Structure and Function - Week 6 Neuropharmacology Flashcards
For a diagnosis of depression, what is the criteria for the symptoms? (2)
Over same two week period
DSM-5: Must have five or more symptoms, which must include one of the core symptoms
What are the core symptoms of depression (2)
Low mood
Anhedonia (loss of interest or pleasure)
What are the other symptoms of depression (6)
Changes in weight or appetite
Fatigue or loss of energy
Sleep changes (insomnia or hypersomnia)
Reduced ability to think or concentrate
Psychomotor (restless or slow movement)
Feelings of worthlessness or guilt
Thoughts of death, self-harm, or suicide attempt.
Describe diagnosis of depression (3)
Typically seen in primary care – most cases are mild or moderate. Complex or severe cases may be referred to specialist care.
May order tests to rule out hypothyroidism, deficiencies, chronic disease etc. but not routinely done
Often co-occurs with anxiety, as well as with chronic disease, pain etc
Describe the onset of depression (3)
Check notes
Describe epidemiology of depression (3)
Depression is more common in women than men (unknown why) but rates of death by suicide are much higher in men
Higher rates of depression in those living in deprived areas, living with a disability, and unemployed (unknown cause and effect)
What is disability adjusted life years? (1)
Takes into account quality of life and risk of premature death from a medical condition
What are the different treatments for depression? (6)
Medication (may be needed short or long term)
Therapy or Counselling (including CBT)
Life changes (work, home life, diet, exercise etc.)
Creative therapies (see Bryan Charnley’s work)
Electroconvulsive therapy (e.g. for major depression)
Magnetic stimulation
What is anxiety? (2)
Anxiety is a biological process – evolutionary benefit to anticipating threats
Described as feelings of worry, dread, unease in absence of a current threat or danger (difference with “fear”).
Describe the symptoms of anxiety (3)
Vary depending on the specific type e.g. the anxiety may be associated with social situations (social anxiety disorder).
Psychological: irritability, restlessness, panic, anxious anticipation, worry, dread, difficulty concentrating.
Somatic: Palpitations, tachycardia, hyperventilation, dry mouth, nausea, stomach pains, urinary frequency, dizziness, muscle tension, sweating, tremor, pain in chest, and more.
What is generalised anxiety disorder? (3)
Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). The person finds it difficult to control the worry
The anxiety and worry are associated with three or more of certain symptoms
Ruled out not due to effects of a substance, another medical condition, or another mental disorder (e.g. posttraumatic stress disorder).
What are the symptoms required for generalised anxiety disorder? (6)
Restlessness/feeling on edge
Difficulty concentrating or mind going blank
Irritability
Being easily fatigued
Muscle tension
Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
Describe the onset of anxiety disorders (2)
Average age of onset tends to be younger than for mood disorders but it also depends on the type of anxiety disorder (huge variability)
Describe the epidemiology of anxiety (3)
Like depression, anxiety is also more common in women but unknown why (difference more pronounced in young).
Many estimates place anxiety disorders 2nd in terms of impact on disability adjusted life years (DALYs).
Describe the treatments available for anxiety disorders (4)
Medication (may be needed short or long term) (antidepressant can be given - anxiolytic)
Therapy or Counselling (including CBT)
Life changes (work, home life, diet, exercise etc.)
Creative therapies
How is activity of monoamine oxidase inhibited? (1)
Anti-TB agents
What is MAO? (2)
Monoamine oxidase (MAO) – an enzyme attached to the outer membrane of mitochondria.
Two subtypes – A and B
Breaks down monoamines
Describe how monoamines are broken down by MAO (2)
Break down of monoamines to metabolites by MAO
Reduced availability of monoamines and releasable pool
Which monoamine does MAO-A break down? (1)
5-HT and norepinephrine mostly broken down by MAO-A
Which monoamine does MAO-B break down? (1)
Dopamine broken down by MAO-A and -B
What happens when MAO is inhibited? (5)
Anti-TB agents targeted both MAO-A and MAO-B
Enzyme inhibited
Monoamines not broken down
Monoamine availability through releasable pool increases
Leads to monoamine hypothesis
Describe monoamine hypothesis (1)
Increased monoamine activity
Describe why Non-selective MAOIs not used as first line treatment for depression? (5)
Elevate levels of norepinephrine when MAO-A and MAO-B inhibited
This can bind to alpha1 adrenergic receptor
Cause blood vessel constriction
Blood pressure rises
Can remain within manageable levels
Patient can experience hyper-tensive crisis - can lead to death
Describe the cheese reaction (7)
Foods contain tyramine - normally broken down by MOA in gut
Not broken down due to inhibition of MAOA
Enters blood stream
Not broken down MAO in neurons
Displaces noradrenaline from its vesicles
Noradrenaline enters blood stream
Raise blood pressure to dangerous levels and can cause death
