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PSY 2120 > Neuroanatomy and Antidepressants > Flashcards

Neuroanatomy and Antidepressants Flashcards

1
Q

Effects of MAOIs

A 
tremors
weight gain
blurred vision
dry mouth
low blood pressure
postural hypotension
first were non-selective and irreversible; this has changed
the "Cheese Effect:
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2
Q

Serotonin Syndrome

A

can be brought on by any antidepressant (AD)
consequence of too much 5-HT
Clinical triad of symptoms
1. Cognitive: headaches, agitation, hypomania, hallucinations, coma
2. Autonomic: sweating, hyperthermia, tachycardia, vasoconstriction, nausea
3. Somatic: myoclonus, hyperreflexia, tremors
can be life-threatening

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3
Q

Effects of TCAs

A

increase ANS function (via anticholinergic effects)
- inhibit the PNS, resulting in dry mouth, constipation, blurred vision, tremors, and sweating
Adrenergic receptor function impaired, resulting in dizziness
Histamine receptor impairment results in a sweet-tooth

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4
Q

Effects of 3rd Generation ADs (SNRIs and Atypicals)

A

antagonism of ACh and histamine receptor activity
enhancement of 5-HT2-3 receptor activity

increase appetite
weight gain
increased BP (blood pressure)
dizziness
dry mouth 
GI problems
etc.
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5
Q

Major Affective Disorders

A

aka mood disorders
characterized by: disordered feelings and disturbances in mood/emotion

2 types:
MDD: depression without mania
Bipolar Disorder: alternating mania and depression

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6
Q

DSM-5 diagnosis of MDD

A

symptoms must be present for at least two weeks, for a substantial portion of the day, every day
there must be a change from previous function
there must be one of either depressed mood or loss of interest
change in appetite and/or weight
sleep and/or psychomotor disturbances
tired/devoid of energy
worthlessness and unwarranted guilt
trouble focussing/thinking clearly/making decisions
thought and/or plans of suicide

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7
Q

Monoamine Theory of Depression

A

mood related to the functioning of monoamine systems, especially 5-HT, NE and DA
increased monoamine levels through cocaine and amphetamine make people feel good, the decrease results in depressive symptoms
Parkinson’s occurs alongside low monoamine levels, and depression rates are abnormally high in that population
the drug Reserpine blocks VMAT (monoamine transporter), and people who were treated with Reserpine developed severe MDD

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8
Q

Glucocorticoid Theory of Depression

A

clinical depression as a consequence of disregulated HPA axis
patients with MDD often have hypercortisolemia
- cortisol normally serves as a negative feedback,
inhibiting the release of CRH and ACTH by acting on
the hypothalamus, pituitary, hippocampus, amygdala,
and cortex
receptors are dynamic, so if cortisol is always present in excess, the receptor population may change, leading to neuronal and structural (and functional) neuroanatomic changes
can work with other theory: chronic stress altering neuroanatomy and monoamine production

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9
Q

Neurophysiology of MAOIs

A

inhibit the activity of MAO
- prevents molecules of DA, NE, and 5-HT from being
destroyed in the cytoplasm when they leak from
vesicles
effect is not limited to the CNS (can have side effects)

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10
Q

Neurophysiology of SSRIs

A

block reuptake of 5-HT without many effects on other monoamine or NT systems

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11
Q

Neurophysiology of SNRIs

A

block reuptake of 5-HT and NE
sometimes can block DA reuptake as well
minimal effects on other NT systems

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12
Q

Neurophysiology of Atypical ADs

A

mechanism of action varies depending on the drug

e.g. can antagonize 5-HT autoreceptors

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13
Q

Antidepressant Absorption

A

first pass metabolism destroys a significant portion of the dose of most ADs
- physicians account for this because most ADs are
taken orally
- this effect is inhibited by alcohol, and is part of the
reason it is dangerous to drink, especially on first and
second gen. ADs

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14
Q

Cheese Effect

A

can occur in MAOI users
MAO is required for the breakdown of the AA tyramine
tyramine found in aged food (e.g. cheese)
excess tyramine causes symptoms mimicking an overactive SNS: sweating, nausea, increased BP, internal bleeding, stroke, death

