Exam #2 Flashcards
Which of the following is not a monoamine?
GABA
What does the ‘Blackout effect’ refer to?
Anterograde amnesia
Which of the following is NOT a negative symptom of schizophrenia?
Akathisia (an inability to remain physically still)
Where is lithium primarily metabolized and excreted?
Kidney (NOT LIVER, like most things! Lithium is often incorrectly thought to be metabolized in the liver).
Which neurotransmitter is closely associated with schizophrenia?
Dopamine
Decreased positive affect in depression is associated with
low Dopamine
low Norepinephrine
Withdrawing from barbiturates can cause
Vivid dreams
What is a key indicator for distinguishing mania from hypomania?
Need for sleep
Mania: Okay with little to none
Hypomania: 4-6 hours/night
What does the ‘N’ in SNRI stand for?
Norepinephrine
Which neurotransmitter is associated with cognitive psychotic symptoms?
Glutamate
What is a common side effect of both SSRIs and SNRIs?
Dizziness
What combination prevents switching into mania with bipolar disorder?
Olanzapine-Fluoxetine combo
Benzodiazepines impact the effects of?
GABA
What do first-generation antipsychotics block?
D2 receptors
What do TCAs act on?
Both serotonin & norepinephrine
What is one effect of barbiturates?
Hypnotic
Which phase is NOT one of the four phases of bipolar?
Astute hypomania
What percentage of people with mania present with psychotic symptoms?
75%
Which of the following is a z-drug?
Luneza
Sonata
Ambien
What does the kindling hypothesis of bipolar disorder suggest?
Episodes become more challenging to predict over time
What is a primary reason for non-adherence to lithium use for bipolar disorder?
Weight gain
What is the oldest antidepressant?
MAOIs
Negative Symptoms of Schizophrenia
Appearing as a deficit to normal functions:
5 A’s
* 1. Affective flattening (restrictions in range/intensity of emotional expression)
* 1. **Alogia **(restrictions in fluency/productivity of thought/speech)
* 1. Avolition (restrictions in goal-directed behavior)
* 1. Anhedonia (lack of pleasure), especially anticipatory anhedonia
* 1. Asociality
Known cause of tardive dyskinesia
Blocking dopamine in receptors
inside the basal ganglia
Most commonly studied neurotransmitters of schizoprenia
Dopamine
Glutamate
1st generation antipsychotics
- “typical” antipsychotics
- act on D2 receptors
- they are dopamine antagonists
2nd generation antipsychotics
- atypical antipsychotics
- acts on D2 receptors AND serotonin 5-HT2 receptors
* serotonin-dopamine antagonists
agranulocytosis
lowered white blood cell count (acute, severe, dangerous)
akathisia
inability to remain still
acute dystonia
involuntary, muscle contractions, causing repetitive movements or abnormal posture that can be painful
tardive dyskinesia
repetitive muscle movements in the face, neck, arms, legs
neuroleptic malignant syndrome
high fever, severe muscle rigidity
an advantage of benzodiazapenes
one antidote for them all: FLUMAZENIL
Benefits of Z drugs
- produces less motor & neurological impairment
- less dependence therefore less abuse, fewer withdrawal sx,
SEDATIVES
ALL SEDATIVES IN SUFFICIENT DOSES CAN PRODUCE AMNESIA & LOSS OF CONSCIOUSNESS
side effects of benzos on older adults
- dementia: memory loss
- ataxia: instability in balance, increased probability of falling
Antidepressants can treat
- depression
- GAD
- OCD
- Panic disorder
- PTSD
- SAD
- BULIMIA
Areas of the brain associated with low level of monoamine as its related to depression: low serotonin affects
prefrontal cortex
amygdala
hypothalamus
Areas of the brain associated with low level of monoamine as its related to depression: low dopamine affects
prefrontal cortex
nucleus accumbens
basal ganglia
hypothalamus
Key monoamines
Serotonin
Dopamine
Norepinephrine
(NOT GABA)
monoamine hypothesis of depression
Posits that depression is caused by a monoamine deficiency (serotonin, dopamine, norepinephrine)
depressive disorders
MDD
bipolar depression
PDD
premenstrual dysphoric disorder
atypical depression
seasonal affective disorder
What are monoamines?
neurotransmitters and neuromodulators that contain one amino group connected to an aromatic ring by a two-carbon chain
(neuromodulates regulate neurons)
PRIMARY negative symptoms of schizophrenia
Abnormal neurodevelopment
SECONDARY negative symptoms of schizophrenia
Caused or made worse by another factor
(ie: Positive symptoms (paranoia)
Depression
Anxiety
Dementia
Medical conditions (pain)
Environmental deprivation
Social stigma
Drug abuse
Side effects of antipsychotic medications)
biological cause of depression
low dopamine
decreased positive affect
biological cause of depression
low norepinephrine
increased negative affect
decreased positive affect
biological cause of depression
low serotonin
increased negative affect
most common residual symptoms after treatment of depression
fatigue
insomnia
decreased concentration
anhedonia
least common residual symptoms after treatment of depression
depressed mood
suicidality
psychomotor retardation
SSRI withdrawal syndrome
FINISH
- flu-like symptoms
- insomnia
- nauseau
- imbalance
- sensory symptoms
- hyperarousal (anxiety, agitation)
Classes of Antidepressants
SSRIs
SNRIs
TCAs
atypical antidepressants
serotonin modulators
monoamine oxidase inhibitors (MOAIs)
insomnia
* initial/early: difficulty falling asleep
* middle: waking up during the night & trouble getting back to sleep
*** terminal/late: **waking up before intended time & cannot go back to sleep
response
50% decrease of symptoms
remission
removal of all symptoms for several months
recovery
sustained remission for 6 months or longer
relapse
symptoms reappear before remission or recovery
recurrence
symptoms reappear after recovery
phases of treatment
acute: 6-8 weeks
continuation: same dose for 9-12 months
maintenance: medication for 1 year or more
