ECT, Serotonin Syndrome and Forensics Flashcards
Action of ECT
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.
Occurrence of ECT Procedure
2-3x/week for a total of 6-12 treatments
True or False: Patient does not feel the stimulus or recall the ECT procedure
Trie
What is monitored during ECT?
Blood pressure and ECG
What is administered during ECT?
short-acting anesthetic and muscle relaxant given
Side effects of ECT
hypotension, hypertension, bradycardia, tachycardia, minor arrhythmias immediately after procedure but resolve quickly
Common aftereffects of ECT :
headache, nausea, muscle pain, transient postictal disorientation, and anterograde amnesia
ECT Contraindicated in:
patients with increased ICP, recent MI or CVA, retinal detachment, adrenal cortex tumor
True or False: ECT is first line depression treatment
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)
Serotonin Syndrome
potentially life threatening drug reaction that results from taking 2 or more medications that increase serotonin levels (serotonergic)
Mild Serotonin Syndrome Side Effects
nervousness, nausea, vomiting, diarrhea, dilated pupils, tremor
Moderate Serotonin Syndrome Side Effects
agitation, restlessness, muscle twitching, involuntary muscle contractions, spasms, sweating, shivering, nystagmus
Severe Serotonin Syndrome Side Effects
confusion, disorientation, delirium, tachycardia, hypertension, hyperthermia, seizures, palpitations/dysrhythmias, fainting
Serotonin Syndrome Onset
few hours after taking a new medication that affects serotonin levels; within 24 hours of starting
Serotonin Increasing Medications Include:
SSRIs, SNRIs, TCAs
Unfit to Stand Trial
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
Not Criminally Responsible due to a Mental Disorder
at the time of the offence are psychotic
Individual Vulnerability Viewpoint:
concerned with notions of susceptibility or at risk health problems
Aggregate Vulnerability Viewpoint:
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
Cholinergic Neurotransmitter and Role
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
Conditions with decreased acetylcholine
Alzheimer’s and Down’s Syndrome
Anticholinergic Effects
Most Psychiatric Medications are Anticholinergic. Side effects: dry mouth, blurred vision, constipation, urinary retention, tachycardia
Dopamine
Excitatory biogenic neurotransmitter that stimulates the body’s natural reward pathways, producing euphoric sensations.
Dopamine increased in
Schizophrenia
Dopamine decreased in
Parkinson’s
Dopamine abnormalities in
Addiction
How do antipsychotic medications act?
Antipsychotic medications act by blocking the effects of dopamine at receptor sites. The more specific the receptor, the less EPS effects
Norepinephrine definition, increased in/decreased in:
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
Serotonin role, increased in:
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
GABA
primary inhibitory neurotransmitter of CNS. Controls neuronal excitability throughout the brain
Decreased GABA leads to
development of seizure disorders
Alcohol, anesthetics, benzodiazepines and sedative/hypnotic barbiturate drugs work because of their
affinity for GABA receptors
