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Year 3 - Psychiatry (DP) > Development, Memory and Addiction > Flashcards

Flashcards in Development, Memory and Addiction Deck (261)
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1

What brain structural changes in Schizphrenia result in a poorer prognosis?

Reduced frontal lobe volume
Reduced frontal lobe grey matter
Increased lateral ventricle volume

2

Where are there consistent reductions in brain structure in Schizophrenia?

Temporal cortex (esp. Superior Temporal Gyrus)
Medial temporal lobe (esp. Hippocampus)

3

What is the neuropil composed of?

Mostly unmyelinated axons, dendrites and glial cells processes

4

What does neuropil form?

Synaptically dense region with a relatively low number of cell bodies:
- eg. Neocortex and olfactory bulb

5

When are grey matter abnormalities present in Schizophrenia?

Early

6

How can brain white matter be investigated?

Diffusion tensor imagine

7

What do higher numbers in fractional anisotropy indicate?

Healthy white matter tracts

8

What do higher numbers in mean diffusivity indicate?

Less healthy white matter tracts

9

Children showing impairment in what areas during infancy are more likely to develop Schizophrenia?

Behaviour
Motor development
Intellect

10

What does ventricular enlargement at diagnosis of Schizophrenia indicate?

It is non-progressive

11

What is the DA hypothesis in Schizophrenia?

Drugs which:
- Release DA (eg. Amphetamine) OR
- D2 receptor agonists (eg. Apopmorphine)
...both produce psychosis

12

According to the DA hypothesis, what effect does Amphetamine have on Schizophrenia?

Worsens it

13

According to the DA hypothesis, what effect do D2 receptor antagonists have in Schizophrenia?

Treat the symptoms

14

What DA pathways are overactive and may be related to Schizophrenia?

Tuberinfundibular (PRL release)
Mesolimbic/Cortical (Motivation and reward)
Nigrostriatal (Extrapyramidal motor system)

15

What do D1 family DA receptors (D1 and D5) do?

Stimulate cAMP

16

What do D2 family DA receptors (D2, D3 and D4) do?

Inhibit adenylyl cyclase
Inhibit voltage-gated calcium channels
Open potassium channels

17

What are the most abundant DA receptors?

D1

18

Where are D2 receptors also present?

Pituitary

19

What receptor is Bromocriptine an agonist of?

D2

20

What receptor is Raclopride an antagonist of?

D3

21

What receptor are Raclopride and Haloperidol antagonists of?

D2

22

What receptor is Quinpirole an agonist of?

D3

23

What receptor is Clozapine an antagonist of?

D4

24

What does subcortical DA hyperactivity result in?

Psychosis

25

What does mesocortical DA hypoactivity result in?

Negative and cognitive symptoms

26

What is the glutamatergic hypothesis?

Altered NMDA receptor subunit expression

27

What drug, which can cause psychosis, is explained by the glutamatergic hypothesis?

Ketamine

28

What is the serotonergic hypothesis?

Serotonin 2A binding potential in frontal cortex slightly small (by 16.3%) in schizophrenic patients

29

What gene alterations are indicated in psychosis?

Neuregulin
Dysbindin
DISC-1

30

What does Neuregulin do?

Signalling protein
Mediates cell-cell interactions and plays critical roles in growth and development

31

What does Dysbindin do?

Essential for adaptive neural plasticity

32

What does DISC-1 do?

Involved in neuritic outgrowth and cortical development via interactions with other proteins

33

What are some examples of typical (1st gen.) antipsychotics?

Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol
Zuclopentixol

34

How do typical antipsychotics work?

D2 inhibition:
- Immediate blockaed
- Delay in onset of effect

35

What are the side effects of typical antipsychotics?

Dry mouth
Muscle stiffness and cramps
Tremor
Extrapyramidal signs:
- Akathisia
- Parkinsonism
- Dystonia

36

What is the definition of an atypical (2nd gen.) antipsychotic?

1. Less likely to induce extrapyramidal symptoms
2. High 5-HT2a:D2 ratio
(3. Better efficacy against negative symptoms)
(4. Effective if atypicals don't work)

37

What are some examples of atypical antipsychotics?

