Psychopharmacology

Question 1

4 principal parts or the brain:

Answer 1

Cerebrum
Dienchephalon
Brain stem
Cerebellum

Question 2

4 stages of pharmacokinetics

Answer 2

Absorption
Distribution
Metabolism
Elimination

Question 3

The common medical issue that caused depression - 10-% of MDD

Answer 3

Hypothyroidism

Question 4

3 treatment of depression

Answer 4

Acute treatment - 6 to 8 weeks
Continuation treatment - minimum 6 months
Maintenance treatment - continued and lifelong

Question 5

Acute treatment

Answer 5

begins with first dose until the patient is asymptomatic (6-8 weeks in best scenario$

Question 6

Continuation treatment:

Answer 6

• To avoid acute relapse, strongly suggested that patients continue treatment for minimum of 6 months
• Should be maintained on the same dosage as the acute treatment phase.

Question 7

Maintenance treatment

Answer 7

• For relapse prevention
• Subsequent episode of depression tend to be more severe and resistant to treatment.
• Continued and lifelong treatment provides the best outcome and protects chronic sufferers from recurrent major depression.

Question 8

Common errors in medication treatment of depression

Answer 8

• under dosing
• poor compliance
  -misdiagnosis (esp problematic with bipolar)
  -co-morbid substance abuse (reduces effectiveness of meds)
• longer term use of benzo
• premature discontinuation
• rapid discontinuation ( esp problematic with venlafaxine and paroxetine)
• serotonin syndrome

Question 9

Primary medication for bipolar

Answer 9

Lithium - providing long term mood stabilisation.

7-fold reduction in suicide rates

Question 10

What medications increase the risk of Parkinson’s

Answer 10

Lithium and antidepressants

Question 11

Medication for GAD

Answer 11

SSRI - if not responding to psychotherapy

Benzo - if not history of alcohol/substance abuse (severe symptoms)

Benzo/diazepam - Valium

Question 12

Medication for stress related anxiety/adjustment disorders, if severe

Answer 12

Benzo

Question 13

Medication for panic disorder

Answer 13

Benzo, antidepressants, MAO inhibitors - eliminate frequency and intensity of panic attacks through anti-panic drugs

Question 14

Medication for social phobia/anxiety

Answer 14

• Sensitive to rejection : MAO inhibitors, venlafaxine, SSRI’s
• Stage fright/public speaking : beta blockers (propanolol/inderal)

Question 15

Treatment errors

Answer 15

• SSRI’s present with increased anxiety as a side effect in the first few weeks of tx can lead to discontinuation
• Prescribing benzo to patient with personal of family history with substance abuse
• Benzo in use with elderly can cause cognitive impairments and contribute to unsteady gait and falls

Question 16

Side effects of antipsychotics

Answer 16

• Sedation
• Anticholinergic
• Extrapyramidal (EPS): parkinson-like side effects, akathisia, acute dystonias, tardive dyskinesia
• weight gain
  -metabolic effects

Question 17

Medication for OCD

Answer 17

Serotinergic antidepressants (with behaviour therapy)

Question 18

Medication for borderline personality disorder - only target symptoms not the personality

Answer 18

SSRI’s : for anger, sensitivity to rejection and impulsivity

Low dose of antipsychotics : for emotional instability and peculiar thinking

Question 19

Medication for ADHD

Answer 19

Newest research targets dopamine dysregulation in the frontal cortex.

Main treatment - stimulants (methylphenidate/ritalin)

but antidepressants (wellbutrn/strattera) and alpha-adrenergic agonists (catapress, intuniv) can also support these primary meds or used as monotherapy.

Question 20

Medication for eating disorders

Answer 20

Atypical antipsychotics to reduce delusional thinking

Bulimia treated like depression

Question 21

Medication for PTSD

Answer 21

SSRI’s - target anxiety/depression

**Benzo’s are ineffective and contribute to worse outcomes