Neurochemistry Of Behavior (Hbhs Exam2)

Front 1

What neurotransmitters are affected in depression? How are they affected?

Back 1

Decrease in norepinephrine, serotonin, or both.

Front 2

What do CSF studies of depressed patients often show?

Back 2

Metabolites of NE and 5HT are often decreased.

Front 3

Where is NE made in the CNS? Name the area and describe its location.

Back 3

All NE for the neuraxis is made the locus ceruleus, located at the angle of the 4th ventricle from middle pons all the way up to the midbrain.

Front 4

Where is 5HT made in the brain? Name the area and describe its location.

Back 4

5HT is made in the dorsal raphe nucleus, located at the level of the inferior colliculus (mainly) and the most rostral pons.

Front 5

What are the two types of major depression? Which type has a worse prognosis.

Back 5

1. major depression without psychotic features
2. major depression with psychotic features--worse prognosis

Front 6

What are the major features (S/S) of the two types of major depression (MD)?

Back 6

Both have:
1. feeling sad/down
2. lack of energy
3. anhedonia
4. decreased (more common) or increased (less common)sleep
5. decreased (more common) or increased (less common) appetite
6. decreased libido
7. guilt/magnification of past transgressions

MD with psychotic features adds psychosis:
may be paranoid, delusional, have negative hallucinations about family members, etc.

Front 7

Describe the time course for resolution of major depression; contrast young vs. old.

Back 7

1. young: body usually automatically recovers within 1-1.5 yrs
2. old: may take about 5 yrs to recover

Front 8

What percentage of patients admitted to hospital for major depression eventually commit suicide?

Back 8

15%

Front 9

Describe how stress directly affects the brain in terms of
1. hormones
2. specific areas of the brain affected

Back 9

Stress activates the HPA axis. ACTH is released from hypothalamus, which increases release of CRH from pituitary, which increases cortisol release from adrenal glands. Prolonged elevated cortisol
1. can be caused by depression
2. can cause cell death in the hippocampus.

Front 10

Describe the MOA of SSRIs.

Back 10

Block reuptake of 5HT back into 5HTergic neurons. So 5HT stays at the postsynaptic site longer, increasing its effective concentration and prolonging its effects.

Front 11

Fluoxetine:
1. Give trade name.
2. What class of drug?
3. Discuss its pharmacology (t1/2, etc.).
4. Significant side effects

Back 11

1. Prozac
2. SSRI
3. Takes a long time to work, takes 5 weeks to wash out, has long t1/2, has significant sexual side effects including loss of erection men and loss of orgasm in women.

Front 12

Citalopram
1. Give trade name.
2. What class of drug?
3. Discuss its pharmacology (t1/2, etc.).
4. Significant side effects

Back 12

1. Celexa
2. SSRI
3. Quicker onset (~2 wks)
4. Least amount of sexual side effects

Front 13

Escitalopram
1. Give trade name.
2. What class of drug?
3. Discuss its pharmacology (t1/2, etc.).
4. Significant side effects

Back 13

*Similar to Celexa/citalopram
1. Lexapro
2. SSRI
3. "acts quickly"
4. few sexual side effects

Front 14

Sertraline
1. Give trade name.
2. What class of drug?
3. Significant side effects

Back 14

1. Zoloft
2. SSRI
3. Side effects:
a. Diarrhea
b. Same sexual side effects as Prozac: "has significant sexual side effects including loss of erection men and loss of orgasm in women."

Front 15

Paroxetine
1. Give trade name.
2. What class of drug?
3. Significant side effects

Back 15

1. Paxil
2. SSRI
3. Same sexual side effects as Prozac: "has significant sexual side effects including loss of erection men and loss of orgasm in women."

Front 16

Bupropion
1. trade name?
2. mechanism of action?
3. side effects?

Back 16

1. Wellbutrin
2. Increases both NE and DA
3. May counter many of the sexual side effects of SSRIs.

Front 17

Mirtazepine
1. trade name?
2. class of drug?
3. indication?

Back 17

1. Remeron
2. 5HT and NE reuptake blockers
3. Used for people who fail to respond to SSRIs

Front 18

Venlafaxine
1. Trade name?
2. Class of drug?
3. Indication?

Back 18

1. Effexor
2. 5HT and NE reuptake blockers
3. Used for people who fail to respond to SSRIs

Front 19

Duloxetine
1. Trade name?
2. Class of drug?
3. Indication?

Back 19

1. Cymbalta
2. 5HT and NE reuptake blockers
3. Used for people who fail to respond to SSRIs

Front 20

What two drugs have been clinically proven to reduce the incidence of suicide among depressed patients?

Back 20

1. Lithium
2. Clozaril (clozapine)

Front 21

List the relative contraindications for ECT.

Back 21

1. intracranial mass
2. recent CVA
3. recent MI

Front 22

List and briefly explain the diagnostic tests necessary prior to ECT.

Back 22

1. CT or MRI of the head to check for intracranial mass or recent bleed.
2. MRI and 2D cardiac echo to determine ejection fraction of left ventricle.
3. EKG
4. Radiographs of back to check for osteoporosis/spinal compression fractures
5. Neuropsychological testing to test cognition.

Front 23

Severely depressed patients often exhibit decreased appetite/anorexia. Discuss the effects of protein malnutrition.

Back 23

Depletion of serum protein secondary to anorexia causes diminished serum oncotic pressure. This leads to edema. Patients are particularly at risk when serum albumin falls to <3.

Front 24

Why is an arm cuff used in ECT?

Back 24

Prevents NM blocking agent from reaching the arm distal to the cuff. Since the arm is unparalyzed, it should exhibit seizure activity if ECT is successful. Allows the clinician to observe and confirm seizure activity when ECT is administered.

Front 25

List the drugs used with ECT administration. Briefly explain what each drug's purpose is.

Back 25

1. Sodium pentathol-general anesthetic
2. succinylcholine-blocks NMJ; causes fasciculations then paralysis
3. beta blocker-blocks the sympathetic discharge that commonly occurs

Front 26

Discuss the acute effects of ECT on autonomic activity.

Back 26

1. First causes parasympathetic discharge that transiently slows the pt.'s HR (sometimes to asystole).
2. Then a compensatory sympathetic discharge that increases HR and BP (often blocked by giving pt. beta blocker).

Front 27

1. What is the risk of death with ECT?
2. What body system is usually primarily involved in ECT-related death?
3. What test(s) are recommended prior to ECT for this reason?

Back 27

1. Same as risk of death D/T general anesthesia: about 1/50,000 to 1/10,000.
2. If death occurs, it's almost always cardiovascular event.
3. EKG and echocardiogram.

Front 28

What are the predictors of ECT success?

Back 28

1. Total seizure time of 226 seconds.
2. Improved score on Folstein Mini-mental Status Exam.

Front 29

Describe the actual ECT procedure (very briefly).

Back 29

Bilateral electrical stimulation with a low amount of current leading to a grand mal seizure.

Front 30

1. What % of pts. improve immediately after ECT?
2. What % relapse in the 1st year?

Back 30

1. 90%
2. 50%