Mental Health Disorders Flashcards
What do mental illnesses involve?
Clinically significant changes in emotion, thinking or behaviour.
According to a 2019 survey, 75% of respondents would be reluctant to disclose a mental illness to their coworker and were 3 times less likely to disclose a mental illness than a physical one. Outline the top 3 reasons for this reluctance.
- Belief that there is a stigma around mental illness
- Not wanting to be treated differently or judged
- Being afraid of negative consequences (i.e., losing job)
What is the Diagnostic and Statistical Manual of Mental Disorders (DSM V)?
Diagnostic tool published by American Psychiatric Association. Useful for having an accurate description of a disorder.
What are the 3 general approaches to identifying the neurochemical basis for a mental health disorder?
- Study neurochemical correlates of animal and human models of the disorder
- Consider neuronal mechanisms of effective drug treatment
- Measure neurotransmitters in patient populations
In what ways can neurotransmitters in patient populations be measured?
CSF, brain scans, post-mortem brain tissue analysis
What is schizophrenia and how common is it?
A chronic condition occurring in 1-1.5% of the global population.
When do symptoms of schizophrenia start?
Often begin in late adolescence and early adulthood.
Why might schizophrenia be categorized as a thought disorder?
Lack of reasoning
Illogical thinking
Failure to recognize reality
What are the two categories for describing symptoms of schizophrenia?
Positive and negative
Give examples of positive symptoms of schizophrenia
Hallucinations
Delusions
Disorganized speech
Unusual ways of thinking
Bizarre behaviour
How do positive symptoms of schizophrenia respond to drug treatment?
Well
Give examples of negative symptoms of schizophrenia
Reduced speech
Flat affect
Loss of motivation
Social withdrawal
Apathy and anhedonia
How do negative symptoms of schizophrenia respond to drug treatment?
Do not respond well
How does the DSM V define schizophrenia?
Characterized by delusions, hallucinations, disorganized speech and behaviour, and other symptoms that cause social or occupational dysfunction.
According to the DSM V, what criteria must be met for an individual to be diagnosed with schizophrenia?
Symptoms must have been present for six months and include at least one month of active symptoms
Differentiate between the role of positive and negative symptoms of schizophrenia in its diagnosis.
Positive symptoms often lead to proper diagnosis.
Negative symptoms may be harder to diagnose and share similarities to other disorders.
What are the drugs used in treatment of schizophrenia referred to as?
Neuroleptics
Antipsychotics
Major tranquilizers
When was the first drug treatment for schizophrenia discovered?
1952
What was the first drug discovered to be effective for some individuals with schizophrenia?
Chlorpromazine
Describe the discovery of chlorpromazine for treatment of schizophrenia.
First used as a pre-anasthetic prior to surgery.
Noticed it induced calmness without sedation
What is the dopamine hypothesis of schizophrenia?
Excess DA function results in positive symptoms of schizophrenia.
How does chlorpromazine relate to dopamine?
Acts as agonist at dopamine, specifically at D2 receptors.
How do amphetamine type drugs relate to dopamine?
Induce psychotic reactions in healthy individuals that could be reverse by dopamine agonists
What needs to happen in order for animal models of schizophrenia to be useful in developing treatments?
Results from animal model must translate into results in the patient with schizophrenia
Describe the animal model example of pre-pulse inhibition
Used as model of sensory gating based on evidence that schizophrenic individuals fail to filter sensory stimuli.
May lead to sensory overload and fragmented thinking.
Procedure used in animals is the same as humans.
What are the two types of neuroleptics?
Typical (first generation)
Atypical (second generation)
How do typical neuroleptics work?
Act on dopamine receptors
Give examples of typical neuroleptics
Chlorpromazine, haloperidol
How do atypical neuroleptics work?
Act on dopamine and serotonin receptors - have some antidepressant effects
Give examples of atypical neuroleptics
Clozapine, risperidone, quetiapine, olanzapine
Are typical or atypical neuroleptics more likely to produce extrapyramidal effects?
Typical
What are some extrapyramidal side effects of neuroleptics?
Parkinsonism and tardive dyskinesia
What is tardive dyskinesia?
