Psychopharmacology: antidepressants

Question 1

What are the indications for Electroconvulsive Therapy?

Answer 1

Most effective and most rapid treatment for
SEVERE MAJOR DEPRESSION
ALSO, When medications or psychotherapy:
 Have not been effective
 Cannot be tolerated
 (in life-threatening cases) will not help the patient quickly enough

Question 2

What is the CGI Improvement/Change (Endpoint) Scale?

Answer 2

It is a 7 point scale that requires the clinician to assess how much the patient’s illness has improved or worsened relative to a baseline state at the beginning of the intervention.

Question 3

Describe the Permissive Theory of Mood Disorders.

Answer 3

When one neurotransmitter is low, the fluctuation of the other causes mood swings (e.g. “if the serotonin is going down and norepinephrine is going haywire, then the person either goes depressed or manic”)

Question 4

Define manic episode.

Answer 4

A distinct period of abnormally and persistently elevated, expansive or irritable mood lasting for at least one week or less if a patient must be hospitalized

Question 5

T or F: To assess the mood of the patient, you need to observe him/her well.

Answer 5

F: To assess the mood, it has to be asked from the patient.

Question 6

Explain the differences among recovery, relapse, and recurrence of depression

Answer 6

RECOVERY - remission of depression for 4-9 months
RELAPSE - person who is still under the remission stage develops depression again
RECURRENCE - depression occurs after the recovery stage

Question 7

Which type of drugs is the first choice in psychopharmacology of depression? How long is the drug trial?

Answer 7

Selective Serotonin Reuptake Inhibitors (SSRI)

Each drug trial should last 4-6 weeks

Question 8

What is double depression?

Answer 8

A depression on top of a dysthymia; when a person recovers from depression, he will still have dysthymia

Question 9

Enumerate 5 Monoamine Oxidase Inhibitors.

Answer 9

Phenelzine, Tranylcypromine, Isocarboxazid, Selegiline, Moclobemide

Question 10

The Withdrawal Syndrome of MAOIs consists of which signs and symptoms?

Answer 10

Anxiety, Headache, Chills, Myalgia, Insomnia, Malaise

Question 11

T or F: A major depressive disorder occurs without a history or mania, mixed, or hypomanic episode.

Answer 11

T

Question 12

This new antidepressant enhances both serotonergic and adrenergic neurotransmission (Noradrenergic and Specific Serotonergic Antagonist).

Answer 12

Mirtazapine

Question 13

Define depression remission.

Answer 13

When the px is ASYMPTOMATIC;
HAMILTON DEPRESSION (HAM-D) SCALE: <10

Question 14

Where are presynaptic β2-adrenergic receptors located? What is their function?

Answer 14

in the serotonergic neurons;

regulate the amount of serotonin released

Question 15

What is the Hamilton Rating Scale for Depression (HAM-D)?

Answer 15

A widely used depression scale with up to 24 items each of which is rated 0 to 4 or 0 to 2, with a total score of 0 to 76. The clinician evaluates the patient’s answers to questions about feelings of guilt, thoughts of suicide, sleep habits, and other symptoms of depression, and the ratings are derived from the clinical interview.

Question 16

Differentiate MAO-A from MAO-B.

Answer 16

MAO-A is implicated in depression, while

MAO-B is implicated in schizophrenia

Question 17

T or F: Enuresis is not an indication for antidepressant use.

Answer 17

F

Question 18

Lithium carbonate inhibits which enzyme?

Answer 18

inositol-1-phosphatase

Question 19

Serotonin Syndrome consists of which signs and symptoms?

Answer 19

Lethargy, Flushing, Restlessness, Diaphoresis, Mental Confusion, Tremors, Hyperthermia, Hypertonicity, Rhabdomyolysis, Renal Failure, Death

Question 20

What is Electroconvulsive Therapy?

Answer 20

A medical treatment for severe mental illness that sends mild electric stimuli to the brain through the scalp in order to
INDUCE A CONTROLLED SEIZURE

Question 21

In Electroconvulsive Therapy, the stimulus is applied on which side of the brain?

Answer 21

The stimulus is applied on non-dominant unilateral side

Question 22

This mood stabilizer is used as an alternative to valproate and lithium and can be safely combined with antipsychotics

Answer 22

Carbamazepine

Question 23

What is the Monoamine Hypothesis of Depression?

Answer 23

Depression is due to a deficiency of monoamine neurotransmitters, notably norepinephrine (NE) and serotonin (5-hydroxytryptamine [5HT])

Question 24

What is the mechanism of Tricyclic/Heterocyclic Antidepressants?

Answer 24

They block the reuptake of both serotonin and norepinephrine.

Question 25

Explain the Norepinephrine Pathway.

Answer 25

The Locus Coeruleus produces norepinephrine which goes to the cortex, subcortex, mesolimbic area, cerebellum and the spine.

Question 26

This biogenic amine is most commonly associated with depression. It functions in pain sensitivity and emotions.

Answer 26

Serotonin

Question 27

T or F: Pregnancy is a contraindication for Electroconvulsive Therapy.

Answer 27

F; ECT has been found safe during all trimesters of pregnancy by the American Psychiatric Association.

Question 28

This mood stabilizer serves as a prophylaxis for mania and depression in bipolar patients.

Answer 28

Lithium carbonate

Question 29

Enumerate the Monoamine Neurotransmitters

Answer 29

Norepinephrine, serotonin, dopamine

Question 30

Gabapentin and lamotrigine are what type of mood stabilizers?

Answer 30

Anticonvulsants; these act on the GABA receptors