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Module 202 Neuroscience & behaviour > T3 L6 Affective disorders > Flashcards

T3 L6 Affective disorders Flashcards

1
Q

What was the first MAOi?

A

Iproniazid

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2
Q

What was the first tricyclic?

A

Imipramine

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3
Q

What studies show a decrease in serotonin concentrations?

A

Acute tryptophan depletion studies

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4
Q

What study showed a reduction in serotonin transporter?

A

Post mortem suicide studies

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5
Q

Where are serotonin cell bodies located?

A

In raphe nuclei

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6
Q

Where are NA cells located?

A

In locus coerulus

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7
Q

What does the monoamine theory of depression suggest?

A

Relative deficiency in synaptic levels of serotonin & noradrenaline in key CNS pathways underlies depressive illness

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8
Q

What is the prefrontal cortex involved in?

A

Executive functions

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9
Q

What is the limbic system involved in?

A

Behaviour
Motivation
Emotion

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10
Q

What structures are included in the limbic system?

A

Hippocampus
Anterior cingulate cortex
Hypothalamus
Amygdala

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11
Q

What types of drugs are primary generation antidepressants?

A

Monoamine oxidase inhibitors

Tricyclic antidepressants

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12
Q

Give some examples of MAOi drugs

A

Phenelzine

Tranylcypromine

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13
Q

How do MAOis work?

A

Non-selectively inhibit enzymes involved in the breakdown of monoamines including serotonin, dopamine and noradrenaline

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14
Q

What are the side effects of MAOi?

A 
Dry mouth
GI side effects
Headache
Drowsiness
Insomnia
Dizziness
Food interactions
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15
Q

Give some examples of tricyclic antidepressants

A

Amitriptyline

Clomipramine

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16
Q

How do tricyclic antidepressants work?

A

Non-selectively inhibit reuptake of monoamines including serotonin, dopamine and noradrenaline

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17
Q

What are the side effects of tricyclic antidepressants?

A 
Constipation
Orthostatic hypotension
Dry mouth
Drowsiness
Cardiac toxicity in overdose
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18
Q

What types of drugs are secondary generation antidepressants?

A

SSRI
SNRI
Alpha & 5-HT2c antagonist
Dopamine-noradrenaline reuptake inhibitor (not approved as antidepressant in UK)

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19
Q

Give some examples of SSRIs

A

Sertraline
Citalopram
Escitalopram
Fluoxetine

20
Q

What can SSRIs be used for?

A 
OCD
PTSD
Panic
GAD
social anxiety
21
Q

What are the side effects of SSRIs?

A 
GI symptoms - nausea, diarrhoea
Headache
Irritability
Anxiety
Reduction in libido & sexual dysfunction
Worse in first few weeks
22
Q

What SSRIs produce the worst withdrawal symptoms?

A

Venlafaxine
Paroxetine
Due to their short half life

23
Q

Give examples of SNRI drugs

A

Venlafaxine

Duloxetine

24
Q

What are some side effects of venlafaxine?

A

Nausea
Vertigo
Headache
Insomnia

25
Q

What do alpha & 5-HT2c antagonists do?

A

Modulate serotonin and noradrenaline release

Example is mirtazapine

26
Q

What are the side effects of mirtazapine?

A 
Drowsiness
Sedation
Hypotension
Increase appetite
Weight gain
27
Q

Describe the link between inflammation and depression

A

Raised plasma cytokine levels (IL-6, TNF-alpha) and inflammatory markers
High comorbidity between chronic inflammation and depression
Administration of cytokines provokes depression

28
Q

What are the medical prefrontal and anterior cingulate cortical regions involved in?

A

Processing emotion and automatic or implicit regulation of emotion

29
Q

What are lateral prefrontal cortical systems involved in?

A

Cognitive control and voluntary or effortful regulation of emotion

30
Q

What structures are in the medial prefrontal-limbic network?

A

Amygdala
Anterior cingulate cortex
Medial prefrontal cortex

31
Q

Give an example of a 1st generation D2/D3 antagonist antipsychotic drug?

A

Haloperidol

32
Q

Give examples of 2nd generation D2/D3 antagonist antipsychotic drugs?

A 
Olanzapine
Risperidone
Quetiapine
Lurasidone
Asenapine
Amisulpride
Clozapine
33
Q

What long term effects do antipsychotics have?

A

Weight gain
Glucose regulation
Lipids
Except for aripiprazole, amisulpride and lurasidone

34
Q

What are the mechanisms of action of lithium?

A

Multiple neurotransmitters including dopamine
Cellular signalling
Neurotrophic factors

35
Q

Give examples of anticonvulsants

A

Valproate
Lamotrigine
Carbamazepine

36
Q

Describe valproate mechanism

A

Actions via GABA, intracellular signalling, sodium channel blockage, epigenetic modulation

37
Q

What can valproate be used for?

A

Anti-manic and prevention of mania

38
Q

What is the concern with valproate?

A

Risk of foetal teratogenesis and impaired intellectual development

39
Q

What is the mechanism of Lamotrigine?

A

Action via GABA, glutamate and sodium channel blackage

40
Q

What is Lamotrigine useful in?

A

Preventing depressive relapses

41
Q

What is Lamotrigine not useful in?

A

Anti-manic agents

42
Q

Describe Carbamazepine use

A

Less effect in maintenance treatment than lithium but may be used as mono therapy if lithium is ineffective
Especially in patients who don’t show classical pattern of episodic euphoric mania
Almost exclusively effective against manic relapse

43
Q

What is the treatment for depressive episodes?

A

Antipsychotics - quetiapine, lurasidone
Fluoxetine / olanzapine combinations
Antidepressants co-prescribed with anti-manic drug
Condiser lamotrigine with anti-manic drug

44
Q

What is the treatment for acute manic episodes?

A

Dopamine antagonists - haloperidol, olanzapine, risperidone, quetiapine
Valproate
Discontinue any antidepressant treatment

45
Q

What alternatives can be used to prevent new episodes if lithium is ineffective?

A

Valproate
Dopamine antagonists / partial agonists
Carbamazepine

46
Q

What are the side effects of long term treatment?

A

Weight gain - most medications, especially olanzapine & quetiapine
Metabolic syndrome - olanzapine, queitapine, risperidone
Hyperlactinemia - dopamine antagonists
Tardive dyskinesia - much lower risk with newer agents
Liver damage - valproate
Kidney & thyroid dysfunction - poorly regulated lithium

Module 202 Neuroscience & behaviour (39 decks)

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