Medicines in Psychiatry

Question 1

What is NbN?

Answer 1

Neuroscience based nomenclature

Question 2

What are the 4 types of treament in medicine?

Answer 2

Chemical
Electrical stimulation
Structural rearrangement
Talking (psycho) therapies

Question 3

What are examples of the 4 types of treatment in psychiatry?

Answer 3

drugs for psychosis e.g. drugs for depression

ECT for depression e.g. neurostimulation for pain syndromes

psychosurgery/deep brain stimulation for severe depression

Cognitive Behaviour Therapy (CBT) e.g. exposure for phobias

Question 4

How are drugs named based on what illnesses they treat?

Answer 4

E.g. antidpressants
Antisychotic
Anxiolytic
Hypnotic

Question 5

What are the pros on classifying drugs by what they treat?

Answer 5

easy for Drs to choose a drug as docs make diagnosis

Question 6

What are the cons on classifying drugs by what they treat?

Answer 6

many psychiatric medicines work in several disorders

E.g. - antidepressants also treat anxiety and OCD (obsessive compulsive disorder)
E.g. – some antipsychotics used as add on (augmentation) treatment for depression

most psychiatric disorders have multiple symptoms and a single medicine might not treat them, all with likely different neurotransmitter mechanisms

Question 7

How does NbN work?

Answer 7

Classification based on pharmacology

Question 8

What medications used to treat schizophrenia?

Answer 8

Dopamine receptor

Question 9

What medications are used to treat depression?

Answer 9

serotonin receptor subtype antagonists for depression

Question 10

What medications are used to improve sleep?

Answer 10

histamine receptor antagonists for sleep

benzodiazepines enhance GABA leads to sleep

Question 11

Which drugs work on sodium channels?

Answer 11

sodium valproate- epilepsy and mood stabilisation carbamazepine - epilepsy and mood stabilisation

Question 12

Which drugs work on calcium channels?

Answer 12

gabapenitin and pregabalin - used in anxiety

Question 13

What are the two relevant types of neurotransmitters?

Answer 13

Fast acting

Slow acting

Question 14

What are the features of fast-acting NTs?

Answer 14

Excitatory – glutamate = > 80% of all neurons - pyramidal cells

Inhibitory – GABA = 15% - inter-neurons

–> content e.g. of memory, movement, vision etc.

Question 15

What are the features of slow-acting NTs

Answer 15

dopamine – serotonin – noradrenaline -acetylcholine
endorphins and other peptides

–> emotions, drives, valence of memory etc.

Question 16

What can an excess of glutamate cause?

Answer 16

Epilepsy

Alcoholism

Question 17

What can GABA deficiency cause?

Answer 17

Anxiety

Question 18

What can serotonin deficiency cause?

Answer 18

Depression

Anxiety

Question 19

What can dopamine excess cause?

Answer 19

Psychosis

Question 20

What can noradrenaline excess cause?

Answer 20

Nightmares

Question 21

What can Acetylcholine deficiency cause?

Answer 21

Impaired memory

Dementia

Question 22

What is an inverse agonist?

Answer 22

Opposite affects to agonists

Question 23

What are receptor subtypes?

Answer 23

Proteins rearrange differently

Have different effects

Question 24

What is allosteric modulation?

Answer 24

Some drugs act on the same site as the natural (endogenous) neurotransmitter
Others work on different sites on the target proteins

Question 25

Explain allosteric modulation in GABA

Answer 25

GABA-A receptor is an ion-channel linked receptor

GABA binds to the GABA receptor = orthosteric site

This binding enhance chloride ion conductance
inhibits neurons calm the brain

Benzodiazepines – barbiturates –alcohol – neurosteroids

All act at allosteric sites on the same protein complex

They enhance the action of GABA
 sedation,
sleep, reduce anxiety, anti-epilepsy

Question 26

What does drug selectivity relate to?

Answer 26

Number of adverse effects due to off target effects