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15
Q

Effects of SSRIs

A 
far fewer side effects than previous ADs
nausea
GI problems
headache
dizziness
sweating
nervousness
agitation

tolerance develops quickly through effects on 5-HT2 receptors

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16
Q

Serotonin Discontinuation Syndrome

A

to avoid, when coming off ADs, decrease dose gradually
lasts on average 1-4 weeks, but can be sever/extended with certain drugs
must be on an AD for at least 4 weeks for this to occur

flu-like symptoms
sleep disturbances
sensorimotor disturbances
mood disturbances
cognitive disturbances
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17
Q

Skull and Vertebral Column

A

bone protecting the CNS

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18
Q

Inferior

A

below (ventral to) something

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19
Q

Rostral

A

toward the beak (anterior)

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20
Q

Caudal

A

towards the tail (posterior)

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21
Q

Coronal Section

A

frontal view into the brain

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22
Q

Horizontal Section

A

dorsal view (top down into brain)

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23
Q

Sagittal Section

A

medial view (side view central into brain)

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24
Q

White Matter

A

collections of myelinated axons

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25
Grey Matter
collections of cell bodies and dendrites
26
Contralateral
2 distinct structures on opposite sides
27
Ipsilateral
2 structures on the same side
28
Medial
toward the midline of the brain
29
Lateral
away from the midline, outside
30
Afferent
moving toward the point of reference (usually the CNS in neuroscience)
31
Efferent
moving away from the point of reference (usually the CNS in neuroscience)
32
Nucleus
collection of cell bodies in CNS
33
Ganglion
collection of cell bodies in PNS
34
Tract
collection of axons in CNS
35
Nerve
collection of axons in PNS
36
Cortex
4 lobes | Frontal, parietal, temporal, occipital
37
Motor Cortex
behind frontal lobe, on precentral gyrus | responsible for movement
38
Sensory Cortex
responsible for sensations
39
Occipital Lobe
responsible for vision
40
Temporal Lobe
responsible for memory, understanding language
41
Corpus Callosum
band of axons that connects corresponding parts of the association cortex of left and right hemispheres matching cortices connect
42
Primary Cortices
main location of a type of signal, subserve one particular function e.g. primary motor cortex- touch and grab primary auditory cortex- sounds primary visual cortex- sight signals
43
Amygdala
almond-shaped group of nuclei at the end of the hippocampus | responsible for emotions (especially fear and anger), emotional behaviour, and motivation
44
Infundibulum/Pituitary Stalk
connects the hypothalamus to the pituitary glad
45
HPA Axis
1) Stressful situation 2) Hypothalamus: CRH 3) Anterior Pituitary: ACTH 4) Adrenal Cortex: Corticosteroid (e.g. cortisol) - creates a negative feedback loop
46
Cerebellum
receives sensory info, spinal cord and brain info regulates voluntary motor movements (e.g. posture, balance, coordination, speech) Mild damage = jerky movement Severe damage = loss of balance/posture
47
Reticular Activating System
Ascending reticular formation filter/prioritizes sensory information habituation (ignoring repetitive/meaningless stimuli) - disregulation contributes to psychosis behavioural arousal consciousness
48
Medulla Oblongata
most caudal portion of the brain stem borders rostral end of spinal cord contains nuclei that act as control centres for ANS - vital functions: breathing, heart rate, temperature control, etc. damage usually results in rapid death
49
Spinal Cord
responsible for exchange between CNS and PNS distributes motor fibres to effector organs collects somatosensory info for the brain has some autonomy from the brain (e.g. reflexive circuits)
50
Somatic Nervous System