Olanzapine
Risperidone
Quetiapine
Clozapine
Aripiprazole
Amilsupride

38

What are the side effects of most/all atypical antipsychotics?

Mostly metabolic:
- Weight gain
- Hyperglycaemia
- Dyslipidaemia and Hypertension
Sexual dysfunction

39

What atypical antipsychotics can cause extrapyramidal symptoms at high doses?

Olanzapine
Risperidone
Amilsupride

40

What side effect can olanzapine have?

Increase PRL at high doses

41

How does an acute dystonic reaction present?

Muscle spasms
Within hours-days of initiation of antipsychotics

42

How are acute dystonic reactions treated?

Ach antagonists:
- Prochlorperazine
- Procyclidine
- Orhphenadine

43

What is tardive dyskinesia?

Repetitive, involuntary movements:
- Grimacing
- Sticking tongue out
- Lip smacking
- Pursing lips
- Blinking

44

How long does tardive dyskinesia take to develop?

Years to develop

45

What effect does stopping medications have on tardive dyskinesia?

It often continues

46

What do drugs with a high affinity for 5-HT2 receptors cause?

Hallucinations
Thought disturbance

47

What drugs have a high affinity for 5-HT2 receptors?

Hallucinogenic indoleamines
Phenylethylamines

48

How is 5-HT2 receptors binding affected in Schizophrenia?

Reduced

49

Blockade of what histamine receptor causes sedation?

H1

50

How does histamine blockade affect appetite?

Increases it

51

Why are newer anti-histamines not as sedative?

Do not cross BBB

52

What is histamine involved in?

Appetite
Pain perception
Regulation of pituitary hormon secretion
Reducing nausea and vomiting

53

What serious side effect can Clozapine have?

Agranulocytosis

54

How are the side effects of Clozapine monitored and prevented?

FBC:
- Weekly for first 6 months
- Fortnightly for next 6 months
- Every 4 weeks thereafter
- For 1 months after cessation

55

If a patient has a sore throat while on Clozapine, what must be done?

FBC!!

56

How does Clozapine cause myocarditis?

IgE-mediated Type 1 sensitivity
OR
Cytokine release
OR
Hypercatecholaminaemia

57

How is myocarditis monitored/prevented while on Clozapine?

Regular ECGs:
- May show nonspecific ST segment changes

58

What is the first line treatment of Schizophrenia?

An atypical antipsychotic (risperidone or olanzapine):
- Continue for 2 weeks

59

During the first line treatment of Schizophrenia, if there is no improvement by what point should an alternative therapy be considered?

4 weeks

60

During the first line treatment of Schizophrenia, if there is only partial improvement by what point should an alternative therapy be considered?

8 weeks

61

If there is remission of the first episode of Schizophrenia, how long should maintenance therapy be continued for?

>=18 months

62

If no response to the first line antipsychotic in Schizophrenia, what can be prescribed?

A different atypical antipsychotic
OR
Chlorpromazine (or another typical low-potency antipsychotic)

63

What drug is used in treatment-resistant Schizophrenia? When is Schizophrenia deemed treatment-resistant?

Clozapine
Poor response to 2 antipsychotics (one of which must be an atypical antipsychotic)

64

How can aggression in hospital be predicted?

Body language

65

How can aggression in hospital be prevented?

De-escalation
Observations
Room layout

66

How can aggression in hospital be treated?

Restraint
Seclusion
Rapid tranquilisation

67

How is a person who has or appears to have a mental disorder defined under section 329 of the Mental Health Act (Scotland)?

Any mental illness
Personality disorder
Learning disability

68

Who can approve a short-term detention or a CTO under the Mental Health Act?

Approved medical practitioner:
- Register practitioner who is either a member/fellow of the Royal College of Psychiatrists OR have 4 yers of continuous psychiatric experience and are sponsored by a local medical director

69

What is the only treatment authorised under Emergency Detention?

Emergency treatment

70

What is the first step of the Tayside Rapid Tranquilisation Policy?

