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Management of Disorders > Psychoactive Drugs in Neuropsychiatry > Flashcards

Psychoactive Drugs in Neuropsychiatry Flashcards

1
Q

What are the two main components of Cannabis?

A

▪️Cannabidiol (CBD)
▪️Tetrahydrocannabinol (THC)

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2
Q

Which component of cannabis is the psychoactive part?

A

THC

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3
Q

What is the endogenous ligands of the endocannabinoid system and where does it come from?

A

▪️Anandamide
▪️Released by postsynaptic neuron in response to increased Ca2+ or activation of specific receptors

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4
Q

What are the main receptors of the endocannabinoid system?

A

CB1 and CB2

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5
Q

How does cannabis act on the endocannabinoid system?

A

Binds to CB1 receptor much stronger than endogenous endocannabinoids such as Anandamide

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6
Q

Where does cannabis have it’s greatest effects?

A

▪️Mostly grey area regions (e.g. cortex)
▪️Midbrain (explains its benefits in pain management?)

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7
Q

Can cannabis be prescribed medicinally in the UK?

A

Yes! But not done often

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8
Q

What two cannabis-based medications have licensed indications in the UK?

A

▪️Sativex (for spasticity in MS)
▪️Nabilone (THC for chemo-induced nausea and vomiting)
▪️Also a form for paediatric epilepsy syndromes

(All the rest are prescribed off-license!)

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9
Q

What is Sativex and how is it usually prescribed?

A

▪️Oromucosal spray that’s 1:1 THC:CBD
▪️For spasticity in MS

(can only be prescribed by experts!)

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10
Q

How might CBD be used for Alzheimer’s disease in the future?

A

▪️Anxiety
▪️Agitation

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11
Q

What conditions are currently being research for cannabis-based interventions?

A

▪️Behavioural symptoms of AD
▪️Chronic neuropathic pain

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12
Q

What is the main concern for the use of cannabis based products in neuropsychiatry?

A

Risk of psychosis

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13
Q

Which component of cannabis is associated with increased psychosis risk?

A

THC

(unclear how protective CBD really is)

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14
Q

How does psychosis risk differ between US states that have legalised cannabis compared to those which haven’t?

A

No increased risk of psychosis BUT trends towards significance

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15
Q

What are stimulants?

A

Drugs that increase activity in the CNS such as amphetamines and amphetamine-related compounds

E.g. Methylphenidate, modafinil

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16
Q

What system do stimulants typically work on in the brain?

A

Dopamine transmission system

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17
Q

How does amphetamine typically work in the brain?

A

▪️Blocks reuptake of dopamine from synaptic cleft (also methylphenidate)
▪️Directly stimulates dopamine production
▪️Reverses dopamine uptake via the dopamine transporter

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18
Q

Why might amphetamines be related to higher rates of psychosis?

A

Action on the dopamine system leads to increased dopamine

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19
Q

What are the main stimulants used in neuropsychiatry?

A

▪️Methylphenidate
▪️Dexamfetamine
▪️Lisdexamfetamine
▪️Modafinil
▪️Atomoxetine

20
Q

What are the main side effects of stimulants used for ADHD?

A

▪️Growth restriction
▪️Cardiac complications (increased HR, BP)
▪️Insomnia

21
Q

What are the main uses of methylphenidate in neuropsychiatry?

A

ADHD

22
Q

What other conditions may possibly be helped by methylphenidate?

A

▪️Apathy in AD and depression
▪️Cognitive function in TBI

23
Q

What is modafinil currently licenced for in the UK?

A

Narcolepsy and other sleep disorders associated with excessive daytime sleepiness

24
Q

What other conditions may possibly be helped by modafinil?

A

▪️Catalepsy in narcolepsy
▪️Fatigue in TBI and chronic fatigue

25
Q

What type of drug is MDMA?

A

A stimulant

(3,4-methylenedioxy-methamphetamine)

26
Q

What brain systems does MDMA act on?

A

Primarily serotonergic system but can act on the dopamine system too

27
Q

How does MDMA work in the brain?

A

Encourages major serotonin release into the synaptic cleft through a range of actions (e.g. prevents 5-HT storage, switches direction of SERT to experort instead of import etc)

28
Q

What are the main effects of MDMA?

A

▪️Wakefulness
▪️Anti-tiredness
▪️Pro-social
▪️Increased empathy

29
Q

What is the main potential use for MDMA in neuropsychiatry?

A

Severe PTSD

30
Q

How is MDMA proposed to aid treatment of severe PTSD?

A

▪️MDMA-assisted therapy
▪️Improves ability to open up and talk about trauma

31
Q

What is the main effect of ketamine in the brain?

A

▪️Acts on NMDA receptors of GABA neurons
▪️Prevents them from inhibiting glutamate release
▪️Produces acute dissociative effects

32
Q

What are currently the three main forms of ketamine used medicinally?

A

▪️Nasal spray esketamine (not in UK)
▪️Tablet
▪️IV ketamine

33
Q

What is ketamine most commonly used for medicinally?

A

A sedative

34
Q

What are the main potential use for ketamine in neuropsychiatry?

A

▪️Treatment-resistant depression - acutely improves mood and possibly suicidality
▪️FND?

35
Q

What are the main issues with ketamine trials in neuropsychiatry?

A

▪️Difficult to blind
▪️Quite bitter

36
Q

What is therapeutic sedation?

A

Using drugs to induce a dissociatove/hypnotic state to facilitate therapy

37
Q

For what disorder might therapeutic sedation show the most promise?

A

FND

E.g. induced by anaesthetic before PT shown to help people with motor related FND (Stone, 2013)

38
Q

Historically, what conditions have shown the best response to psychedelics?

A

▪️Depression
▪️Anxiety
▪️Alcohol/Substance misuse
▪️PTSD?

39
Q

What psychedelic is most commonly used in research?

A

Psilocybin

40
Q

Why might psychedelics have important cross-diagnostic potential?

A

▪️Target common underlying mechanisms (e.g. negative habits, biases, ruminations)
▪️Disrupt these as oppose to the conditions themselves?

41
Q

What is the main issue with psychedelic research?

A

Interplay between placebo and expectancy:

▪️Hard to truly blind
▪️Psychedelics modulate expectancy, making people more suggestible which increases placebo effects
▪️Placebo group gets negative expectancy effect

42
Q

What is the predictive processing model in FND?

A

▪️Brain makes predictions based on experience
▪️These are mainly accurate
▪️Prediction is stronger than sensory input so we experience something in the middle
▪️In FND, expectation is greater so experience symptoms despite sensation

43
Q

How might psychedelics improve FND symptoms based on the predictive processing model?

A

▪️Disrupt predictive processes
▪️Reduction of influence of top-down predictions
▪️More sensory mediated experience

44
Q

What brain regions are most commonly implicated in FND studies and how might psychedelics effect this?

A

▪️Default mode network
▪️Psychedelics may reduce DMN connectivity
▪️Deconstraining effect = enhancing communication between new networks
▪️Reduces prediction errors?

45
Q

How is LSD thought to help FND?

A

Modification of neural circuits associated with self-representation

46
Q

What is the PsiFund?

A

A open-label fMRI study of oral psilocybin plus psychological support for FND

Management of Disorders (28 decks)

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