mood disorders and antidepressant drugs Flashcards
where is marcus aurelius
in front of the cerebellum, midline nuclei in the brainstem
MRI data - The mean gray matter volume of the … is reduced
in patients with major depressive disorder (and also in bipolar disorder)
subgenual anterior cingulate cortex
Note: stress can also alter … signalling
glutamatergic
what do you need to check at regular intervals in lithium tx
renal and thyroid
lithium is tx for
bipolar, acute mania, schizophrenia
what is the risk order for mania switch? (precipitation of manic episodes)
TCAs > SNRIs > MAOIs > SSRIs
(treatment-refractory severe depression with suicide risk)
electroconvulsive therapy
NMDA glutamate receptor antagonist); approved for treatment-resistant depression; nasal spray
esketamine
progesterone-related compound, positive modulator of GABAA receptors); approved for post-partum depression; intravenous
brexanolone
what is a better version of citalopram
escitalopram
triad pf schizophrenia
positive - hallucinations, delusions
negative - introversion, apathy, low-self-esteem, personal neglect
cognitive - working memory impaires, attention deficit, executive dysfunction
what is current book with mental diagnoses criteria
DSM 5
which is the domain of schizophreinia which is the most important predictor of outcome
cognitive dysfunction
what eeg abnormality in schizophrenia
abnormal ERPs (event related potentials
genes associated with schizophrenia
DISC 1
dysbindin
comt
brain structural changes in schizophrenia
Larger ventricles and
smaller mesial temporal lobe structures
which condition shows hypofrontality in cognitive tasks
schizophrenia
diagnosis of schizophrenia
at least two of the following symptoms :
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic* behaviour
Negative symptoms (i.e. affective flattening, avolition…)
At least one of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.
at least over 6 months of which active symptoms for a whole month
which brain cells can be hyperactive in sch, leading to synaptic loss
microglia
which inflammatory markers can be raised in episodes of sch psychosis
tnf alpha
il6
crp
Schizophrenia is associated with a dual dopaminergic imbalance: hyperactivity in the … and hypoactivity in the…
striatum (mesolimbic pathway –ventral striatum and also in the dorsal striatum),
mesocortical pathway – frontal cortex (to the cortex)
do schizophrenia pts make more or less dopamine
more
dopamine receptors are the main targets of schizophrenia drugs. Which receptors
D2/D3
which was the first neuroleptic drug? what is the new name for neuroleptic
chlorpromazine
anti-psychotic
which antipsychotics as first choice for sch
atypical (also called 2nd generation
atypical (also called 2nd generation) examples
risperidone, olanzapine,** clozapine**, quetiapine,
paliperidone, aripiprazole
all atypical antipsychotics have antagonist activity at which receptor other than dopamine
5HT2A
Clozapine moa
Clozapine blocks D4 receptors with high affinity
Aripiprazole moa
is a partial agonist at presynaptic D2 receptors (dampens them down)
but an antagonist at D2 postsynaptic receptors (blocks them) so double action
typical (1st gen) antipsychotics examples
chlorpromazine, thioridazine,
fluphenazine, haloperidol, flupenthixol
what are the extrapyridimal effects of antipsychotics and why
Extrapyramidal effects (EPS) (acute dystonias, parkinsonism,
tardive dyskinesia) ; approx. 60% D2 receptor occupancy required for
antipsychotic efficacy; if >80% D2 receptors are blocked, risk of EPS
what is tardive dyskinesia
involuntary mvts in orofacial area
involuntary mvts in orofacial area name
tardive dyskinesia
Rise in prolactin due to antipsychotic can lead to
sexual dysfunction, galactorrhoea, amenorrhoea
3 metabolic complications of atypical psychotics
Weight gain (atypicals)
Dyslipidemia (atypicals)
Type 2 diabetes (atypicals)
clozapine and haloperidol have muscarinic affinity. what side effects result
dry mouth
dry eyes etc
examples of drugs that can be depot antipsychotics
fluphenazine decanoate or haloperidol decanoate
main side effects of typical antipsych
extra pyridimidal effects
main side effects of atypical antipsych
metabolic complications
what is Neuroleptic malignant syndrome
what is it associated with
mostly typical antipsychs
hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability
Occurs in up to 2-3% of patients taking antipsychotics (mostly typical drugs)
30% schizophrenic patients do not respond to treatment
??? – drug of choice in drug resistance
what dangerous side effect
clozapine
agranulocytosis
Schizophrenia is associated with decreased …transmission in the cortex
Schizophrenia is associated with decreased glutamatergic transmission
(hypoglutamatergic state in the cortex)
