Chapter 3 Flashcards by Renee English

Define antipsychotics
A) Medications believed to explicitly combat the symptoms of psychosis
B) A form of randomized control trial that involves two stages. In stage one, all participants receive active medication. In stage two, participants who have responded to the treatment are randomized and some begin to receive placebos
C) Medications that are psychoactive (meaning they impact mood, thoughts, or behaviour); they are prescribed for psychiatric reasons
D) A type of drug, often prescribed as an antidepressant, designed on the assumption that depression results from low levels of the neurotransmitter serotonin

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Define direct-to-consumer advertising
A) A practice formally legal in only two countries, whereby advertisements are aimed at those who will ultimately consume medications, rather than at the physicians who prescribe them
B) A form of randomized control trial that involves two stages. In stage one, all participants receive active medication. In stage two, participants who have responded to the treatment are randomized and some begin to receive placebos
C) Medications that are psychoactive (meaning they impact mood, thoughts, or behaviour); they are prescribed for psychiatric reasons
D) A type of drug, often prescribed as an antidepressant, designed on the assumption that depression results from low levels of the neurotransmitter serotonin

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Define discontinuation trial
A) A practice formally legal in only two countries, whereby advertisements are aimed at those who will ultimately consume medications, rather than at the physicians who prescribe them
B) A form of randomized control trial that involves two stages. In stage one, all participants receive active medication. In stage two, participants who have responded to the treatment are randomized and some begin to receive placebos
C) Medications that are psychoactive (meaning they impact mood, thoughts, or behaviour); they are prescribed for psychiatric reasons
D) A type of drug, often prescribed as an antidepressant, designed on the assumption that depression results from low levels of the neurotransmitter serotonin

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Define disease mongering
A) A practice formally legal in only two countries, whereby advertisements are aimed at those who will ultimately consume medications, rather than at the physicians who prescribe them
B) The practice of prescribing drugs for reasons not officially approved by drug regulators
C) Medications that are psychoactive (meaning they impact mood, thoughts, or behaviour); they are prescribed for psychiatric reasons
D) The process by which pharmaceutical companies “sell disease” by promoting awareness of a particular condition, stressing its dramatic impact on sufferers, and then offering a solution in the form of a drug

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Define “off-label” prescribing
A) A practice formally legal in only two countries, whereby advertisements are aimed at those who will ultimately consume medications, rather than at the physicians who prescribe them
B) The practice of prescribing drugs for reasons not officially approved by drug regulators
C) Medications that are psychoactive (meaning they impact mood, thoughts, or behaviour); they are prescribed for psychiatric reasons
D) The process by which pharmaceutical companies “sell disease” by promoting awareness of a particular condition, stressing its dramatic impact on sufferers, and then offering a solution in the form of a drug

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Define psychopharmaceuticals
A) Medications believed to explicitly combat the symptoms of psychosis
B) The practice of prescribing drugs for reasons not officially approved by drug regulators
C) Medications that are psychoactive (meaning they impact mood, thoughts, or behaviour); they are prescribed for psychiatric reasons
D) Medications that generally impact a person by sedating or calming them, including both major and minor tranquilizers

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Define selective serotonin reuptake inhibitor (SSRI)
A) Medications believed to explicitly combat the symptoms of psychosis
B) The practice of prescribing drugs for reasons not officially approved by drug regulators
C) A type of drug, often prescribed as an antidepressant, designed on the assumption that depression results from low levels of the neurotransmitter serotonin
D) Medications that generally impact a person by sedating or calming them, including both major and minor tranquilizers

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Define tranquilizers
A) Medications believed to explicitly combat the symptoms of psychosis
B) The practice of prescribing drugs for reasons not officially approved by drug regulators
C) A type of drug, often prescribed as an antidepressant, designed on the assumption that depression results from low levels of the neurotransmitter serotonin
D) Medications that generally impact a person by sedating or calming them, including both major and minor tranquilizers

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Antidepressants treat: 
A) anxiety 
B) bipolar disorder
C) mania
D) depression

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Anxiolytics treat: 
A) anxiety 
B) bipolar disorder
C) mania
D) depression

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Mood stabilizers treat: 
A) anxiety 
B) bipolar disorder
C) mania
D) depression

