induced hypertensive crisis- eating foods high in tyramine (red wine, fava beans, aged cheese, liver, orange pulp, pickled or smoked fish or meats, package soups, yeast vitamin supplements, meat extracts, and dry meats) can trigger a dangerous increase in blood pressure. Certain medications such as SSRIs should not be taken with MAOIs because it can cause serotonin syndrome that is potentially life threatening.

Question 46

Mechanisms of action of antidepressants

Answer 46

The primary mechanism of action of most antidepressants is to block reuptake of serotonin and or norepinephrine, thus increasing the levels of those neurotransmitters in the brain. As their name implies, SSRIs have a selective impact on serotonin. Wellbutrin (bupropion) is an anomaly, as its effect is to increase dopamine. It typically takes a couple of weeks for antidepressant medications to take effect.

Antidepressants are use to treat major depressive disorder, bipolar disorder depressed, anxiety, trauma, obsessive-compulsive disorder, chronic pain, bulimia nervosa, premature ejaculation, severe bereavement, anorexia nervosa, premenstrual dysphoric disorder, enuresis, childhood sleepwalking or night terrors, persistent depressive disorder (dysthymia), and borderline personality disorder.

Antidepressants do not cause dependence, tolerance, or addiction. Abruptly stopping antidepressants can precipitate withdrawal symptoms that are not life-threatening. Both TCAs and MAOIs are highly lethal when patients attempt suicide by medication overdose. Lethality further increases if TCAs and MAOIs are combined with alcohol. In contract, SSRIs, Wellbutrin and Remeron are no very lethal.

Question 47

Withdrawal for alcohol and benzodiazepines

Answer 47

Benzodiazepines (BZ) are either used as an anxiolytics to reduce anxiety or a sedative/hypnotic to induce sedation and improve sleep. Some BZ such as Klonopin (clonazepam) is use to treat acute mania and other time used to treat akathisia and alcohol withdrawal. BZ facilitate GABA’s ability to bind to its receptor site, enhancing the effects of GABA. GABA is a major inhibitory neurotransmitter in the brain and increase GABA results in reducing anxiety, increased sedation, muscle relaxation, and reduction in seizures.

The most common side effects of BZs are drowsiness and dizziness. Other side effects include mild cognitive impairments, impaired coordination, nightmares, headaches, upset stomach, and memory problems.

The side effects of non-BZ such as Buspar include: dizziness, headache, nausea, lightheadedness, excitement, and insomnia.

Patients on BZ can develop both physiological and psychological dependence. Xanax is one of the most addictive BZ. It provide a buss and due to it short half-life (how long it last in the body) that resulting in many experiencing mini-withdrawal symptoms. Patients can definitely develop tolerance for BZ which requires them to take larger doses to have a similar effect.

BZ and alcohol are “cross-tolerant”, meaning that people who develop a tolerance for BZ also experience an increased tolerance for alcohol. BZ can be used to reduce the symptoms of alcohol withdrawal.

Withdrawal syndrome from BZ is very serious and can be fatal. Never abruptly stop taking BZ, but it should be tapered by a doctor. Stage 1 withdrawal symptoms: tremors, sweating, agitation, increased autonomic reactions. State 2 symptoms: hallucinations and panic. Stage 3 withdrawal includes single or multiple grand mal or tonic clonic seizures.

Question 48

Lithium Toxicity

Answer 48

Lithium and anticonvulsants are used as mood stabilizers (to treat bipolar, depression, schizophrenia, impulse control disorders, cyclothymic disorder, and borderline personality disorder. Anticonvulsants are also used to treat seizures and chronic pain disorders such as trigeminal neuralgia.

The side effects of lithium include fine hand tremors, gastric destress (e.g. nausea, diarrhea, and bloating), weight gain, sedation, hair loss, acne, polyuria, polydipsia. The most severe side effect is lithium toxicity is potentially fatal and always a medical emergency. The initial symptoms mimic the flu and include vomiting, abdominal pain, and severe diarrhea. Other signs of lithium toxicity include tremor, ataxia, coma, seizures, confusion, and irregular heart beat.

Lithium does not cause tolerance, addiction, dependence, or withdrawal. Because of its side effects and the nature of bipolar disorder, non-compliance is a major problem with the use of lithium

Side effects of anticonvulsants include drowsiness, dizziness, headache, diarrhea, nausea, and vomiting. They may also increase the risk of suicidal thoughts and behaviors.

Anticonvulsants do not cause tolerance, dependence, or withdrawal.

