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Flashcards in Addiction Deck (54):
1

voluntary motor behavior

BG

2

input stage of BG

caudate/putamen

3

caudate + putamen =?

corpus striatum

4

striatum --> pallidus --> thalamus

loop

5

planning, controlling impulsivity

PFC

6

early assessment of keys in env and linking to cues in emotional responses

amygdala

7

processing memory, general emotion regulation

hippocampus

8

circuit for translating emotion into action

CSPT:
PFC/Amygdala/Hippo --> nuc acc --> V pallidum --> MD thalamus --> cortical motor planning regions

9

nuclei that supply DA in the mesencephalon

SN, VTA

10

cells in striatum:accumbens that receive this input? what are they able to do w multiple inputs?

medium spiny neuron
receives GABA
INTEGRATORS!!! of glutamate from cortical regions with DA from VTA

11

lots of these are found in the striatum

opioids
(DA+opioids involved in addiction)

12

convey info
modulate info

DA
muOpioids

13

key site in brain to stimulate DA reward

VTA
can block D1 receptors to blunt this
destroying VTA blunts reward fxn

14

wanting chemical
liking chemical (hedonic response: liking chocolate cake after eating)

DA
opioids

15

which pathway will amphetamines effect?

wanting/goal-pursuit
NOT "liking"

16

neurochemical most predictive in reward stimulai

DA
most active when cues to predict reward, or when we have to learn something new (when env changes)

17

opponent process theory

A process: euphoria (e.g.)
B process: counteradaptation initiated to oppose the A process; over time this gets stronger and stronger

When A is removed then strong B leads to dysphoria

w/d theory: constantly taking drug to stave off B process

18

cue-elicited cocaine craving elicits?

DA release in the striatum

19

low striatal D2 receptor binding correlates with diminished activity where?

PFC

20

impulsivity results from impaired fxn of what?

PFC inhibitory control

21

compulsivity results from shift in what?

PFC-accumbens motor circuits to emphasis on dorsal striatal control (habit-mediator)

22

incentive-sensitization hypothesis

drug use leads to sensitization of DA ability to produce drug wanting

23

reward-error prediction hypothesis

enhanced DA release during drug taking produces condition in which all stimuli encountered during this period are experienced as being better than expected

24

big addiction characteristics

loss of control of limiting intake
taking persists despite negative consequences
alternatives no longer pursues
potential for relapse throughout lifespan

25

def: a) tendency to choose immediate reinforcement over delayed gratification, even when smaller or less beneficial, and b) impairment of inhibiting a course of action once initiated

impulsive behavior

26

def: perseveration in a certain behavior even in the face of unsuccessful/adverse outcomes

compulsive behavior

27

a gradual decrease in the use of alcohol past 20 years of age or so

desistence: usually due to other reinforcers e.g. career/family etc

28

epi of substance use d/o's

70% of drug abusers are unemployed
300% higher med costs
50% of domestic violence, major crimes assoc
17% of pregnant women smoke, 13% use alcohol
24% of suicides have BAC >0.1

29

genetic fx of alcohol abuse
low levels of what in CSF?

sons of fathers have 50% chance
inheritance of impulsivity as well as general addictive tendency
serotonin

30

other factors assoc in development of addiction

parental discouragement and monitoring
focus on academics
defense mechanisms (denial/rationalization)
early psychoactive substance use

31

almost all drugs of abuse elevate what neurochemical in the where?

DA in the nuc accumbens

32

locations of DA-producing neurons

SN -->
VTA --> Acb/amyg/hippo/PFC (MCL pathway)

33

how would you take away the "good" of food/drugs/other goal objects?
what projection plays role in wanting/seeking and reward-learning

block DA receptors

mesocorticolimbic projection

34

system involved in "wanting"
peptides involved in liking

DA (VTA-Acb)
opioids (endorph/enkeph)

35

3 components of the striatum
dorsal striatum?
ventral striatum?

caudate + putamen + nucleus accumbens
caudate + putamen
nuc accumbens

36

loops that direct conscious control of voluntary motor action; hijacked in substance use d/o

cortico-striato-pallidal-thalamic

37

inputs to Acb: motivation and emotion

amygdala and hippocampus
also PFC

38

drugs augment the transmission of what where?

DA in the nuc accumbens

39

hypothesis that states that DA codes for affective experience of reward

anhedonia

40

neither reward-based nor w/d-based theories describe what?

lifelong propensity to relapse

41

which theory does not require drug to cause subjective state of euphoria?
which theory describes increased wanting while decreased liking?

reward-learning
incentive-sensitiztion

42

this theory posits that individuals w/addiction acts compulsively due to diminishment in these 2 brain regions

PFC and anterior cingulate cortex

43

BAC levels: 50, 80, 200-300, 400-600

50 --> loss of cognition, judgment, coord
80 --> driving impaired
200 --> all faculties
400 --> coma/death

44

tx for alcohol w/d (w/in 72h)

tx: supportive
w/d: BZD taper + thiamine, Mg (incr glutamate to offset opponent-process of dec GABA and incr glutamate) and anticonvulsants (gabapentin) modulate Glu, diazepam, lorazepam

45

tx for opioid w/d

tx: naloxone
w/d: buprenorphine or methadone, clonidine/BZD regimen, suboxone, psychosocial support

46

tx for stimulant w/d

tx: BZD's
w/d: support + antidepressants

47

wernicke's encephalopathy

due to thiamine deficiency (give thiamine)
confusion, ataxia, ophthalmoplegia

48

meds and psychosocial tx (3) for alcohol

naltrexone, acamposate, disulfuram, buprenorphine + methadone for cocaine

CBT: relapse prevention, motivational enhancement (learn to avoid stimuli and chose positive habits), 12 step

49

timeline of w/d sx:
alcohol
BZD's
opioids
stimulants

sx subside in 72-96h; DT's for 10+ days
depends on half-life (d-wks)
days (heroin/morphine) to wks (methadone)
cocaine shorter than methamphetamine

50

dangerous sx of:
alcohol
BZD's
opioids
stimulants

psychosis, delirium, seizures
seizures
dehydration (NVD), leave to get more
leave to get more

51

common sx of:
alcohol
BZD's
opioids
stimulants

anx, nausea, tremors, sleep, restlessness, sweating, headaches, pulse, HTN
same as above
NVD, craving, rhinorrhea, tearing, muscle aches/cramps, gooseflesh, dilated pupils

tired, prolonged sleeping, amotivational, depressed, overeating, craving

52

tx of BZD w/d

switch to long-acting BZD and taper
some now use anticonvulsants

53

goal of substance use tx

prevent relapse!
most common time is 1st month-1 yr

54

MOA naltrexone
acamprosate effects which two systems?
MOA disulfiram (induction of fear)

interferes with + reinforcement (blocks effects of opioids released during use/cravings)
GABA/Glutamate; may decrease DA in nuc accumbens
antagonizes aldehyde dehydrogenase