Stereotypes involuntary movements (e.g., lip smacking, fly catching movements of tongue or movements of arms and legs)
What is the rule of thirds for neuroleptics?
- One third show excellent improvement with meds
- One third show some improvement but may still require further hospital admissions
- One third will be resistant to drug treatment, require significant time in hospitals
Describe the inquest of Ashley Smith
Mental health issues
Transferred around
Choked to death in cell while guards watched and died
Some argue should also look back to when she was in another institution and restrained and received forcible injections of unnecessary drugs
What are the three categories that the DSM V divides anxiety disorders into?
- Anxiety disorders
- OCD
- Traumatic related disorders
Give 4 examples of anxiety disorders.
- GAD
- Social anxiety disorder
- Panic disorder
- Phobias
What is generalized anxiety categorized by?
Constant excessive worry about daily life events and activities
What is social anxiety?
Extreme fear of being evaluated/criticized by others
What is the estimated lifetime prevalence of social anxiety?
12%
What is a panic attack?
A sudden rush of intense fear or discomfort, which includes at least 4 of the possible symptoms.
List some of the symptoms of a panic attack.
Racing heart
Sweating
Shaking or trembling
Shortness of breath or feelings of being smothered
Feeling of choking
Chest pain or discomfort
Nausea or upset stomach
Dizziness or lightheadedness
Fear of dying
How do panic attacks relate to panic disorders?
Panic attacks are unexpected and unpredictable.
Having a panic attack DOES NOT mean you have panic disorder.
What is the role of GABA in anxiety?
GABA is an inhibitory neurotransmitter that modulates anxiety.
What is gaba-induced inhibition important for?
Controlling excitability of local circuit and regulates the amygdala
What is the amygdala?
Forms part of the limbic system and plays an important role in the processing of emotions
Give examples of disorders that are suspected of being linked to abnormal amygdala functioning
Anxiety
Autism
Depression
PTSD
Phobias
What are drugs used to treat anxiety known as?
Anxiolytics
What are the 3 major types of anxiolytics?
- Barbiturates
- Benzodiazepines
- 2nd generation anxiolytics
What are benzodiazepines?
Clinically useful GABA modulators
What was discovered when BDZ binding site was mapped in 1977?
Widely distributed on many GABA receptors
What was the first benzodiazepine used?
Chlordiazepoxide
What did chlordiazepoxide represent?
First true anxiolytic that targeted anxiety without producing excessive sedation.
What are some benefits of chlordiazepoxide?
Low incidence of metabolic tolerance
Very safe therapeutic incidence
Less severe withdrawal syndrome
What are benzodiazepines useful for in addition to treatment of anxiety disorders?
Useful for presurgical administration when patient will be conscious during the procedure.
What is a newer BDZ used for rapid relaxation during brief surgical procedures?
Midazolam
What is produced when taking BDZs?
Anterograde amnesia
Why is anterograde amnesia an undesirable side effect, use a forensic example.
Cases where a BDZ has been used to facilitate an SA can result in poor recollection
Delay in reporting the incident, reducing chance of potential forensic evidence during testing
Creates reliability issues later
What is anterograde amnesia?
Inability to form new memories
What is buspirone?
2nd gen anxiolytic
Who is busiprone useful for?
People who also have clinical depression
What are benefits of buspirone?
Little abuse potential
No reported dependence issues
What anxiety disorders is buspirone effective in treating?
GAD, less effective in others
What receptors foes buspirone act on?
5-HT
How are anxiety and depression related?
Strong linke between anxiety and clinical depression.
Comorbidity study showed 55% of people with depression also have anxiety disorder
What are the two principle types of affective disorders?
- Major depression
- Bipolar disorder
What are affective disorders characterized by?
Extreme and inappropriate exaggeration of mood or affect
Differentiate between mood and affect.
Mood = an individual’s emotional state
Affect = Expression of such emotions
Differentiate between reactive and pathological depression.
Reactive - state of sadness that occurs in response to situations
Pathological - resemble emotional state of reactive but significantly differs in intensity and duration
What was the first theory for the chemical basis of affective disorders?
Monoamine hypothesis
What led to the monoamine hypothesis?