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What was the first (and for more than a century dominant) psychoactive drug in America?
A) Heroin
B) Cocaine
C) Alcohol
D) Marijuana

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Which two psychoactive drugs succeeded (came after) alcohol? 
A) Morphine and heroin 
B) Morphine and cocaine 
C) Morphine and marijuana
D) Cocaine and heroin

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Which psychoactive drug was considered to be “applicable in all cases where the object is to relieve pain, quiet restlessness, promote sleep, or allay nervous irritation in any shape”?
A) Cocaine 
B) Heroin 
C) Fentanyl 
D) Morphine

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Which psychoactive drug was widely adopted as a “brain tonic” and stimulant?
A) Cocaine 
B) Heroin 
C) Fentanyl 
D) Morphine

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True or False?
Unregulated markets for psychoactive substances proved dangerous, producing, for example, a widespread epidemic of addiction to opiates and cocaine

True

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What did the 1906 Food and Drug Act require?
A) It required all drugs being sold to be non-expired
B) It required a psychologist’s prescription for the sale of opiates and cocaine
C) It required that psychoactive substances be listed on the label
D) It required a physician’s prescription for the sale of opiates and cocaine

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What did the 1914 Harrison Anti-Narcotic Act require?
A) It required all drugs being sold to be non-expired
B) It required a psychologist’s prescription for the sale of opiates and cocaine
C) It required that psychoactive substances be listed on the label
D) It required a physician’s prescription for the sale of opiates and cocaine

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Britain’s Dangerous Drugs Act took place in \_\_\_\_\_\_\_. 
A) 1920
B) 1939
C) 1929
D) 1960

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Canada’s Opium and Narcotic Drug Act took place in \_\_\_\_\_\_\_. 
A) 1920
B) 1939
C) 1929
D) 1960

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True or False?

In many countries, sales not involving physicians, now legally defined as “non-medical,” were not criminalized

False

In many countries, sales not involving physicians, now legally defined as “non-medical,” were criminalized

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What were the two categories of drugs introduced after morphine and cocaine required physicians for prescriptions?
A) Barbiturate sedatives and alcohol
B) Barbiturate sedatives and fentanyl
C) Alcohol and amphetamine stimulants
D) Barbiturate sedatives and amphetamine stimulants

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By the \_\_\_\_\_\_\_\_\_\_, barbiturates and amphetamines were among the most widely used medicines in America
A) 1930s
B) 1950s
C) 1900s
D) 1970s

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When were barbiturate sedatives first introduced?
A) 1920s
B) 1950s
C) 1900s
D) 1930s

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``` When were amphetamine stimulants first introduced? A) 1920s B) 1950s C) 1900s D) 1930s ```

``` By the 1950s, at least _______ of all prescriptions included one or both of the barbiturate sedatives and amphetamine stimulants A) 50% B) 25% C) 5% D) 75% ```

True or False? | By the 1950s, overdose fatality rates for barbiturates alone were at epidemic levels

True

True or False? | After WWI, psychoactive drugs were reframed as psychiatric medicines, known as psychopharmaceuticals

False | After WWII, psychoactive drugs were reframed as psychiatric medicines, known as psychopharmaceuticals

Which of the following does not include the series of revolutionary drugs offered by pharmaceutical companies? A) The “tranquilizer” Thorazine (chlorpromazine) B) The “mood elevators”, including monoamine oxidase inhibitors (MAOIs) and tricyclics C) the “minor tranquilizer” Miltown D) the “significant tranquilizer” Prombate

What was Miltown claimed to do? A) Claimed to have a specific effect on depression rather than being a general sedative like the barbiturates B) Claimed to have a specific effect on anxiety rather than being a general sedative like the barbiturates C) Claimed to have a specific effect on phobia levels rather than being a general sedative like the barbiturates.

