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