controls voluntary motor outputs comprised of sensory neurons (conveys information from 5 senses) motor neurons (impulses from CNS to skeletal muscles)
51
Autonomic Nervous System
sensory neurons in visceral organs motor neurons to smooth muscle, cardiac muscle, glands 2 functional divisions - sympathetic: fight or flight - parasympathetic: rest and digest CNS- Preganglionic neuron- Autonomic ganglion- Postganglionic neuron- Target tissue
52
Structural/Functional Abnormalities in Depressed Brains
hyperactive amygdala | reduced pre-frontal cortex, hippocampus, and nucleus accumbens
53
Types of Antidepressants
most work by increasing activity in 1+ monoamine system(s) classified by principle mechanism of action 1. MAOIs and TCAs 2. SSRIs 3. SNRIs and Atypicals
54
Neurophysiology of TCAs
block reuptake (main form of daectivation) of 5-HT and NE also affects other NT systems e.g. antagonises muscarinic, histamine and A-1 adrenergic receptors non-specific = many unwanted side effects
55
Pharmacokinetics of MAOIs
Absorption: widely varied time Distribution: readily cross BBB Metabolism: mostly in liver Elimination: Half-life of 2-4 hours
56
Pharmacokinetics of TCAs
Absorption: 1-3 hours Distribution: high bioavailabilit; readily cross BBB Metabolism: in liver Elimination: Half-life of 24 hours
57
Pharmacokinetics of 2nd and 3rd Generation ADs
Absorption: 4-8 hours Distribution: high bioavailability Metabolism: in liver Elimination: Half-life of less than 24 hours
58
Parasympathetic Nervous System (PNS) Pathway
1. Craniosacral division (nerves at top & bottom of spine) 2. Pre-ganglionic axon terminals release ACh (long axon) 3. Post ganglionic neuron releases ACh or NO (short axon)
59
Functions of the NS
relay info (sensory system [afferent]) - sensory neurons interpret/make decisions (association system) - interneurons carry out some action (motor system [efferent]) - motor neurons
60
Dura Mater
tough outer layer of meninges | made of fibrous tissue
61
Arachnoid Layer
like a spider web thin sheet of delicate connective tissue between dura and pia mater
62
Pia Mater
moderately tough inner layer of meninges | clings directly to brain's surface
63
Ventricular System
hollow, interconnected chambers in brain made up of 2 lateral ventricles, 3rd ventricle, 4th ventricle, interventricular foramen, cerebral aqueduct and the central canal the Choroid Plexis produces CSF filled with CSF
64
Interventricular Foramen
connects lateral and third ventricles
65
Flow of CSF
3 openings above the 4th ventricle allow CSF to flow outside and recirculate - Foramen of Magendie - 2 Lateral foramina of Luschka Ends up being absorbed by bloodstream
66
Frontal Lobe
``` front of brain motor cortex responsible for executive functions (thinking, planning, organising, etc.) emotional and behavioural control personality ```
67
Parietal Lobe
Responsible for... perception, making sense of the world arithmetic spelling
68
Central Sulcus
Major valley in centre of brain | Separates frontal and parietal lobes
69
Lateral Fissure
predominant sulcus in brain | front bottom up diagonally
70
Precentral Gyrus
primary motor cortex
71
Postcentral Gyrus
somatosensory cortex
72
Longitudinal Fissure
Separates left and right brain hemispheres
73
Sensory Association Cortices
receives information from adjacent primary sensory area analyzes info received e.g. the visual association cortex analyzes shape, size, orientation, colour, etc
74
Multimodal Association Cortex
analyzes and interprets sensory experiences provides perceptions, memory, reasoning, verbalization, judgement, and emotions integrates senses directs information to appropriate area for response
75
Forebrain
Lateral - Cerebral Cortex - Basal Ganglia - Limbic System Third Ventricle - Thalamus - Hypothalamus
76
Basal Ganglia
3 components 1. Caudate Nucleus 2. Putamen 3. Globus Pallidus Striatum (combo of 1 &2) is the major input centre main function is motor control also responsible for motor learning, executive function/behaviour and emotions Parkinson's disease occurs when messenger neurons for Basal Ganglia are damaged
77
Limbic System
hippocampus and amygdala | responsible for emotion and memory
78
Hippocampus
beneath the cortex of the temporal lobe | mainly responsible for memory
