WEEK 11: Mental Health Flashcards
T or F
‘poor mental health’ is the same as a ‘mental health disorder’.
F
“Mental” is a broad term and refers to the mind or the … system
central nervous
‘Mental health’ refers to what four main functions?
emotion, mood, thinking and behaviour
In order for a person’s mental health to be classified as being influenced by a disorder they must have changes in emotion, mood, thinking or behaviour that…
- are persistent
- are associated with distress and/or disablement
- interfere with functioning in social, work or family activities/life
T or F
Not all anxiety disorders are regarded to be mental health disorders
T
T or F
Both psychologists and psychiatrists can provide psychotherapy.
T
What is somnolence?
Excessive sleeping. The opposite of insomnia.
T or F
tricyclic antidepressants (TCAs) often cause insomnia
F
They often cause sedation
T or F
selective serotonin reuptake inhibitors (SSRIs) tend to cause insomnia
T
T or F
Among the antipsychotic agents, there is much variability regarding the effects on sleep.
T
What does a hypnotic drug do?
Cause sedation.
Which brain regions are most commonly associated with mood?
The amygdala, hypothalamus and the hippocampus
What key neurotransmitters are involved in mood, motivation and movement?
Dopamine, serotonin and noradrenaline.
T or F
Each neurotransmitter is distinct in its structure and receptors.
T
Why does cocaine cause euphoric effects?
Cocaine is a drug that can inhibit neurotransmitter transporters, thus increasing synaptic concentrations of neurotransmitters.
T or F
Most synapses have an “auto-receptor”
F
All of them do
The various stages of sleep are generally defined based on…
eye movements
In adults, REM sleep takes up approximately …% of total sleep
25%
What is REM sleep rebound?
A compensatory increase in the frequency, depth, and intensity of REM sleep following sleep deprivation or significant stressors.
We might spend …% of our night’s sleep in NREM Stage 2.
50%
NREM Stage … is a time of recovery from toxins in the brain and may only last for a total of 40 minutes.
3
in NREM Stage …, our body prepares for deep sleep with a slowing of heart rate and a decrease in body temperature.
2
Time spent in NREM stages … and … decreases with age.
3 and 4
…% of the adult population struggles with insomnia
35%
List some things that can cause insomnia.
Stress, pregnancy, lifestyle factors, mental health disorders, irregular sleep schedules, age, neurological disorders, physical pain, medications and other sleep disorders.
What is the major inhibitory neurotransmitter in the CNS?
GABA (gamma-aminobutyric acid)
GABA is made from … using enzymatic steps
glutamine
T or F
Both ionotropic and metabotropic receptors have inhibitory consequences if activated by GABA.
T
What two main receptor types does GABA have?
ionotropic and metabotropic
… convert GABA to glutamine for movement back to the neuron.
Astrocytes
GABA is synthesized in the pre-synaptic terminal from glutamate by ….
glutamic acid decarboxylase (GAD).
GABA is then recruited into synaptic vesicles via the action of ….
vesicular GABA transporter (vGAT).
Released GABA is cleared from the synapse by membrane-bound ….
GABA transporters (GATs)
In astrocytes, GABA is recycled into synaptic vesicles or taken up by mitochondria, where it is metabolized by …. to glutamine for neuronal uptake.
GABA transaminase (GABA-T)
GABAA receptors have a central pore that is permeable to negatively charged …. following activation by GABA.
chloride ions
T or F
While most GABAA receptors have two alphas, and two betas, the fifth subunit can vary.
T
60% of GABAA receptors are in the α…β…γ… configuration.
α1β2γ2
T or F
Ethanol, benzodiazepines and barbiturates work by activating GABAA receptors.
F
Each of these compounds do not activate the GABAA receptor themselves, but when they are bound, they enhance the response of the GABAA receptor to GABA itself.
What are positive allosteric modulators?
compounds that enhance receptors’ structural responses in a positive or favourable way.
An ideal anti-insomnia medication is one that can…
be a potent sedative at night with limited to no remaining sedation during daytime.
Depending on concentration, benzodiazepines can cause what 4 effects?
- hypnosis (sleep-inducing)
- anaesthesia
- anticonvulsant
- muscle-relaxing effects.
T or F
Overdose via benzodiazepines due to respiratory or nervous system depression is rare.
T
That said, a combination of benzodiazepines with other agents that cause respiratory depression can be fatal.
T or F
What must patients avoid when taking benzodiazepines to avoid respiratory depression?
Alcohol and opioids.
Why can a combination of alcohol and benzodiazepines cause respiratory depression?
Both benzodiazepines and alcohol are positive allosteric modulators at GABAA receptors.
T or F
Benzodiazepines can be addictive
F
But patients may build tolerance or dependence to them.
What class of drugs is likely to cause REM rebound when discontinued?
Benzodiazepines
T or F
Benzodiazepines may suppress REM sleep.
T
T or F
Zolpidem can cause REM rebound when discontinued.
F
T or F
Zolpidem in not a benzodiazepine
T
Though it is benzodiazepine-like
T or F
The hypnotic effects of benzodiazepines are concentration-dependent.
T
There are at least … different alpha subunits comprising the GABAA receptor.
six (α1-6)
There are at least … different beta subunits comprising the GABAA receptor.
three (β1-3)
List the 5 different types of subunits comprising the GABAA receptor.
Alpha
Beta
Gamma
Sigma
Epsilon
(Regarding GABAA receptors) Benzodiazepines have an affinity for all forms of …-subunits
alpha
T or F
Benzodiazepines produce different effects depending on which GABAA subunit is activated.
T
Benzodiazepine induced sedation and amnesia is mediated through the …-… subunit of GABAA receptors.