``` In the 1960s and 1970s, what was the single most prescribed drug in the world? A) Librium B) Valium C) Magnesium D) Iron ```

B In the 1970s, Valium became the single most prescribed drug in the United States, with nearly 90 million bottles consumed every year

Which of the following is not true about the Kefauver Harris Amendment? A) It occurred during the 1960s when Senator Estes Kefauver completed a high-profiled investigation of the pharmaceutical industry B) It was an amendment to the Federal Food, Drug, and Cosmetic Act C) The bar of “effectiveness” for testing medications was set very high D) It required pharmaceutical companies to demonstrate not only that their medications were safe, but also that they were “effective”

C The bar of “effectiveness” for testing medications was set very low, and consequently, the pharmaceutical market become flooded with replicated, pre-existing treatments

``` In which particular segment of the American population did the blockbuster drug, Valium, arouse concerns in the 1970s? A) Black, middle-class women B) Asian, high-class women C) White, middle-class women D) Latino, low-class men ```

``` Among Americans between the ages of 18 and 44, antidepressants are the ______ most common prescription. A) 5th B) 4th C) 3rd D) 1st ```

``` Today, _____________ are among the most commonly used prescription drugs in North America and Europe A) psychiatric medications B) opiates C) Lithium and Valium D) Librium and Valium ```

``` About _____ of Americans taking antidepressant medication have done so for ________ years or longer. A) 14%, 20 B) 14%, 10 C) 20%, 20 D) 20%, 10 ```

True or False? | A consistent international trend is that women are more than twice as likely as men to use psychiatric drugs

True

True or False? | There is a broad trend toward decreasing sedative-hypnotic use with increasing age

False | There is a broad trend toward increasing sedative-hypnotic use with increasing age

``` According to WHO, which of the following is not true about naming standards? A) Each drug has a chemical name B) Each drug has a generic name C) Each drug has a trade name D) All drugs have a name length limit ```

What does the term “polypharmacy” refer to? A) Referring to the simultaneous use of 2 or more prescription drugs B) Referring to the sporadic use of 2 or more prescription drugs C) Referring to the simultaneous use of 5 or more prescription drugs D) Referring to the sporadic use of 5 or more prescription drugs

True or False? | Acute conditions are often a direct response to a personal trauma, loss, physical illness, or toxicity

True

The language of psychiatry divides the natural course of a psychiatric condition into phases: A) mild or major B) mild or severe C) acute or chronic

True or False? The term “maintenance” has been applied since the early 1960s to the practice of prescribing psychiatric drugs for extended durations, sometimes a lifetime

True

True or False? | “Chronic disease” has traditionally been a term describing whatever illness is curable in a short amount of time

False | “Chronic disease” has traditionally been a term describing whatever illness was not curable and not immediately fatal

True or False? | One concern of discontinuation trials are the effects of drug withdrawal

True

True or False? | Psychiatric drugs don’t have withdrawal effects when stopped suddenly

False | Psychiatric drugs, like most drugs that act on the brain, tend to cause withdrawal effects when stopped suddenly

True or False? Psychopharmaceuticals are not merely medications; they are also commercial objects produced by an industry where market logics dictate that they must increase their customer base and boost sales

True

True or False? It is difficult to truly discern the extent to which medications are the cause of positive change as a component of treatment

True

True or False | Alcohol is a psychoactive substance with toxic effects

True | Alcohol consumption produces intoxication and continued use may lead to dependence

True or False? | Barbiturates and amphetamines were thought of as “psychiatric drugs”

False | Barbiturates and amphetamines were not thought of as “psychiatric drugs”

At which point did psychoactive drugs begin to be described and understood as psychiatric medications? A) Following WWI B) Following WWII C) Following the Cold War

True or False? Miltown was the first “blockbuster” pharmaceutical drug with high consumption and large cultural impact, and it claimed to treat anxiety without the risks of barbiturate medications

True

``` What is the most recent pharmaceutical-driven epidemic? A) Morphine B) Heroin C) Cocaine D) Fentanyl (opioid crisis) ```

``` Which drug was increasingly prescribed for pain, partially due to aggressive marketing and under-appreciation of risks related to the drug? A) Fentanyl B) Cocaine C) Oxycodone D) Heroin ```

``` Between 2005 and 2008, _______ of Americans filled a prescription for a daily antidepressant medication A) 4% B) 5% C) 11% D) 27% ```

``` Between 2005 and 2008, _______ of Americans had received a monthly antidepressant prescription for two or more consecutive years A) 7% B) 17% C) 11% D) 27% ```

``` Prozac (fluoxetine) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

A, B

``` Zoloft (sertraline) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

A, B

``` Effexor (venlafaxine) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

A, B

``` Seroquel (quetiapine) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

A, C, D

``` Abilify (aripiprazole) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

A, C

``` Zyprexa (olanzapine) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

A, C