Question 49

Meds for major Categories of Disorders

Answer 49

I. Antipsychotics also called neuroleptics or major tranquilizers used to treat schizophrenia, other psychotic disorders (delusional disorder, brief psychotic disorder, and schizoaffective disorder), bipolar disorder, delirium, Tourette’s disorder, ASD, PTSD, and major depressive disorder

1st Generation/Conventional/Typical/Traditional Antipsychotics: may end with the suffix “azine”

1. Thorazine (chlorpromazine)
2. Prolixin (fluphenazine)
3. Haldol (halperidol)
4. Trilafon (perphanazine)

2nd Generation/Atypical/Novel Antipsychotics:

1. Clozaril (clozapine)
2. Risperdal (risperidone)
3. Zyprexa (olanzapine)
4. Invega (paliperiodone)
5. Seroquel (quetiapine)
6. Geodon (ziprasidone)
7. Abilify (ariprazole)

II. Antidepressants used to treat major depressive disorder, bipolar disorder depressed, anxiety disorders, Trauma-related disorders, obsessive-compulsive disorders, chronic pain disorders, bulimia disorder, premature ejaculation, severe bereavement, anorexia nervous, premenstrual dysphoric disorder, enuresis, childhood sleepwalking or night terrors, persistent depressive disorder, and borderline personality disorder.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

1. Prozac, Serafem (fluoxetine)
2. Zoloft (sertraline)
3. Paxil (paroxetine)
4. Effexor (venlafaxine) [SNRI]
5. Lexapro (escitalopam)
6. Cymbalta (duloxetine) [SNRI]

Tricyclics (TCAs)- end with “amine” or “tyline”

1. Elavil (amitryptyline)
2. Anafranil (clomipramine)
3. Tofranil (imipramine)

Monoamine-Oxidase Inhibitors (MAOIs)

1. Nardil (phenelzine)
2. Marplan (isocarboxazid)
3. Parnate (tranylcypromine)
4. Ensam (selegiline) patch

Other Antidepressants

1. Wellbutrin (ibupropion)
2. Remeron (mirtazipine)
3. Ludiomil (maprotiline)
4. Desyrel (trazodone)

III. Benzodiazepines and Other Antianxiety/Sleep Agents: used to treat anxiety disorders or induce sedation and improve sleep

Anxiolytics (BZs) end with “pam” or “lam”

1. Xanax (alprazolam)
2. Klonopin (clonazepam)
3. Valium (diazepam)
4. Ativan (lorazepam)

Sedative/Hypnotics (BZs)

1. Restoril (temazepam)
2. Halcion (traizolam)

Non-Benzodiazepine Anxiolytics
1. Buspar (buspirone)

Non-Benzodiazepine Sedative/Hponotics
Ambien (zolpidem)

IV. Mood Stabilizers

Lithium- used to treat bipolar disorder, depression, schizophrenia, impulse control disorders, cyclothymic disorder, and borderline personality disorder

1. Eskalith (lithium carbonate)
2. Lithobid (lithium citrate)

Anticonvulsants- used to treat seizures, stabilize moods, and pain relief

1. Tegretol (carbamazepine)
2. Neurontin (gabapentin)
3. Depakote (divalproex)
4. Depakene (valproic acid)
5. Lamictal (lamotrigine)
6. Topamax (topiramate)

V. Stimulants- used to treat ADHD, treatment-resistant depression, treatment-resistant obesity, narcolepsy, and chronic medically debilitating conditions (e.g. AIDS, and Cancer)

1. Ritalin (methylphenidate)
2. Adderall (amphetamine)
3. Concerta (methylphenidate)
4. Dexedrine (dextroamphetamine)
5. Vyvanse (lisdexamfetamine)
6. Mydayis (mixed amphetamine salts)
7. Strattera (atomoxetine) [SNRI] {non-stimulant}
8. Intuvia (guafacine) [non-stimulant]

Stimulants work by both increasing the release of dopamine and norepinephrine and by blocking their reuptake. As a result, there is an overall increase in levels of dopamine and norepinephrine.

Side effects of stimulants include loss of appetite, insomnia, headaches, stomach aches or nausea, anxiety, irritability, dysphoria, and increased heart rate and blood pressure. Sometimes they can cause movement disorders (tics) and temporarily suppress growth in children.

Stimulants can cause psychological dependence and drug abuse. They can also cause physical dependency, tolerance (especially when used for narcolepsy), addiction, and withdrawal. Withdrawal symptoms include increased appetite, weight gain, increase sleep, decreased energy, and uncommonly, paranoid symptoms. Overdose is rarely lethal.

Question 50

Pain Management and Meds

Answer 50

Chronic pain is considered to be a multi-factorial process, largely affected by neural memories of previous pain. According to the centralization of pain theory, sensitization to pain occurs when the brain is exposed to repeated pain signals or nerve stimulation. As a result of neural plasticity (the brain’s ability to change in response to one’s experience) neurons develop a memory for responding to pain signals. Repeated or frequent simulation (exposure to pain) results in a stronger brain memory. The brain responds more quickly when exposed to the same signals in the future, with a lowered pain threshold and a stronger pain response.

Opiates pain medications are used to treat pain typically on a time-contingent (e.g. on a fixed interval schedule) that on a pain-contingent (e.g. PRN or as needed) schedule. Time-contingent schedules reduce the likelihood of addiction to pain medications and provide better pain control.