α1
What is the most commonly distributed GABAA receptor subunit throughout the brain?
α1
Sleep and relief from anxiety are medicated by GABAA receptor complexes with … and … subunits.
α2 and α3
T or F
Z-hypnotics can be used to treat anxiety as well as insomnia.
F
Z-hypnotics are only used to treat insomnia.
The inhibitory effects of Z-hypnotics on GABAA receptors are reversible in the presence of … as an antagonist.
flumazenil
The Z-hypnotics interact with GABAA receptors containing … subunits.
gamma (γ)
Zolpidem medicates its effects mostly via the … containing GABAA receptors.
α1
Zolpidem medicates its effects partially through … and … subunits.
α2 and α3
Zolpidem has very little affinity for … subunits on GABAA receptors.
α5
T or F
Benzodiazepines have a comparatively short half-life compared to Z-hypnotics.
F
vice versa
T or F
Between benzodiazepines and Z-hypnotics, benzodiazepines carry the greatest risk of abuse potential and development of tolerance.
T
T or F
Zolpidem is not generally used for anticonvulsant effects, as it is less effective than benzodiazepines at this.
T
The Z-hypnotic with the longest duration of action is…
Zopiclone
T or F
Eszopiclone has a more rapid onset of action when compared with zopiclone.
T
Our physiological mechanism for aligning hormonal levels and processes with our environment is largely driven by …. during a 24-hour period.
our exposure to light and dark
Physical light is perceived by the … and passed via the …. to the …..
retina
optic nerve
occipital cortex
The brains … is where light cues from the environment are received.
suprachiasmatic nucleus (SCN)
Melatonin is a hormone produced by the … of the brain.
pineal gland
T or F
Melatonin secretion decreases in darkness and increases during light exposure.
F
Vice versa.
When prompted by darkness what does melatonin do to promote sleep?
lowers body temperature and contributes to drowsiness.
The function of melatonin is timed by the …. of the hypothalamus.
suprachiasmatic nucleus
T or F
Melatonin is an agonist for at least three receptor types.
T
What receptor types does melatonin agonize?
MT1, MT2 and MT3.
T or F
MT2 and MT3 are both GPCRs.
F
MT1 and MT2 are GPCRs.
When MT1 and MT2 are activated they inhibit the enzyme …. which leads to a reduction in …
adenylyl cyclase
cAMP
What can MT1 receptors activate?
MT1 receptors can also activate phospholipase C (PLC).
Other than inhibiting adenylyl cyclase and reducing cAMP what else can MT2 receptors inhibit and reduce?
guanylyl cyclase and reduces cGMP formation.
T or F
Melatonin is made exclusively in the pineal gland.
F
It is also locally synthesised in the retina and gastrointestinal tract.
Outside of the pineal gland what effects is melatonin thought to have?
Melatonin is also thought to function primarily as an antioxidant in the GIT and retina.
The actions of melatonin can be mimicked by the binding of …
agomelatin
Agomelatin is a … and … receptor agonist.
M1 and M2
What is narcolepsy?
A sleep disorder characterized by feeling extreme sleepiness every day; vivid hallucinations, sleep paralysis, cataplexy, and disrupted and fragmented sleep).
What causes narcolepsy?
When hypocretin neurons die off in the hypothalamus. The cause is unknown, though an autoimmune disorder is suspected.
Hypocretin neurons produce … and …
hypocretin-1 and hypocretin-2
(also called orexin A and B)
How does hypocretin-1 and hypocretin-2 (aka orexin A and B) susatin wakefulness?
by activating neurons throughout the brain.
What two receptors in the CNS are involved in the effects of the hypocretins?
hctr1 and hctr2.
Hypocretin neurons stimulate … neurons and increase their rate of firing.
histaminergic
Of the histamine receptors in the body, … activation leads to a sedative effect.
H1R
Presynaptic … have inhibitory effects when activated by histamine, leading to a reduction in histamine release and synthesis.
H3Rs
H3Rs are “constitutively active”, meaning…
that they have efficacy even in histamine’s absence.
What is cataplexy?
A syptom of Narcolepsy often triggered by strong emotions, results in the patient not being able to control their muscles. Patients are unable to move for 30 sec to 2 min. In severe attacks, the patient may fall and experience paralysis for several minutes, being fully aware of what is happening
Narcolepsy type 1 is characterised by…
cataplexy and low levels of hypocretin
Narcolepsy type 2 is characterised by…
cataplexy and normal levels of hypocretin.
… is the R-isomer of modafinil.
Armodafinil
T or F
Armodafinil has been shown to have a longer duration of effect in patients compared to modafinil.
T
Elevated concentrations of dexamphetamine can inhibit … enzyme activity.
MAO
T or F
The urge to move one’s legs is the main symptom of restless legs syndrome.
T
T or F
Most drugs prescribed to treat RLS aren’t recommended during pregnancy.
T
What are the three types of sleep apnoea?
Obstructive sleep apnoea
Central sleep apnoea
Complex sleep apnoea
What is the most common type of sleep apnoea?
Obstructive sleep apnoea
What is sleep apnoea?
A condition in which breathing repeatedly pauses or becomes shallow or infrequent during sleep, often with loud snoring.
What are some associated risk factors for central sleep apnoea?
congestive heart failure, being a middle-aged to older male, a previous stroke, using opioid medications.
What causes central sleep apnoea?
when the the brain is not correctly regulating the muscles involved in breathing.
What lifestyle changes can be implemented to treat obstructive sleep apnoea?
Losing weight, smoking.
T or F
CPAP devices are not as effective as surgery for the treatment of sleep apnoea.
F
Surgery is not thought to be as effective as CPAP devices.