``` Prozac is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` Lithium is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` Epival (divalproex) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` Valium (diazepam) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` Ativan (lorazepam) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` BuSpar (buspirone) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` Risperdal (risperidone) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` Lamictal (lamotrigine) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

``` Clozaril (clozapine) is: A) an antidepressant B) an anti-anxiety agent (anxiolytics) C) an antipsychotic D) a mood stabilizer ```

Which of the following commonly used psychiatric drugs is not FDA approved for combination treatment for treatment-resistant depression? A) Abilify B) Effexor C) Zyprexa

``` Antipsychotic medications produced in the 1950s and 1960s are also called _________. A) “atypical antipsychotics” B) “typical antipsychotics.” C) “minor antipsychotics” D) “major antipsychotics” ```

``` Antipsychotic drugs produced toward the end of the twentieth century, act differently on neuroreceptors and are often referred to as __________. A) “atypical antipsychotics” B) “typical antipsychotics.” C) “minor antipsychotics” D) “major antipsychotics” ```

True or False? “Atypical depression” is a subtype of depression thought more likely to be relieved by MAOIs than tricyclics antidepressants

True

True or False? | Atypical depression was characterized by a person’s ability to feel brighter in response to positive events

True

True or False? | People with melancholic depression are believed to have a mood that remains down regardless of what happens around them

True

True or False? In the 1970s, many psychiatrists felt confident that if an individual felt better when taking an MAOI, they could be diagnosed with atypical depression

True

True or False? Biological psychiatrists believed that mental illness was primarily a biological phenomenon, rooted in dysfunction of the brain

True

True or False? | Regulation of psychopharmaceutical marketing and requirements for demonstrating drug “effectiveness” are strong

False Regulation of psychopharmaceutical marketing and requirements for demonstrating drug “effectiveness” are weak and just need to perform better than a placebo

True or False? | Some critics point to disease mongering as the medicalization of normal human experience and diversity

True | (Eg. Shyness becomes characterized as an “anxiety disorder”

Which of the following concerns led to changes in the regulation and marketing of Valium? A) Decreasing numbers of American women experienced overdose episodes and dependence related to Valium B) Everyone was using Valium C) Feminists argued that Valium was being prescribed to women for conditions that were social problems - fatigue, nervousness, anxiety - rather than mental illness

``` Antidepressant use increased ________ in the United States between 1988 and 2008 A) 4% B) 40% C) 400% D 55% ```

True or False? | Drug naming is often organized by families of diagnostic categories (focus on symptoms)

True

Which of the following frameworks are not commonly used to help us make sense of what is observed clinically? A) Questionnaires and surveys B) Consensus statements C) Evidence-based medicine D) Causal reasoning/Pharmacological reason

Which of the following is false about consensus statements? A) They’re sometimes called treatment guidelines B) They’re concerned with patient confidentiality C) They were developed by “neutral” experts in an attempt to resolve controversial questions about public health D) It was an approach developed by the United States National Institutes of Health in the 1970s

Which of the following is false about evidence-based medicine? A) It’s a framework which ranks medical knowledge and research according to the level of evidence supporting the knowledge, largely related to the method used to generate findings B) Large clinical trials are the highest level of authority for evidence-based practice C) Large clinical trials are the lowest level of authority for evidence-based practice D) It was a framework developed at McMaster University

Which of the following is false about causal reasoning/pharmacological reason? A) It’s a process where physicians consider a patient’s response to a medication as part of the process of arriving at a diagnosis (diagnostic process involves cycle of trying and observing) B) This form of reason is mediated by cultural norms, pharmaceutical advertising, beliefs about patients and illnesses C) This cannot promote off-label prescribing and polypharmacy D) This can promote off-label prescribing and polypharmacy E) Andrew Lakoff (an anthropologist) used the phrase “Pharmacological Reason” to describe this process

True or False? Psychopharmaceuticals are medications, but not commercial products (commodities) intended to produce profit for pharmaceutical corporations

False Psychopharmaceuticals are medications, and they are also commercial products (commodities) intended to produce profit for pharmaceutical corporations

True or False? | Discontinuation trials are used to determine when and how people can stop using maintenance therapies