Consider non-drug approaches:
- Distraction
- Seclusion
- Conversation

71

For the second step of the Tayside Rapid Tranquilisation Policy, what drug can be used if any of the following are met:
- Unknown PMHx or DHx
- Heart disease
- No Hx of typical antipsychotics
- Current illicit drug use

PO Lorazepam 1-2mg

72

For the second step of the Tayside Rapid Tranquilisation Policy, what drugs can be used if there is a confirmed history of significant typical antipsychotic exposure?

PO Lorazepam 1-2mg
AND/OR
PO Haloperidol 5mg

73

When can the third stage of the Tayside Rapid Tranquilisation Policy be initiated?

If PO therapy unsuccessful
OR
Effect required within 30 minutes

74

For the third step of the Tayside Rapid Tranquilisation Policy, what drug can be used if any of the following are met:
- Unknown PMHx or DHx
- Heart disease
- No Hx of typical antipsychotics
- Current illicit drug use

IM Lorazepam 1-2mg:
- Mixed 1:1 in water or NaCl

75

For the third step of the Tayside Rapid Tranquilisation Policy, what drugs can be used if there is a confirmed history of significant typical antipsychotic exposure?

IM Lorazepam 1-2mg:
- Mixed 1:1 in water or NaCl
AND/OR
IM Haloperidol 5mg:
- Not in same syringe as Lorazepam

76

What monitoring is required in IM Haloperidol is used in the Tayside Rapid Tranquilisation Policy? How frequently and for how long?

Respiratory rate
Pulse rate
BP
Every 5-10 minutes for 1 hour

77

When can the fourth step of the Tayside Rapid Tranquilisation Policy be initiated? What is the fourth step?

After waiting 30 minutes, another IM injection can be given
If this fails, get senior help

78

How can inner experience and behaviours deviating from the expectations of the individuals be manifested in the diagnosis of a Personality Disorder?

Cognition (perceiving/interpreting self and others)
Affectivity (of emotional response):
- Range
- Intensity
- Lability
- Appropriateness
Interpersonal functioning
Impulse control

79

How is the enduring pattern of behaviour changes in a Personality Disorder described?

Inflexible
Pervasive

80

What do the behaviour changes in a Personality Disorder lead to?

Clinically significant distress
OR
Impairment in social/occupational/other functioning

81

What personality disorder is characterised by feelings of excessive doubt and caution, preoccupation with lists/rules, perfectionism, excessive scrupulousness, pedantry, stubbornness and unreasonable insistence that others submit to their way of doing things?

Anankastic (F60.5)

82

What kinds of personality disorders are classed as Cluster A; 'Odd and Eccentric' in DSM-V?

Paranoid
Schizoid
Schizotypical

83

What kinds of personality disorders are classed as Cluster B; 'Dramatic, emotional, erratic' in DSM-V?

Antisocial
Borderline
Histrionic
Narcissistic

84

What kinds of personality disorders are classed as Cluster C; 'Anxious and fearful' in DSM-V?

Avoidant
Dependent
Obsessive-Compulsive

85

What personality disorder is characterised by distrust and suspicion of others. It begins in early adulthood and presents with >=4 of the following:
- Suspecting others of exploiting/harming them
- Preoccupied with unjustified doubts of others loyalty
- Reluctance to confide in others
- Reads hidden meanings from benign remarks
- Persistently bears grudges
- Feels attacked and quickly reacts angrily
- Recurrent suspicions regarding partner's fidelity

Paranoid personality disorder

86

What personality disorder is characterised by detachment from social relationships, restricted range of emotional expression, beginning in early adulthood and presents with >=4 of the following:
- Doesn't desire/enjoy close relationships
- Chooses solitary activities
- Little interest in sex
- Takes pleasure in few/no activities
- Lacks close friends
- Appears indifferent to praise/criticism
- Emotional detachment or flat affect

Schizoid personality disorder

87

What personality disorder is characterised by disregard for and violation of the rights of others, occurs since around 15 years of age and is present with >=3 of the following:
- Failure to conform to social norms (forensic Hx)
- Deceitfulness
- Impulsivity
- Aggressiveness
- Reckless disregard for safety of self/others
- Consistent irresponsibility (ccupations/finances)
- Lack of remorse

