ECT, Serotonin Syndrome and Forensics

Question 1

Action of ECT

Answer 1

initiate generalized seizure by an electrical current. Down regulates beta adrenergic receptors in much the same way as antidepressant medications. Also upregulates serotonin and increases blood flow and glucose to the frontal lobes.

Question 2

Occurrence of ECT Procedure

Answer 2

2-3x/week for a total of 6-12 treatments

Question 3

True or False: Patient does not feel the stimulus or recall the ECT procedure

Answer 3

Trie

Question 4

What is monitored during ECT?

Answer 4

Blood pressure and ECG

Question 5

What is administered during ECT?

Answer 5

short-acting anesthetic and muscle relaxant given

Question 6

Side effects of ECT

Answer 6

hypotension, hypertension, bradycardia, tachycardia, minor arrhythmias immediately after procedure but resolve quickly

Question 7

Common aftereffects of ECT :

Answer 7

headache, nausea, muscle pain, transient postictal disorientation, and anterograde amnesia

Question 8

ECT Contraindicated in:

Answer 8

patients with increased ICP, recent MI or CVA, retinal detachment, adrenal cortex tumor

Question 9

True or False: ECT is first line depression treatment

Answer 9

False

Not first-line treatment for depression but rather used to treat patients whose disorder is refractory, intolerant to initial drug treatments and patients who are severely ill that rapid treatment is required (malnutrition, catatonia or suicidality)

Question 10

Serotonin Syndrome

Answer 10

potentially life threatening drug reaction that results from taking 2 or more medications that increase serotonin levels (serotonergic)

Question 11

Mild Serotonin Syndrome Side Effects

Answer 11

nervousness, nausea, vomiting, diarrhea, dilated pupils, tremor

Question 12

Moderate Serotonin Syndrome Side Effects

Answer 12

agitation, restlessness, muscle twitching, involuntary muscle contractions, spasms, sweating, shivering, nystagmus

Question 13

Severe Serotonin Syndrome Side Effects

Answer 13

confusion, disorientation, delirium, tachycardia, hypertension, hyperthermia, seizures, palpitations/dysrhythmias, fainting

Question 14

Serotonin Syndrome Onset

Answer 14

few hours after taking a new medication that affects serotonin levels; within 24 hours of starting

Question 15

Serotonin Increasing Medications Include:

Answer 15

SSRIs, SNRIs, TCAs

Question 16

Unfit to Stand Trial

Answer 16

unable on the account of mental illness to conduct a defense at any stage of the proceedings before a verdict in rendered.
3 Criteria:
1. Unable to understand the object or nature of the proceedings
2. Unable to understand the consequences of the proceedings
3. Unable to communicate with counsel

Question 17

Not Criminally Responsible due to a Mental Disorder

Answer 17

at the time of the offence are psychotic

Question 18

Individual Vulnerability Viewpoint:

Answer 18

concerned with notions of susceptibility or at risk health problems

Question 19

Aggregate Vulnerability Viewpoint:

Answer 19

focuses on those with a greater than average risk of developing physical, psychological, or social health challenges by virtue of marginalized status, limited access to resources, and personal characteristics

Question 20

Cholinergic Neurotransmitter and Role

Answer 20

Acetylcholine

Role in: Intellectual Functioning and Memory
Chief Neurotransmitter of Parasympathetic Nervous System: contracts smooth muscle, dilates blood vessels, increases secretions and slows heart rate

Question 21

Conditions with decreased acetylcholine

Answer 21

Alzheimer’s and Down’s Syndrome

Question 22

Anticholinergic Effects

Answer 22

Most Psychiatric Medications are Anticholinergic. Side effects: dry mouth, blurred vision, constipation, urinary retention, tachycardia

Question 23

Dopamine

Answer 23

Excitatory biogenic neurotransmitter that stimulates the body’s natural reward pathways, producing euphoric sensations.

Question 24

Dopamine increased in

Answer 24

Schizophrenia

Question 25

Dopamine decreased in

Answer 25

Parkinson’s

Question 26

Dopamine abnormalities in

Answer 26

Addiction

Question 27

How do antipsychotic medications act?

Answer 27

Antipsychotic medications act by blocking the effects of dopamine at receptor sites. The more specific the receptor, the less EPS effects

Question 28

Norepinephrine definition, increased in/decreased in:

Answer 28

Excitatory neurotransmitter that plays a major role in generating and maintaining mood states.
Decreased in: depression
Excessive in: manic, plays role in physical anxiety symptoms
Heavily concentrated in sympathetic nerves; fight or flight response

Question 29

Serotonin role, increased in:

Answer 29

Excitatory neurotransmitter than plays a role in emotions, cognition, sensory perception, sleep, and appetite
Decreased in: depression and insomnia
Dysfunctional pathways lead to: OCD, panic disorder, anxiety

Question 30

GABA

Answer 30

primary inhibitory neurotransmitter of CNS. Controls neuronal excitability throughout the brain

Question 31

Decreased GABA leads to

Answer 31

development of seizure disorders

Question 32

Alcohol, anesthetics, benzodiazepines and sedative/hypnotic barbiturate drugs work because of their

Answer 32

affinity for GABA receptors