True

Which of the following is false about maintenance therapy? A) Labels the people using these medications as chronically, permanently ill (which creates stigmatization) B) Involved with the use of medications to prevent future illness C) Often used for people diagnosed only with Major Depressive Disorder D) Often used for people diagnosed with Major Depressive Disorder, Bipolar Disorder, Schizophrenia

``` By the 1950s, druggists sold more than ______ doses of barbiturates and amphetamines for each man, woman and child living in the United States each year A) 1 million B) 50 C) 600 D) 1000 ```

True or False? In the 1950s, barbiturates and amphetamines were sold to manage symptoms (insomnia, anxiety, depression) that today, would be seen as indications of mental illness

True

``` Following WWII, psychiatry as a profession began to expand beyond asylums and into the customer realm, although _______ psychiatrists still worked in hospitals, so it was gradual A) 2/7 B) 1/3 C) 2/3 D) 1/7 ```

True or False? | Thorazine (chlorpromazine) was a tranquilizer used to treat and restore psychotic patients

True

Which of the following is not a mood elevator capable of treating even very severely depressed patients? A) MAOIs (monoamine oxidase) B) NATs (national antipsychotic treatments) C) Tricyclics

True or False? Miltown (as a minor tranquilizer) had a specific effect on anxiety rather than being a general sedative (like barbiturates)

True

Which of the following is not true about Miltown? A) General practitioners prescribed more than 80% of the Miltown sold B) It was viewed as non-addictive and safe C) It’s a “minor” tranquilizer D) It’s truly a psychiatric medication and overshadowed antipsychotics and antidepressants E) Viewed as an agent to combat depression

E | Miltown was viewed as an agent to combat anxiety

True or False? SSRI antidepressants appeared to correct serotonin imbalances, leading to theories emphasizing neurotransmitter based causes of depression

True

When a new wave of blockbuster psychopharmaceuticals hit, which of the following is false? A) Xanax and Prozac became the new antidepressants B) There was no rebranding of older medications C) Ritalin re-conceptualized as frontline treatment for ADHD, where it was formerly used as an antidepressant D) Aderall became an ADHD medication after being formerly used as an anti-obesity drug

B | There was rebranding of older medications: Ritalin and Adderall

True or False? | The term “disease mongering” was introduced by David Healy (a psychiatrist) in 1997

True

``` It has been argued by __________ that since the 1990s, pharmaceutical companies played a greater role in defining what gets counted as illness (where this was driven by physicians preciously) A) Peter Conrad B) David Michaelson C) David Healy D) Sigmund Freud ```

True or False? | The naming of antipsychotics did not include reference to neurochemical mechanisms

False | The naming of antipsychotics included reference to neurochemical mechanisms

True or False Effectiveness refers to effect in the real world outside of trail conditions when there are more complicating factors in the environment and due to context

True

True or False? Atypical depression was characterized by an increase in appetite, sleeping more than usual, feeling “leaden paralysis” as a heavy sensation in the limbs

True Atypical depression was characterized by an increase in appetite, sleeping more than usual, feeling “leaden paralysis” as a heavy sensation in the limbs

Define off-label prescribing A) Refers to the use of medications for reasons not officially approved by drug regulators, and accounts for significant proportion of prescribing in North America B) A term that began appearing in medical journals around 2003 partially due to concerns about unforeseen adverse effects stemming from combinations C) A medical term referring to the simultaneous use of 5 or more prescription drugs D) Illegal drinking

Define de-prescribing A) Refers to the use of medications for reasons not officially approved by drug regulators, and accounts for significant proportion of prescribing in North America B) A term that began appearing in medical journals around 2003 partially due to concerns about unforeseen adverse effects stemming from combinations C) A medical term referring to the simultaneous use of 5 or more prescription drugs D) Illegal drinking

``` Which of the following is an example of a chronic condition? A) Anxiety B) Insomnia C) Psychosis D) Major Depressive Disorder ```

True or False? | Some medications were discovered by “accident”

True (Eg. Chlorpromazine (as the first psychopharmaceutical) was originally tested for surgical patients) (Eg. MAOIs originally thought of as anti-tuberculosis medications and later used for treating depression)

True or False? | Most psychopharmaceutical breakthroughs occurred through the 1940s to 1960s

True

What does BED stand for? A) Brooding Electric Duck B) Binge Eating Disorder