Antisocial personality disorder

88

What personality disorder is characterised by instability of interpersonal relationships, self-image and affects, marked impulsivitiy, beginning by early adulthood and presenting with >=5 of the following:
- Frantic efforts to avoid abandonment
- Unstable/Intense interpersonal relationships
- Identity disturbance
- Impulsivity in two areas (sex, spending, substance abuse, reckless driving, binge eating)
- Recurrent DSH/suicidal ideation
- Marked reactivity of affect
- Chronic feelings of emptiness
- Inappropriate, intense anger
- Transient, stress-related paranoid ideation or severe dissociation

Borderline personality disorder

89

What personality disorder is characterised by social inhibition and feeling inadequate, beginning in early adulthood and presenting with >=4 of the following:
- Avoiding occupational activities
- Unwilling to socialise unless knowing you'll be liked
- Restraint with intimacy
- Preoccupation with being rejected
- Inhibited in new social situations
- Views self as socially inept or inferior
- Unusually resistant to engage in new activities

Avoidant personality disorder

90

What personality disorder is characterised by excessive need to be taken care of, beginning in early adulthood and presenting with >=5 of the following:
- Needs excessive advice for everyday decisions
- Needs others to assume responsibility
- Difficulty expressing disagreement
- Difficulty being independent
- Goes to excessive lengths to obtain support
- Feels helpless when alone
- Urgently seeks another relationship for support
- Unrealistically preoccupied with fears of being left to take care of themselves

Dependent personality disorder

91

What personality disorder is characterised by a preoccupation with orderliness, perfectionism and interpersonal control at the expense of flexibility and openness. It begins in early adulthood and presents with >=4 of the following:
- Preoccupied with rules, lists etc
- Perfectionism affecting task completion
- Excessively devoted to work
- Inflexible about morality/ethics/values
- Hoarding
- Reluctance to delegate
- Frugal
- Stubborn

Obsessive-Compulsive personality disorder

92

What is the most common personality disorder?

Obsessive-Compulsive personality disorder (1.9% prevalence)

93

How is avoidant PD treated?

Social skills training
Antidepressants

94

How is borderline PD treated?

Dialectical Behavioural Therapy
'Mentalism' (Interpret own actions as meaningful)
Medication is usually for comorbidities

95

Borderline PD is over-represented in atypical depression, what drugs may help?

MAOIs:
- Phenelzine also for hostility

96

What is the IQ range for a mild learning disability?

50-69

97

What is the IQ range for a moderate learning disability?

35-49

98

What is the IQ range for a severe learning disability?

20-34

99

What is the IQ range for a profound learning disability?

<20

100

What is the IQ range for a borderline learning disability?

>=70 (-84)

101

What is the most commonly used psychometric assessment scale?

Wechsler Adult Intelligent Scale

102

What are O'Brien's Principles?

Essentially that those with learning disabilities continue to grow and are worthy of all the dignity and rights of any citizen

103

What do people with a mild learning disability usually have problems with?

Delayed speech
Difficulties reading and writing

104

What do people with a moderate learning disability usually have problems with?

Slow comprehension and language
Limited achievements
Delayed self-care and motor skills

105

What common comorbidities are seen in moderate learning disorders?

Epilepsy
Physical disability

106

What are some prenatal aetiologies of learning disability?

Genetic
Chromosomal
Intrauterine

107

What are some perinatal aetiologies of learning disability?

Birth trauma
Anoxia

108

What are some postnatal aetiologies of learning disability?

Infection
Head injury

109

What is the incidence of Down's Syndrome at maternal age 30?

1/1000

110

What is the incidence of Down's Syndrome at maternal age 40?

1/84

111

What is the incidence of Down's Syndrome at maternal age 50?

1/44

112

What is the typical IQ range in Down's Syndrome?

30-55

113

What is Down's Syndrome associated with?

Schizophrenia

114

What is Patau Syndrome?

Trisomy 13

115

What is the incidence of Patau Syndrome?

0.2/1000

116

How many Patau Syndrome patients survive 1 year?

