WEEK 13: Mental Health Flashcards
Type 1 Bipolar is characterised by…
extreme highs and extreme lows.
Type 2 Bipolar disorder is characterised by…
Brief periods of elation (though not as extreme as in type 1) followed by long periods of depression.
Extreme highs in bipolar are called ….
manic episodes
What are some symptoms of a manic episode?
Racing thoughts, exceptional energy, extreme happiness, sleeplessness, rapid speech, impulsive actions and risky behaviours.
What are some symptoms of a bipolar depressive episode?
Feeling worthless or excessively guilty, changes in appetite, dwindling interest in hobbies, persistent thoughts of suicide, slowness, and a low mood.
… to …% of adults show symptoms indicative of bipolar disorder.
1 to 3%
What causes bipolar disorder?
A disruption to the brain’s “pruning” process causes the neural connections in the brain to be maze-like and impossible to navigate, leading to bipolar disorder.
Bipolar hallucinations (which emerge during extreme phases of bipolar disorder) are attributed to the overabundance of which neurotransmitter?
Dopamine.
T or F
Bipolar disorder can run in families.
T
T or F
(Regarding bipolar disorders)
Sometimes, symptoms of depression and mania can occur at the same time.
T
T or F
Most people with bipolar disorder have additional psychiatric conditions (such as substance abuse and anxiety).
T
It can take an average of … years for people to enter treatment for bipolar disorder after symptoms begin.
10
T or F
Bipolar patients experience a period of “normality” before having either a manic or depressive episode.
F
Not always
List some medications that can lead to mania.
Antidepressants, drugs that enhance dopamine activity, non-prescription weight loss drugs, St John’s wort, and others
T or F
Alcohol intoxication cannot trigger a mania episode
F
T or F
Drug withdrawal can trigger a mania episode in bipolar.
T
What medical conditions can trigger a manic episode?
Endocrine or hormonal dysregulation, infections, CNS disorders and others
What environmental factors can trigger a manic episode?
Sleep deprivation, bright light therapy, and deep-brain stimulation (DBS)
T or F
Full mania is less severe than hypomania
F
vice versa
T or F
A patient with Type 2 diabetes will likely experience “full manic” episode.
F
A patient with Type 1 diabetes will
Is hypomania more prevalent in type 1 or type 2 diabetes?
Type 2
Medications to treat bipolar disorder include:
Atypical antipsychotics, anticonvulsants, benzodiazepines and lithium
Lithium is thought to increase inhibitory neurotransmission via …
GABA
lithium is thought to decrease the excitatory neurotransmission of … and …
glutamate
dopamine
T or F
Bipolar disorder is considered to be a neurodegenerative process
T
T or F
Lithium has antioxidant, anticonvulsant, and anti-apoptotic benefits.
F
Just antioxidant and anti-apoptotic
T or F
Lithium is a substrate for Na-K-ATPase.
F
T or F
Lithium ions mimic sodium ions
T
Lithium inhibits …. which blocks the phosphoinositide pathway. This effect is thought to modulate …. systems
inositol monophosphate
GPCR second messenger
The synaptic impacts of lithium use is that it inhibits …., while promoting …., thus potentially stabilising function between mania and depressive episodes.
excitatory neurotransmission
inhibitory neurotransmission
How do lithium ions reduce intracellular increases in Ca2+ ions?
Li+ ions interfere with the release of dopamine and reduce the involvement of inositol phosphate cycle, thus reducing intracellular increases in Ca2+ ions.
When do patients with psychosis usually experience their first psychotic episode?
At 25 years of age
… is the most linked condition to psychoses
Schizophrenia
List some factors that are thought to contribute to schizophrenia
Drug addiction, extreme depression, alcoholism, physical brain damage, genes and medication overdose.
T or F
Schizophrenia symptoms always develop slowly
F
They can develop slowly or rapidly
T or F
Most people with schizophrenia will experience one to several episodes but then return to normalcy with no impairment.
T
What are some examples of positive symptoms in schizophrenia?
delusions, hallucinations, thinking difficulties.
What are some examples of negative symptoms in schizophrenia?
loss of drive, blunted or inappropriate emotions, and social withdrawal.
After a schizophrenia diagnosis, it is estimated that 10-15% of patients will be deceased 10-30 years later, mostly due to …
suicide.
What are the 4 dopaminergic pathways?
mesocortical
nigrostriatal
mesolimbic, and
tuberoinfundibular
Dopamine is made from the the enzymatic conversion of the amino acid … to ….
tyrosine
leva-dopa (L-DOPA).
Within the presynaptic neuron,
dopamine (DA) is packaged into vesicles via the ….
versicular monoamine transporter 2 (VMAT-2).
L-DOPA undergoes … to form dopamine (DA) (A).
decarboxylation
Dopamine can be catabolized by …. or …. enzymes.
catechol-O-methyltransferase (COMT)
monoamine oxidase (MAOB)
Dopamine is recycled by reuptake via the ….
