DISORDERS

Question 0

Clinical depression, imbalance of which neurotransmitter?

Answer 0

Norepinephrine and or serotonin

Question 1

Alzheimer’s disease, imbalance of which neurotransmitter?

Answer 1

Acetylcholine

Question 2

Epilepsy is due to an imbalance of which neurotransmitters?

Answer 2

Researchers believe that some people with epilepsy have an abnormally high level of excitatory neurotransmitters that increase neuronal activity, while others have an abnormally low level of inhibitory neurotransmitters that decrease neuronal activity in the brain(Wells, 8015). Either situation can result in too much neuronal activity and cause epilepsy. One of the most-studied neurotransmitters is GABA (gamma-aminobutyric acid) which is an excitatory and inhibitory (in up to 90% of synapses that don’t use glutamate) neurotransmitter. NMDA (n-methyl-d-aspartate) is another extensively researched neurotransmitter that plays a vital role in the development in of an epileptic brain.

Question 3

Huntington’s disease, imbalance of which neurotransmitter?

Answer 3

Deficient in GABA

Question 4

Hyper-insomnia, imbalance of which neurotransmitter?

Answer 4

Excess of serotonin

Question 5

Insomnia, imbalance of which neurotransmitter?

Answer 5

Deficient serotonin

Question 6

Mania, imbalance of which neurotransmitter?

Answer 6

Excess NE

Question 7

Parkinson’s disease, imbalance of which neurotransmitter?

Answer 7

Deficient DA, with too little dopamine movement becomes difficult. Parkinson’s disease is one result of low levels of dopamine

Question 8

Schizophrenia, imbalance of which neurotransmitter?

Answer 8

Deficient GABA leads to excess DA

Question 9

Tardive dyskinesia, imbalance of which neurotransmitter?

Answer 9

Low DA levels over a length of time

Question 10

Difference between Parkinsonism (drug induced)/Parkinson’s disease (idiopathic) and TD

Answer 10

In many ways, tardive dyskinesia and similar (but unrelated) movement disorders are the opposite of Parkinson’s disease. Tardive dyskinesia patients have great difficulty staying still, whereas those with Parkinson’s disease have a great deal of difficulty moving at all.

Drugs used to treat mental illness work by blocking the receptors that receive signals from the brain. The signals are transmitted by the neurochemical dopamine, which is why these drugs are called “dopamine antagonists.” In both tardive dyskinesia and Parkinson’s disease, insufficient amounts of this chemical are produced, or the chemical and the receptors are not functioning as they should. This is why some patients on antipsychotic medications can sometimes develop symptoms of Parkinson’s disease, although this is not necessarily the disease itself (symptoms without the disease are called “Parkinsonism”). However, true Parkinson’s disease is most often genetic.

There have been extremely rare cases in which tardive dyskinesia has been known to appear in a patient for no known cause. In virtually all other cases however, the culprit is a dopamine antagonist.

Because both disorders are related to dopamine production and transmission, tardive dyskinesia and Parkinson’s disease can be managed with many of the same treatments, though strictly speaking, neither are curable (tardive dyskinesia has been known to go into remission in many patients however, particularly if they have been on the drug for only a short time). Both may be treated and managed with a combination of levodopa and dopamine agonists (medications that facilitate the function of dopamine).

Question 11

While hallucinations are commonly seen with _________, they may also be associated with__________

Answer 11

Delirium and Dementia

Question 12

Patients with Dementia are, however, particularly susceptible to developing ___________ in the presence of any inter urgent infection.

Answer 12

Delirium

Question 13

In Alzheimer’s Disorder may person experience delusions or hallucinations?

Answer 13

Psychotic sxs are common. Delusions experienced in up to 50% of cases; hallucinations seen in up to 25% of cases.

Question 14

L-dopa is commonly used to treat______

Answer 14

Parkinson’s Disease

Question 15

Described bipolar 1 and bipolar 2 disorders

Answer 15

Bipolar I Disorder is the more serious of the two types of Bipolar Disorder. This is due to the presence of Manic Episodes in the criteria for Bipolar I Disorder. There is an absence of Manic Episodes in the criteria for Bipolar II Disorder, rather it involves a history of hypomania. Hypomania is similar to mania; however, it is not serious enough to cause social or occupational impairment, hospitalization, or psychotic features (American Psychiatric Association, 2000).

Bipolar I Disorder may be described as occurring on a continuum of severity ranging from mild forms of depression with brief mania to severe depression with rapid cycling mania. Psychotic features may also accompany episodes of severe mania and depression (Thomas, 2004).