18%

117

What is Edward's Syndrome?

Trisomy 18

118

How does Cri du chat syndrome present and what causes it?

Microcephaly
Profound/Severe learning disability
Chromosome 5p deletion

119

How does Angelman syndrome present and what causes it?

Learning disability
Ataxia
Paroxysms of laughter
Chromosome 15q(11-13) deletion:
- Maternally derived

120

How does Prader-Willi syndrome present and what causes it?

Learning disability
Over-eating
Self-injurious behaviour
Chromosome 15q(11-13) deletion:
- Paternally derived

121

How does DiGeorge syndrome present and what causes it?

50% have learning diability
Cleft palate
Cardiac abnormalities
Abnormal facies
Chromosome 22q11.2 deletion

122

What else can DiGeorge syndrome be called?

Velo-Cardiofacial syndrome

123

What is Turner's syndrome?

45, XO

124

What is Klinefelter's syndrome?

47, XXX

125

What is the incidence of Fragile X?

1/1000

126

What causes Fragile x?

Faulty FMR1 gene

127

What genetic protein defect is a cause of severe learning disability?

Phenylketonuria

128

What genetic carbohydrate defect is a cause of severe learning disability?

Mucopolysaccharidoses

129

What genetic lipid metabolism defect is a cause of severe learning disability?

Neurolipidoses

130

How is Tuberous Sclerosis inherited?

Autosomal dominant

131

What does TSC1 code for?

Hamarton
On chromosome 9q34

132

What does TSC2 code for?

Tuberin
On chromosome 16p13.3

133

How is Lesch-Nyhan syndrome inherited?

X-linked recessive

134

What causes Lesch-Nyhan syndrome?

Mutations in HPRT1 gene:
- Codes for hypoxanthine-guanine phosphoribosyltransferase
Results in uric acid build up:
- Gout
- Kidney problems

135

What else does Lesch-Nyhan syndrome result in?

Neurological dysfunction
Cognitive and behavioural disturbances:
- Including self-mutilation

136

What causes holoprosencephaly?

Prosencephalon (forebrain) fails to divide into two hemispheres

137

What prenatal maternal infections can cause learning disabilities?

Rubella
CMV
Toxoplasmosis

138

What is Foetal Alcohol Spectrum Disorder associated with?

Mild learning disability
ADHD

139

What perinatal infections are associated with learning disabilities?

Neonatal septicaemia
Pneumonia
Meningitis/Encephalitis

140

What newborn complications (other than infections) can result in learning disabilities?

Respiratory destress
Hyperbilirubinaemia
Hypoglycaemia
Extreme prematurity

141

What is the Flynn Effect?

Average IQ in the US rises 3 points per decade:
- Therefore ~10 points per generation

142

What factors contribute to underdiagnosis of psychotic comorbidities in learning disability?

Intellect
Diagnostic overshadowing
Compliance ('Talked out of' symptoms)
Eager to please

143

When might antipsychotics be used in the context of learning disability?

Psychosis
Behavioural disturbance
Autism
ADHD

144

When might antidepressants be used in the context of learning disability?

Depression
Anxiety disorders
Self-harm
Autism

145

When might anticonvulsants be used in the context of learning disability?

Bipolar affective disorder
Episodic dyscontrol

146

When might stimulants be used in the context of learning disability?

ADHD

147

When might opiate antagonists be used in the context of learning disability?

Repetitive self-harm

148

When might anti-libidinal drugs be used in the context of learning disability?

Sexual offending

149

When might beta-blockers be used in the context of learning disability?

Autonomic arousal

150

How does Schizophrenia present in learning disability?

3 times more common
Early onset (mean age 23)
Negative symptoms more common
Main presentation may be change in behaviour

151

How does Schizophrenia present in severe learning disability?

Unexplained aggression
Bizarre behaviour
Social withdrawal
Mood lability
Increased mannerisms/stereotypes

152

How common is bipolar affective disorder in learning disability?

2-12%

153

How common is a depressive disorder in learning disability?

3 times

154

What anxiety disorder is more common in learning disability?