Observed that the drug reserpine (treats high blood pressure) had depression as a side-effect in a significant number of patients
Reserpine prevents packaging of neurotransmitters into vesicles in the neurons and leads to a reduction in monoamines (DA, NE, 5-HT)
What is the supporting evidence for the monoamine hypothesis?
Two main categories of antidepressant drugs, Monoamine oxidize inhibitors (MAOIs) nd tricyclic antidepressants (TCAs) both increase the function of 5-HT and/or NE.
What are the drug categories for the treatment of depression?
MAOIs
TCAs
SSRIs
Atypical antidepressants
How do MAOIs work?
Prevent the enzyme monoamine oxidase from removing the monoamine neurotransmitters from the CNS.
Makes more of these neurotransmitters available to effect changes in cells and circuits impacted by depression.
What diet restrictions are imposed on those using MAOIs?
No foods containing high levels of tyramine e.g., cheese, sauerkraut, cured meats, draft beer, fermented soy products
Why can’t those on MAOIs eat foods containing high levels of tyramine?
Interaction can cause significantly high blood pressure
Give examples of MAOIs
Isocarboxazid
Phenelzine
Selegiline
How do TCAs work?
Block reuptake of the neurotransmitters 5-HT and NE increasing their levels in the CNS
Do TCAs exclusively effect NE and 5-HT?
No.
Also block histamine receptors which contributes to some of their side effects (e.g., sedation)
Give examples of TCAs.
Amitriptyline
Desipramine
Imipramine
Nortriptyline
Protriptyline
Trimipramine
Give examples of SSRIs
Fluoxetine
Paroxetine
Sertraline
Give examples of atypical antidepressants.
Bupropion
Mirtazapine
Duloxetine
How does bupropion work?
Selectively inhibits dopamine and noradrenaline re-uptake.
Also stimulates the release of noradrenaline and dopamine from the presynaptic neuron
How does mirtazapine differ from other antidepressants?
Does not inhibit reuptake of 5-HT, DA or NE and doesn’t act via MAO.
Where is mirtazapine an antagonist
Alpha^2, 5HT^2 and 5HT^3 receptors
How does duloxetine work?
Inhibits the reuptake of serotonin and norepinephrine (NE) and also increases dopamine in some brain areas
Besides depression, what else can be treated with duloxetine?
GAD
What is the most effective drug category in treating depression?
Double blind placebo controlled trials show no type of drug category is more effective in treating depression. No way to predict individual responses
Why can’t we predict individual responses to antidepressants?
We understand how each drug works at the neurochemical level but clinical effects must be more complicated and depend on compensatory changes.
How long might it take for antidrepressants to work?
1-2 weeks for significant symptom changes
4-6 weeks for max effectiveness to be reached.
What has been shown about ketamine?
IV administration at sub-anaesthetic doses can produce a rapid reduction in depression symptoms
What are symptoms of bipolar disorder?
Moods alternate from mania to depression
What is mania?
During periods of mania individuals feel faultless, full of fun, bursting with energy and ideas.
Can make impulsive decisions and may become involved in activities with negative consequences.
What are drugs used to treat mania referred to as?
Mood stabilizers
Give examples of drugs used to treat mania.
Lithium
Valproic acid
Carbamazepine
What is the most effective medication for patients with bipolar disorder?
Lithium carbonate
Describe the effects of lithium
No effect on healthy individuals
Eliminates or reduces manic episodes without causing depression or sedation
Particularly effective in reducing suicide
How does lithium work?
Enhances 5-HT interactions:
Elevates brain tryptophan, 5-HT and 5-HIAA (5HT metabolite) and increases 5-HT release
Reduces catecholamine activity by enhancing reuptake and reducing release
How does valproate work?
Increases GABA levels and affects DA and glutamate neurotransmission
What s carbamazepine?
An anticonvulsant that resembles TCAs and inhibits NE reuptake
Compare lithium and carbamazepine.
Similar time course and extent of effectiveness
Different side effects.
Give examples of brain areas that are affected by both substance use disorders and mental illnesses.
Circuits that mediate reward, decision making, impulse control, emotions
Give examples of neurotransmitter systems that have been implicated in both substance use disorders and other mental disorders.
DA, 5-HT, glutamate, GABA, norepinephrine
