Drugs and Mental Health

Question 1

What are the psychological effects of anxiety? (3)

Answer 1

Feeling worried, nervous, agitated

Question 2

What are the somatic and autonomic effects of anxiety? (3)

Answer 2

Tachycardia, sweating, sleep disorder, tense muscles

Question 3

What drugs are used to treat anxiety and give examples (3)

Answer 3

Anxiety reducing drugs called anxiolytics
Benzodiazepines (also used as hypnotics - insomnia)
Buspirone (5-HT1A) partial agonist,
Beta-adrenoceptor antagonists e.g. propranolol
SSRIs

Question 4

What receptors do benzodiazepines act on? (10

Answer 4

GABA

Question 5

Mechanism of action of benzodiazepines (3)

Answer 5

Selectively act on GABAA receptors (mediate fast inhibitory synaptic transmission) - positive allosteric modulators

Enhance GABA response by facilitation of opening of GABA - activated Cl- channels (enhance frequency of opening)

Question 6

Effects of benzodiazepine (5)

Answer 6

reduce anxiety (acute anxiety states)
sedation (decrease REM sleep)
reduce muscle tone and coordination
anticonvulsant (epilepsy)
anterograde amnesia (minor surgical procedures)

Question 7

Overdose of benzodiazepine can cause what problems? (2)

Answer 7

Prolonged sleep
Overdose + CNS depressants (alcohol) = severe respiratory depression

Question 8

Unwanted effects of benzodiazepines (5)

Answer 8

Drowsiness, confusion, amnesia, impaired coordination e.g. driving performance

Question 9

Depression affects how much of the population? (1)

Answer 9

Affects approximately 10% of the population

Question 10

How is depression diagnosed (characteristics)? (3)

Answer 10

Sad, depressed mood (every day/min 2 weeks)
Loss of “pleasure” = anhedonia + 4 of following:
Disruption of appetite, sleep, concentration
Loss of energy, fatigue
Negative self-concept
recurrent thoughts of death, suicide
Reactive or endogenous: not clear distinction & not generally recognised

Question 11

What is the biogenic amine hypothesis (3)

Answer 11

Theory that depression is a result of decreased amine levels in brain - NA especially, but also 5-HT and DA

Question 12

What drugs are used to treat depression? (3)

Answer 12

Tricyclic antidepressants (TCA)
Monoamine oxidase inhibitors (MAOI)
Specific (or selective) serotonin reuptake inhibitors (SSRI)

Question 13

How do Specific Serotonin Reuptake Inhibitors work? (3)

Answer 13

Blocks reuptake pump increases 5HT in somatodentritic area
5HT1A autoreceptors desensitise due to constant activation
Lack of inhibition of impulse flow
Increase 5HT from axon terminal
Postsynaptic receptors desensitise

Question 14

Unwanted effects of SSRIs (5)

Answer 14

Nausea, anorexia
Insomnia rather than sedation
Some reports of aggression, violence
Sexual dysfunction
Loss of libido
Failure of orgasm

Question 15

What is Schizophrenia and what is its symptom onset? (3)

Answer 15

Schizo = to cleave/split & phrenia = the mind

Psychiatric disease/disorder (group of illnesses)

Symptomatic onset in early adulthood & persists throughout life

Question 16

What are the positive (aka type 1) symptoms of Schizophrenia? (3)

Answer 16

Hallucinations; aural & visual (especially aural – voices)
Delusions – persecution complex (paranoia)
Inappropriate emotions and actions

Often presented in younger patients more

Question 17

What are the negative (aka type 2) symptoms of Schizophrenia? (5)

Answer 17

Apathy
Depression
Social incompetence
Loss of insight (can’t recognise own illness)

Older patients often present with type II

Question 18

What are the cognitive symptoms of Schizophrenia? (4)

Answer 18

Attention, memory, executive functions

Question 19

What is the dopamine hypothesis? (2)

Answer 19

Dysregulation of dopamine neurotransmission: abuse of stimulants leads to schizophrenic-like psychosis via release of dopamine

Question 20

How does the dopamine hypothesis link to schizophrenia? (2)

Answer 20

In animals, DA release produces specific stereotypy likened to that in schizophrenia
D2 receptor agonists e.g. bromocriptine & apomorphine, produce similar stereotypy & exacerbate schizo’ symptoms

Question 21

What is a hyperactive DA system associated with? (1)

Answer 21

Associated with positive symptoms

Question 22

What is a hypoactive DA system associated with? (1)

Answer 22

Associated with negative symptoms

Question 23

What drugs are used to treat Schizophrenia? (3)

Answer 23

Antipsychotics (AKA neuroleptics) split into two groups:
Typical e.g. haloperidol, chlorpromazine
Atypical e.g. quetiapine, clozapine

Question 24

What are the problems with using antipsychotics used to treat Schizophrenia? (5)

Answer 24

Clinical effects mediated once at least 65% receptor occupancy – best when at least 80%

High D1/D2 receptor occupancy

Limited/no effect on negative symptoms and cognition

> 30% patients poor responders ~50% out-patients are non-compliant

many side-effects as a consequence of promiscuous receptor profile

Question 25

What can antipsychotics cause? (2)

Answer 25

Extrapyramidal Syndrome (EPS)
- Parkinson-like symptoms, akathisia
- dose-dependant & reversible

Question 26

What are the endocrine effects of using antipsychotics? (5)

Answer 26

DA in hypothalamus acts as release inhibiting factor for prolactin from pituitary

APs therefore increase prolactin

Causes galactorrhea, infertility, gynacomastia in men

DA controls other hormones

APs cause decrease in growth hormone

Question 27

Unwanted effects of antipsychotics not related to DA (4)

Answer 27

Blockade of muscarinic receptors
- dry mouth, blurred vision etc
- often subject to tolerance
- may be beneficial in EPS as less disturbance of balance between excitation (ACh) / inhibition (DA)