Psych - 2 Flashcards
BPD manic description (DIGFAST)
*how long must “manic” episodes last to meet dx?
◦Distractibility ◦Insomnia ◦Grandiosity ◦Flight of Ideas ◦Activity (goal directed) ◦Speech (pressured) ◦Thoughtlessness
*must last >1 wk
Lithium is used for ______
BPD:
◦Bipolar I & II
◦Efficacy in all phases of illness: mania, depression, maintenance
Unipolar Depression:
◦Antidepressant augmentation
Lithium mechanism of action :
*Interferes with recycling of ______
*__________ and _______ depletion are candidate mechanisms for therapeutic effects
*_____ (+/-) of adenylyl cyclase (TSH & ADH insensitivity)
- Affects multiple second messenger systems
- Interferes with recycling of phosphatidylinositol bisphosphate (PIP2)
- Wnt pathway/GSK-3Beta and inositol depletion are candidate mechanisms for therapeutic effects
- Inhibition of adenylyl cyclase (TSH & ADH insensitivity)
Lithium side effects
*what are med interactions / contraindications
◦Excreted almost entirely by kidneys (small amount in sweat/feces) - avoid in renal failure
◦Excretion is inhibited by NSAIDs, thiazide diuretics, ACE inhibitors, calcium channel blockers (promotes Lithium toxicity)
◦Use less in elderly and pregnancy (terato - E Stein’s Anamoly)
_____ drugs can cause ebstein anomoly (def?)
Lithium (def = malformation of tricupsid valve)
Psychosis definition / symptoms?
*Psychosis is generally defined as a loss of contact with reality with resulting functional and social impairment ;
*Psychotic Symptoms include:
◦Hallucinations
◦Delusions
◦Formal Thought Disorder (disorganized thoughts)
Uses of antipsychotics
PSYCHOTIC DISORDERS (schizophrenia etc) ; MOOD DISORDERS (BPD, depression etc … usually as add on / adjunctive therapy as mood stabilizer or treat psychotic features) ; DELERIUM ; BEHAVIORAL PROBS (dementia, ASD, aggressive disorders)
Schizophrenia diagnosis definition (symptoms / time)
Characteristic Symptoms: 2 or more, each present for a significant portion of the time for one month (or less if treated):
◦Delusions
◦Hallucinations
◦Disorganized Speech
◦Grossly disorganized or catatonic behavior
◦Negative symptoms (affective flattening, alogia, or avolition)
**+ signs of social / occupational dysfunction or disturbances for > 6 months
Increased dopamine makes psychosis ______(better or worse)
–worse (hypothesis though … becuase coke/amphetamiens PCP/ketamine which either inc dopamine or block reuptake all inc psychosis episodes)
*why = dopamine = involved in “reward” feedback (why inc leads to euphoria)
PCP/ketamine are used _____(treat or induce) psychosis … mech?
-induce (temporarily)
◦PCP and ketamine antagonize NMDA glutamate receptors
◦PCP facilitates dopamine release within the accumbens (mesolimbic system) but inhibits dopamine release in the prefrontal cortex (mesocortical system)
2 mechanisms of antipsychotics
◦Blockade of D2 receptors (typical & atypical)
◦Blockade of D2 and 5-HT2a receptors (atypical)
D1,5 receptor activations leads to ______ (+/-) adenylyl cyclist and cAMP ; D2,3,4 _______ +/- ac and cAMP
**where do antipsychotics act?
1/5 = increase ; 2/3/4 = inhibits /decrease
*AS block D2 receptors … so inc adenylyl Cyclades and inc cAMP »_space; blocking D2 receptors leads to caudate/putamen impaired movement, anterior pituitary-prolactin elevation and antiemeesis (like 5-HT3)
Typical vs atypical antipsychotics
TYPICAL (haloperidol, inapsine, pimozide) = dec sedation and inc EPS (extraparamidal symttoms)
MORE ATYPICAL (ziprazidone, clozapine) = more sedation
Side effects of ____(typical or atypical) antipsychotics = extrapyramidal effects
-typical»_space; atypical …. decrease dopamine in basal ganglia symptoms so get PARKINSON SYMTPOMS = bradykinesia, tremor, dystonia etc
Antipsychotics can lead to _____(inc or dec) prolactin
-inc prolactin (becuase blocking the D2 receptor …. dopamine usually blocks prolactin release)
What is mech behind each in _____(typical or atypical) antipsychotics meds:
- sedation
- postural hypotension
- dry mouth
Atypical»_space; typical (not just D2 but more 5-HT2a too)
Sedation (H1 blockade)
◦Low-potency Typicals, Quetiapine, Clozapine, Olanzapine
Postural hypotension (Alpha 1 blockade) ◦Quetiapine, Clozapine, Low-potency Typicals
Dry mouth, urinary retention, and cognitive impairment (Muscarinic cholinergic blockade)
What is drug? Person on new psych medication for 1 year, develops with involuntary repetative twitching movements of hands and face
- long-term antipsychotics (dopamine blockers)
* can also occur from long-term levodopa (interesting inc dopa?)
Neuroleptic malignant syndrome?
- def
- induced by _____
- treatment??
◦May be caused by any neuroleptic but agitation and high potency neuroleptic in dehydrated patient is classic scenario
◦Muscle rigidity, fever, leukocytosis, altered mental status, and myoglobinemia
◦Potentially fatal if untreated
◦Supportive (fluids, electrolytes)
◦May use dantrolene, bromocriptine, or ECT
Metabolic side effects of antipsychotics?
◦Weight gain associated with hyperglycemia, hyperlipidemia, and hypertension
◦Often leads to diabetes mellitus and progressive cardiovascular disease
Side effects of antipsychotics
- -bradykinesia, hyperprolactinemi (dec dopa)
- -sedation, postural hypotension, dry mouth
- -metabolic (weight gain, hyperglycemia, HTN, hyperlipid)
- -tachyarrythmias, tornadoes, hyperK+, hypo Mg, HypoCa2+
- -seizures (clozapine)
- -agranulocytosis (clozapine)
Antipsychotics ____(inc or decrease) the seizure threshold ? What is main drug?
- ALL neuroleptics lower the seizure threshold d
- CLOZAPINE is most associated
Electrolyte imbalances (3) from antipsychotics?
◦Risk increased with hyperkalemia, hypomagnesemia, and hypocalcemia
Depression diagnostic criteria (SIGE CAPS)
*how many symptoms? How long??
◦Depressed Mood or Anhedonia* ◦Sleep disturbance (+/-) ◦Interest (anhedonia)* ◦Guilt (feelings of worthlessness or guilt) ◦Energy (fatigue or loss of energy) ◦Concentration (or make decisions) ◦Appetite (+/-) ◦Psychomotor agitation or retardation ◦Suicide (or recurrent thoughts of death)
** need 5 out of 9 for > 2 weeks **
3 main NT involved in depression?
***where are the nuclei (production centers) found??
1-NE - locus coeruleus (in dorsal pons) ;
2-DOPAMINE - ventral tegmentum area (central brainstem)
3-SEROTONIN - caudal raphe nuclei (medulla) and rostal raphe nuclei (dorsal pons/brainstem)
