DISORDERS Flashcards
Clinical depression, imbalance of which neurotransmitter?
Norepinephrine and or serotonin
Alzheimer’s disease, imbalance of which neurotransmitter?
Acetylcholine
Epilepsy is due to an imbalance of which neurotransmitters?
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.
Huntington’s disease, imbalance of which neurotransmitter?
Deficient in GABA
Hyper-insomnia, imbalance of which neurotransmitter?
Excess of serotonin
Insomnia, imbalance of which neurotransmitter?
Deficient serotonin
Mania, imbalance of which neurotransmitter?
Excess NE
Parkinson’s disease, imbalance of which neurotransmitter?
Deficient DA, with too little dopamine movement becomes difficult. Parkinson’s disease is one result of low levels of dopamine
Schizophrenia, imbalance of which neurotransmitter?
Deficient GABA leads to excess DA
Tardive dyskinesia, imbalance of which neurotransmitter?
Low DA levels over a length of time
Difference between Parkinsonism (drug induced)/Parkinson’s disease (idiopathic) and TD
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).
While hallucinations are commonly seen with _________, they may also be associated with__________
Delirium and Dementia
Patients with Dementia are, however, particularly susceptible to developing ___________ in the presence of any inter urgent infection.
Delirium
In Alzheimer’s Disorder may person experience delusions or hallucinations?
Psychotic sxs are common. Delusions experienced in up to 50% of cases; hallucinations seen in up to 25% of cases.
L-dopa is commonly used to treat______
Parkinson’s Disease
Described bipolar 1 and bipolar 2 disorders
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).
Criteria for Bipolar 1
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
Criteria for Bipolar 2
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.
What is the criteria for Rapid Cycling in bipolar disorder
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.
Criteria for Mixed Bipolar
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.
Criteria for Cyclothymia in bipolar disorder
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.
Which agent would be preferable in a patient with bipolar depression?
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.
Lamotrigine (Lamictal) blocks the release of _____________and inhibits _________ channels.
Blocks the release of glutamate and inhibits voltage-sensitive sodium channels.
Gabapentin was designed as a GABA agonist, but …it does not bind to GABA sites. It seems to increase GABA levels by __________
Influencing the GABA transporter. Clonazapam binds to the benzodiazepine binding site on the GABA-A receptor.
Topiramate has multiple mechanism of action but it uniquely prevents ______ of the ______ receptor.
Akin ate Inhibition of the AMPA receptor
Carbamazepine inhibited both:
Pre/post synaptic sodium channels.
True or false: SSRIs may increase neuroleptic blood levels.
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.
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?
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.
Lithium side effects may include
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
Lithium’s main effects are post synaptic, at the level of __________
G-proteins and second messengers.
Hypothyroidism labs
Versus
Hyperthyroidism labs
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.
