Addiction

Question 1

voluntary motor behavior

Answer 1

BG

Question 2

input stage of BG

Answer 2

caudate/putamen

Question 3

caudate + putamen =?

Answer 3

corpus striatum

Question 4

striatum –> pallidus –> thalamus

Answer 4

loop

Question 5

planning, controlling impulsivity

Answer 5

PFC

Question 6

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

Answer 6

amygdala

Question 7

processing memory, general emotion regulation

Answer 7

hippocampus

Question 8

circuit for translating emotion into action

Answer 8

CSPT:

PFC/Amygdala/Hippo –> nuc acc –> V pallidum –> MD thalamus –> cortical motor planning regions

Question 9

nuclei that supply DA in the mesencephalon

Answer 9

SN, VTA

Question 10

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

Answer 10

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

Question 11

lots of these are found in the striatum

Answer 11

opioids

DA+opioids involved in addiction

Question 12

convey info

modulate info

Answer 12

DA

muOpioids

Question 13

key site in brain to stimulate DA reward

Answer 13

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

Question 14

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

Answer 14

DA

opioids

Question 15

which pathway will amphetamines effect?

Answer 15

wanting/goal-pursuit

NOT “liking”

Question 16

neurochemical most predictive in reward stimulai

Answer 16

DA

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

Question 17

opponent process theory

Answer 17

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

Question 18

cue-elicited cocaine craving elicits?

Answer 18

DA release in the striatum

Question 19

low striatal D2 receptor binding correlates with diminished activity where?

Answer 19

PFC

Question 20

impulsivity results from impaired fxn of what?

Answer 20

PFC inhibitory control

Question 21

compulsivity results from shift in what?

Answer 21

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

Question 22

incentive-sensitization hypothesis

Answer 22

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

Question 23

reward-error prediction hypothesis

Answer 23

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

Question 24

big addiction characteristics

Answer 24

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

Question 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

Answer 25

impulsive behavior

Question 26

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

Answer 26

compulsive behavior

Question 27

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

Answer 27

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

Question 28

epi of substance use d/o's

Answer 28

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

Question 29

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

Answer 29

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

Question 30

other factors assoc in development of addiction

Answer 30

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

Question 31

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

Answer 31

DA in the nuc accumbens

Question 32

locations of DA-producing neurons

Answer 32

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

Question 33

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

Answer 33

block DA receptors mesocorticolimbic projection

Question 34

system involved in "wanting" | peptides involved in liking

Answer 34

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

Question 35

3 components of the striatum dorsal striatum? ventral striatum?

Answer 35

caudate + putamen + nucleus accumbens caudate + putamen nuc accumbens

Question 36

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

Answer 36

cortico-striato-pallidal-thalamic

Question 37

inputs to Acb: motivation and emotion

Answer 37

amygdala and hippocampus | also PFC

Question 38

drugs augment the transmission of what where?

Answer 38

DA in the nuc accumbens

Question 39

hypothesis that states that DA codes for affective experience of reward

Answer 39

anhedonia

Question 40

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

Answer 40

lifelong propensity to relapse

Question 41

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

Answer 41

reward-learning | incentive-sensitiztion

Question 42

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

Answer 42

PFC and anterior cingulate cortex

Question 43

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

Answer 43

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

Question 44

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

Answer 44

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

Question 45

tx for opioid w/d

Answer 45

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

Question 46

tx for stimulant w/d

Answer 46

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

Question 47

wernicke's encephalopathy

Answer 47

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

Question 48

meds and psychosocial tx (3) for alcohol

Answer 48

naltrexone, acamposate, disulfuram, buprenorphine + methadone for cocaine CBT: relapse prevention, motivational enhancement (learn to avoid stimuli and chose positive habits), 12 step

Question 49

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

Answer 49

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

Question 50

``` dangerous sx of: alcohol BZD's opioids stimulants ```

Answer 50

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

Question 51

``` common sx of: alcohol BZD's opioids stimulants ```

Answer 51

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

Question 52

tx of BZD w/d

Answer 52

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

Question 53

goal of substance use tx

Answer 53

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

Question 54

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

Answer 54

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