Question 16

Criteria for Bipolar 1

Answer 16

A person affected by bipolar I disorder has had at least one manic episode in his or her life.

A manic episode is a period of abnormally elevated mood, accompanied by abnormal behavior that disrupts life

Question 17

Criteria for Bipolar 2

Answer 17

Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time.

However, in bipolar II disorder, the “up” moods never reach full-on mania.

Question 18

What is the criteria for Rapid Cycling in bipolar disorder

Answer 18

In rapid cycling, a person with bipolar disorder experiences four or more episodes of mania or depression in one year (12 months)

About 10% to 20% of people with bipolar disorder have rapid cycling.

Question 19

Criteria for Mixed Bipolar

Answer 19

Mixed Bipolar
In most forms of bipolar disorder, moods alternate between elevated and depressed over time.

But with mixed bipolar disorder, a person experiences both mania and depression simultaneously or in rapid sequence.

Question 20

Criteria for Cyclothymia in bipolar disorder

Answer 20

Cyclothymic Disorder is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to individuals who experience mood cycling over a two year period, but have not met the diagnostic criteria for Bipolar I, Bipolar II, or Depressive disorder.

Question 21

Which agent would be preferable in a patient with bipolar depression?

Answer 21

Bupropion (Wellbutrin - NDRI) (this medication shown to have a lower switch rate than TCAs in type 1 bipolar disorder).

Imipramine (Tofranil), a TCA or class with a high mania switch rate.

Question 22

Lamotrigine (Lamictal) blocks the release of _____________and inhibits _________ channels.

Answer 22

Blocks the release of glutamate and inhibits voltage-sensitive sodium channels.

Question 23

Gabapentin was designed as a GABA agonist, but …it does not bind to GABA sites. It seems to increase GABA levels by __________

Answer 23

Influencing the GABA transporter. Clonazapam binds to the benzodiazepine binding site on the GABA-A receptor.

Question 24

Topiramate has multiple mechanism of action but it uniquely prevents ______ of the ______ receptor.

Answer 24

Akin ate Inhibition of the AMPA receptor

Question 25

Carbamazepine inhibited both:

Answer 25

Pre/post synaptic sodium channels.

Question 26

True or false: SSRIs may increase neuroleptic blood levels.

Answer 26

True: SSRIs, such as fluoxetine, may increase neuroleptic blood levels secondary to inhibition of CYP P450 hepatic enzymes- 2D6 and 3A4 (increases clozapine levels also) or Fluvoxamine at 1A2, 2D6, or 3A4; of which inhibits enzymes that metabolize clozapine (1A2 and 3A4) leading to toxicity.

Question 27

MAOIs have numerous toxic drug-drug interactions generally classified as the “serotonin syndrome” and “hypertensive crises.” What type of drugs should not be combined with an MAOI?

Answer 27

SSRI’s such as Fluvoxamine, citalopram, fluoxetine

the TCAs, most particular Clomipramine, which has the highest serotonergic uptake inhibition effect among the TCAs.

Busipirone (Buspar) also has serotonergic effects.

Medication with stimulant properties and dopaminergic agents, such as bupropion (Wellbutrin) may cause hypertensive crises.

Note: For insomnia induced MAOIs, either Trazodone (Desyrel)and Clonazepam (Klonopin) may be safely used to facilitate sleep.

Question 28

Lithium side effects may include

Answer 28

Nephrotic syndrome (mild azotemia or elevated creatinine levels)
Sick Sinus syndrome  (can produce blockade of the sinoatrial node)
Insulin-like effects 
Hypothyroidism (high TSH and low free T4) 
Psoriasis
Mild Leukocytosis 
Sedation
Cognitive difficulties
Dry mouth
Hand tremor 
Weight gain
Polydipsia
Polyuria
Diarrhea, 
Acne

Note: Leukopnia occurs with Carbamazepine

Question 29

Lithium’s main effects are post synaptic, at the level of __________

Answer 29

G-proteins and second messengers.

Question 30

Hypothyroidism labs

Versus

Hyperthyroidism labs

Answer 30

Since the pituitary gland would normally release TSH if the T4 is low, a high TSH level would confirm that the thyroid gland (not the pituitary gland) is responsible for the hypothyroidism. When thyroid hormone levels decrease, the TSH rises and vice versa.
If the T4 level is low and TSH is not elevated, the pituitary gland is more likely to be the cause for the hypothyroidism.

An elevated T4 or T3, in association with a low or suppressed TSH, establishes hyperthyroidism. An elevated TSH in conjunction with a low T4, is encountered in hypothyroidism.