DA transporter
… on the presynaptic neuron monitor DA levels in the synaptic gap and attenuate DA release when activated.
Autoreceptors
… receptors are the most predominant subtype of DA receptors in the brain.
D2
The DA receptors (D1-D5) are grouped into … families based on their general topology.
two
T or F
All the DA receptors are present in the same brain regions.
F
these are present in different brain regions
T or F
The activation of different DA receptors can lead to opposing effects.
T
What are D2 receptors involved in?
They are involved in mood, emotional stability in the limbic system as well as movement control in the basal ganglia.
What D receptors are in the D1 receptor family?
D1 and D5
What D receptors are in the D2 receptor family?
D2, D3 and D4
In schizophrenia, the … pathway is …, leading to negative symptoms
mesocortical
hypodopaminergic
In schizophrenia, the … pathway is …, leading to positive symptoms
mesolimbic
hyperdopaminergic
There may be decreased levels of … in cerebrospinal fluid, prefrontal cortex and the hippocampus of schizophrenics
glutamate
Atypical antipsychotics have low affinity for … receptors, but are good antagonists of … receptors
D2
5-HT2
T or F
Dopamine based antipsychotics are only partially effective in most (70%) and ineffective entirely for some patients
T
T or F
NMDA glutamate receptor antagonists worsen cognitive, positive, and negative symptoms in unmedicated schizophrenic patients.
T
T or F
NMDA agonists don’t improve schizophrenia symptoms
F
They might
T or F
NMDA glutamate receptor “hypofunction” may reduce the level of activity of mesocortical DA neurons, reducing activity of dopamine in the hippocampus
F
in the frontal cortex
All “atypical” (aka second generation) antipsychotics are those developed after what year?
1990
Typical/First-Generation Antipsychotics have what side effects?
side effects of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD)
“Atypical” Second-Generation Antipsychotics have what side effects?
weight gain, sedation and risk of diabetes
Second-generation antipsychotics were modeled on … and … receptor antagonism
5-HT2
D2
First-Generation Antipsychotics were modelled on … antagonism.
D2
T or F
Antipsychotics are not often used for lifelong management.
F
Do first-generation antipsychotics reduce positive or negative schizophrenia symptoms?
positive
List some symptoms of extra-pyramidal syndrome
Shuffling gait, tremor at rest, rigidity and stooped posture
T or F
D2 receptor antagonism helps to alleviate the positive symptoms of schizophrenia in the mesolimbic dopaminergic pathway
T
Reversible D2 receptor antagonism in the …. pathway mimics the motor effects occurring with the neurodegeneration of dopaminergic neurons.
nigrostriatal dopaminergic
T or F
The therapeutic window for first-generation antipsychotics is small.
T
If there is an 80%+ blockage of D2 receptors caused by typical antipsychotics what symptoms can patients experience?
- hyperprolactinemia in the pituitary gland
- acute dystonia
- tardive dyskinesia (with long term use)
- elevated prolactin levels, which may lead to breast tissue development.
T or F
Haloperidol has been found to be 50-fold more potent than chlorpromazine for D2 receptor antagonism with the same efficacy for the relief of psychological features.
T
T or F
Atypical Second-Generation Antipsychotics were designated as being “atypical” in that they did not have a strong tendency towards EPS side effects.
T
T or F
The antagonism of D2 receptors is reduced in 2nd-gen antipsychotics compared to 1st-gen.
T
Atypical drugs also bind to D2 receptors but more loosely, resulting in a “fast off” and a reduced risk of EPS.
T or F
Atypical antipsychotics treat the negative symptoms of schizophrenia, not the positive
F
They treat both.
Medications that block 5-HT2 receptors have been linked to what side effects?
Increased food intake: commonly resulting in weight gain
Dyslipidaemia: increased mean total cholesterol serum levels
Hypertriglyceridemia: increased triglyceride levels
Increased risk of Type 2 diabetes mellitus
T or F
Even when given in therapeutic doses, clozapine can cause EPS
F
Not when given in therapeutic ranges.
Why are patients on clozapine required to regularly get blood tests?
Clozapine was once pulled from the market due to its side effect of agranulocytosis which led to patient deaths. Patients on clozapine are required to regularly submit for haematological monitoring of granulocytopenia* before agranulocytosis develops.
T or F
Clozapine has much less muscarinic ACh antagonism compared to risperidone.
F
vice versa
T or F
A partial agonist can be considered to be a ‘modulator’, adjusting levels depending on whether they are too high or too low.
T
What is a psychotropic drug?
A mood-altering drug
T or F
Maintaining a comparatively high concentration of the monoamine in synapses associated with mood may lead to insomnia
T
T or F
Antagonism of monoamine receptors in key brain regions may be associated with sleepiness
T
T or F
The impacts of antidepressants on sleep/wake patterns are helpful in most patients naturally experiencing insomnia
F
T or F
Sedating medications cross the blood-brain barrier far more easily than those which cause insomnia
F
T or F
Withdrawal of patients from long-term treatment with antidepressants may induce insomnia and REM rebound
T