OCD

155

What anxiety disorder is less common in learning disability?

Agoraphobia

156

What is the M:F ratio of autism?

4:1

157

What are the triad of symptoms in autism?

Abnormal social interaction
Communication impairment
Rigid/Restricted or repetitive behaviour, interests and activities

158

How many units of alcohol indicate higher risk drinking?

>35 units per week (regularly)

159

How many units of alcohol indicate increased risk drinking?

15-35 units per week

160

How many units of alcohol indicate low risk drinking?

=<14 units per week spread over >=3 days

161

What does the AUDIT tool aim to do?

Detect hazardous drinking

162

What does the CAGE tool aim to do?

Detect alcohol abuse and dependence

163

What does the TWEAK tool aim to do?

Screens for alcohol problems in pregnant women

164

What does the MAST tool aim to do?

Full version useful for psychiatric settings

165

What do the PAT and FAST tools aim to do?

A+E testing

166

What does GGT indicate?

Degree of liver injury

167

What does Carbohydrate Deficient Transferrin indicate?

Identifies men drinking >=5 units per day for >=1 years

168

What is FRAMES in regard to alcohol abuse?

Feedback - Review problems due to alcohol
Responsibility - Patient is responsible for change
Advice - Reduction/Abstinence
Menu - Provide options for change
Empathy
Self efficacy - Encourage optimism for change

169

When should referral be considered in alcohol abuse?

Signs of moderate-severe alcoholism
Failure to benefit from structured brief advice and want more help
Signs of severe alcohol impairment or comorbidity

170

What are some specialist interventions for alcohol abuse?

Detoxification
Relapse prevention:
- Psychosocial
- Pharmacological

171

What channels does alcohol inhibit? What does chronic use result in?

Excitatory NMDA-glutamate ion channels
Chronic use -> Receptor upregulation

172

What channels does alcohol potentiate? What does chronic use result in?

Inhibitory GABAa controlled ion channels
Chronic use -> Receptor downregulation

173

What does alcohol withdrawal result in?

Excess glutamate activity -> Nerve cell toxicity
CNS excitability

174

When do alcohol withdrawal symptoms peak?

24-48 hours

175

When does delirium tremens tend to occur?

Usually within 24 hours

176

How long does it take for alcohol withdrawal symptoms to resolve?

5-7 days

177

How can delirium tremens cause death?

Cardiovascular collapse
Infection

178

What benzodiazepines are used in alcohol withdrawal and why?

Long-acting agents:
- Diazepam
- Chlordiazepam

179

How do BZDs work in alcohol withdrawal?

Cross tolerant with alcohol:
- At on GABAa

180

How long is the BZD dose reduced over in alcohol withdrawal?

>=7 days

181

How is BZD therapy guided in alcohol withdrawal?

CIWA-Ar

182

Why can Thiamine be prescribed in alcohol withdrawal?

Prophylaxis against Wernick'e Encephalopathy

183

How is Thiamine given in alcohol withdrawal?

Parenteral only

184

What is the first line drug for relapse prevention in alcohol abuse? How does it work?

Naltrexone
Opioid antagonist:
- Reduces reward from alcohol

185

How does Disulfiram prevent alcohol abuse relapse?

Inhibits acetylaldehyde dehydrogenase:
- Acetylaldehyde accumulates if alcohol consumed

186

What symptoms does Disulfiram cause if alcohol is consumed?

Flushed skin
Tachycardia
Nausea and vomiting
Arrhythmias
Hypotension

187

How does Acamprosate work in preventing alcohol abuse relapse?

Acts centrally on glutamate and GABA systems
Reduces cravings

188

When is Acamprosate started?

As soon as detoxification finishes

189

When there is a relapse, what happens to acamprosate?

Continued throughout

190

What are the side effects of acamprosate?

Headache
Diarrhoea
Nausea

191

When would detoxification be used for opiate abuse?

Shorter history
Uncomplicated
Relatively stable socially
Detoxing TO something (not from something)

192

When is opiate blockade used for opiate abuse?

If an impulsive relapser

193

What drugs can be prescribed to assist with detoxification from opiate abuse?