79
Thalamus
``` 2 distinct lobes - 1 per hemisphere (contralateral) - connected by massa intermedia primary sensory cortex - relays sensory info from receptors to proper brain area sleep, consciousness, alertness ```
80
Hypothalamus
control over 4 Fs: fight, flee, feed, mate controls ANS controls endocrine system
81
Anterior Pituitary Gland
hypothalamus creates hormone directly delivered to anterior pituitary via local blood circuits anterior pituitary produces hormones and releases them into the bloodstream - e.g. HPA axis secretion of these hormones is regulated by hypothalamus
82
Tegmentum
includes many structures... reticular formation (rostral): consciousness nuclei: eye movements periaqueductal grey matter: pain modulation red nucleus: motor coordination substantia nigra: DA system (to striatum), reward & movement ventral tegmental area: point of origin for mesolimbic and mesocortical dopaminergic pathways
83
Posterior Pituitary
neural tissue; an extension of the hypothalamus hypothalamus produces posterior pituitary hormones and directly controls their secretion oxytocin: milk, contractions (birth) vasopressin (ADH): urine output neurosecretory cells' axon terminals are in the posterior pituitary and secrete peptide hormones - these are picked up by capillaries and go into general circulation
84
Midbrain
surrounding cerebral aqueduct tectum: dorsal to cerebral aqueduct tegmentum: ventral to cerebral aqueduct mesencephalon
85
Brainstem
part of the midbrain and part of hindbrain but not all collectively - tegmentum - pons - medulla
86
Hindbrain
fourth ventricle region Cerebellum Pons Medulla Oblongata
87
Pons
``` bulge in brain stem contains portion of reticular formation functionally connects cerebellum and cortex Influences ANS functions heart rate blood pressure respiration ```
88
Reticulospinal Tracts
``` Descending reticular formation Affects ANS activity (breathing, BP, etc) Reflexes (e.g. coughing) Posture Balance Motor Control ```
89
Components of the Spinal Cord
``` Vertebral column: bony cage Central canal: filled with CSF White matter: myelinated axons Grey matter: unmyelinated axons and soma Motoneuron: ventral Sensory neuron: dorsal 31 pairs of mixed spinal nerves ```
90
Peripheral Nervous System
means through which the brain and spinal cord communicate with the rest of the body (cranial and spinal nerves) conveys sensory info to CNS conveys motor info from CNS to effectors
91
Sympathetic Nervous System Pathway
1. Nerves leave/enter CNS in thoracicolumbar region (centre of spine) 2. Pre-ganglionic neurons release ACh (short) 3. Post-ganglionic neuron (long) releases NE
92
Tectum
Superior (top) Colliculi: visual system | Inferior (bottom) Colliculi: auditory system
93
Tolerance to ADs
therapeutic effectiveness may show some tolerance after a few months - extent and clinical significance unclear tolerance to many side effects occurs within several weeks - except tiredness with SSRIs
94
Withdrawal from TCAs
``` DO NOT ABRUPTLY DISCONTINUE restlessness anxiety chills akathesia (compulsion to move) muscle aches ```
95
Withdrawal from SSRIs
``` DO NOT ABRUPTLY DISCONTINUE dizziness lightheadedness insomnia fatigue anxiety nausea headache sensory disturbances ```
96
Withdrawal from SNRIs
DO NOT ABRUPTLY DISCONTINUE heart palpitations nausea delusions
97
Problem with Monoamine Theory of Depression
lag time between the start of antidepressant treatment and any alleviation of depressive symptoms (4-6 weeks, up to 12)
98
Effectiveness in Treating Depression
efficacy roughly similar for all classes of ADs significant individual differences and different types of depression respond differently 60-70% of individuals with MDD get relief from some symptoms 30-50% show full remission
99
Limitations in AD Effectiveness and Development
All ADs have lengthy response time - clinically significant effects occur after 2 weeks of treatment - full effects after 4 weeks (time for downstream neuroadaptive effects to occur) Treatment-resistant depression - successive failed attempts at significant sympton reduction - 29-46% of patients

PSY 2120 (4 decks)

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