Alpha-2 adrenergic agonists:
- Lofexidine

194

What adjunct drugs can be prescribed in detoxification from opiate abuse?

Loperamide
Hypnotics
NSAIDs

195

What are some opioid substitution therapies?

Methadone
Buprenorphine

196

What effect does mephedrone have?

Inhibits reuptake of serotonin, NA and DA
DA release
Stimulant (Self-confidence, talkative)
Empathogenic (Intimacy, openness, dancing)

197

What is sympathetic toxidrome?

Acute toxic effects of amphetamine-type substances

198

What are the symptoms of serotonin syndreom?

Agitation
Hyperreflexia
Tremor
Myoclonus
Sweating
Diarrhoea
Shivering
Ataxia
Fever
Confusion
Hypomania
Confusion

199

What drugs can cause serotonin syndrome?

Antidepressants
OTC cough medications
Antimigraines
Antibiotics
Tramadol
Herbal products

200

What is methiopropamine?

Structural analogue of methamphetamine

201

How does methipropamine work?

NA and DA reuptake inhibitor

202

What is CHING?

Cocaine substitute
79% ethylphenidate
Cut with lidocaine

203

How does CHING work?

DA and NA reuptake inhibitor

204

What effects do synthetic cannabinoids have over cannabis?

Psychosis
Increased agitation
Increased hallucinations
Sympathemimetic effects (2-3x as likely)
CVS problems

205

What primary effect does ketamine have?

Sedative

206

What is a ketamine bladder?

Urge incontinence
Reduced volume
Detrusor over-activity
Painful haematuria

207

How does ketamine work?

NMDA receptor antagonist

208

How do we do urine toxicology?

20ml urine in white universal container

209

What does a urine immunoassay detect?

Benzodiazepines
Meth
Opiates
Amphetamines
Barbituates
Cocaine
Cannabinoids
Alcohol

210

What CAGE score indicates the possibility of alcoholism?

>=2 Yes repsonses

211

What sensation does the mesolimbic pathway produce?

Reward

212

What does the mseolimbic pathway connect?

Ventral Tegmental Area to the Nucleus Accumbens

213

What does the mesolimbic pathway release?

DA into the Nucleus Accumbens -> Reward

214

What effect does DA have in the Nucleus Accumbens?

Motivating signal
Incentivises behaviour
Involved in normal pleasurable experiences

215

What drugs increase DA release?

Amphetamine
Cocaine
Nicotine
Morphine

216

In fMRI studies, non-addict controls (gambling) had increased blood flow to striatum after winning. Addicts had a lower response. What does this suggest? What is the potential mechanism?

Tolerance to reward:
- Repeated DA release -> DA receptor downregulation
- Threshold for reward increased (during abstinence)
- Normal pleasurable experiences don't evoke reward

217

What are the initial stages of drug-taking driven by?

Reward (positive reinforcement)

218

What are the late stages of drug-taking driven by?

Becomes a thirst:
- Negative reinforcement

219

What happens to orbitofronal cortex activation in addicts when presented with drug cues? What does this correlate with?

Increased activation:
- Correlates with self-reported drug cravings
- Changes persists into abstinence

220

What is the role of the prefrontal cortex in behaviour?

Helps intention-guided behaviour
Modulates powerful effects of reward system
Sets goals and focuses attention
Keep emotions and impulses under control:
- Long term goal achievment

221

How does an adolescents response to reward compare to an adults?

Equivalent
Strong stimulus reward

222

How does an adolescents prefrontal cortex control compare to a childs? What does this mean?

Equivalent
Reduced attention:
- Minimal judgement and impulse control

223

In terms of memory and habit forming, what parts of the brain are important in acquisition, consolidation and expression of drug stimulus learning?

Hippocampus
Striatum
Amygdala

224

What type of learning is the striatum responsible for?

Habit

225

What type of learning is the hippocampus responsible for?

Decelerative

226

What effects does stress have on DA release?

Increased release in neural reward pathway

227

What do the following parts of the brain belong to:
- Hippocampus
- Fornix
- Mamillary bodies
- Anterior thalamic nuclei
- Cingulate gyrus
- Enterohinal cortex

Circuit of Papex

228

What is the function of the right side of the amygdala?

Negative emotions:
- Fear
- Sadness

229

What is the function of the left side of the amygdala?

Both pleasant and unpleasant emotions
Reward

230

What are the three stages of memory?

Encoding -> Storage -> Retrieval

231

In the multi-store model of memory, what commits a sensory memory to short-term memory?

Attention

232

In the multi-store model of memory, what commits a short-term memory to long-term memory?

Rehearsal

233

In the multi-store model of memory, what recalls a long-term memory to short-term memory?

Retrieval

234

In the multi-store model of memory, what is recall?

The ability to recollect something from the short-term memory

235

How long does sensory memory last for?

<1 second

236

How long does short-term memory last for?

<1 minute

237

What are the two types of long-term memory?

Explicit (conscious)
Implicit (unconscious)

238

What are the two types of explicit memory?

Episodic (events, experiences)
Semantic (facts, concepts)

239

What is the type of implicit memory? What does it allow us to undertake?

Procedural memory:
- Skills
- Tasks

240

What features need to be present to diagnose Alzheimer's?

1. Presence of dementia
2. Insidious onset and slow deterioration
3. Absence of clinical/investigation evidence of a biological cause
4. Absence of a sudden, apopleptic onset or of focal neurological damage early in illness

241

What biological causes may be differential diagnoses for Alzheimer's?

Hypothyroid
Hypercalcaemia
Vit B12 deficiency
Niacin (Vit B3) deficiency - ie. Pellagra
Neurosyphilis
Normal pressure hydrocephalus
Subdural haematoma

242

What is the neuropathology of Alzheimer's?

Amyloid plaques
Neurofibrillary tangles

243

How can vascular dementia present?

Abrupt onset or stepwise deterioration in:
- Memory loss
- Intellectual impairment
- Focal neurological signs

244

How are insight and judgement affected in vascular dementia?

Often preserved

245

How can vascular dementia be confirmed?

CT
Neuropathology

246

What are associated features in vascular dementia?

Hypertension
Carotid bruit
Emotional lability

247

What is the central feature of Lewy Body Dementia?

Progressive dementia;
- Deficits in attention and executive functions

248

What are the core features in Lewy Body Dementia?

Fluctuating cognition:
- Pronounced variations in attention and alertness
Complex visual hallucinations:
- Well formed
- Detailed
Spontaneous Parkinsonism

249

What are some suggestive features of Lewy Body Dementia?

REM sleep behaviour disorder (years before onset)
Severe neuroleptic sensitivity (50%)
Low DA transporter uptake in basal ganglia:
- SPECT
- PET

250

What are some supportive signs in Lewy Body Dementia?

Repeated falls
Transint loss of consciousness
ANS dysfunction

251

What indicates a probable diagnosis of Lewy Body Dementia?

Dementia PLUS >=2 core features
OR
Dementia PLUS:
- 1 core features AND
- >=1 suggestive features

252

What indicates a possible diagnosis of Lewy Body Dementia?

Dementia PLUS 1 core feature
OR
Dementia PLUS >=1 suggestive features

253

What are Lewy Bodies?

Alpha-synuclein proteins in cytoplasm of neurones

254

Where is DA lost in Lewy Body Dementia?

Substantia nigra

255

What other neurones are lost in Lewy Body Dementia?

Ach-producing

256

What are the three types of Fronto-Temporal Dementia?

Behavioural variant
Semantic dementia
Progressive non-fluent aphasia

257

What are usually preserved in FTD?

Memory
Perception
Spatial skills
Praxis

258

What are Pick Bodies?

Tau-positive spherical cytoplasmic neuronal inclusions composed of straight filaments

259

What are Pick Cells?

Ballooned neurones with dissolution of chromatin

260

Apart from Pick's Disease, what else are Pick Bodies and Cells seen in?

FTD

261

How is alcohol-related dementia diagnosed?

Memory impairment plus >=1 of the following:
- Apraxia
- Aphasia
- Agnosia
- Disturbance in executive functioning
- Functional impairment