drug & beh txt 7-9

Review of Key Concepts

This section provides a framework for reviewing the key concepts from the provided sources. Consider each point and think about what you already know. If you're unsure, return to the relevant source material for clarification.

CNS Depressants and Inhalants:

• Mechanism of action of CNS depressants on the central nervous system.

• Distinctions among sedatives, hypnotics, and anxiolytics.

• Medical and nonmedical uses of various CNS depressants.

• Historical context and evolution of CNS depressants (e.g., bromides, barbiturates, benzodiazepines).

• Risks associated with nonmedical use, including dependence, overdose, and specific dangers of inhalants and GHB.

• Role of GABA receptors and chloride ion influx in CNS depression.

• Differences between benzodiazepines and nonbenzodiazepine hypnotics ("Z-drugs").

• Dependence liability (psychological vs. physical) and factors influencing each.

• Toxicity of sedative-hypnotics and combined risks (e.g., with opioids).

• Common substances abused as inhalants and their specific dangers.

Psychotherapeutic Drugs and Treatment for Mental Disorders:

• Definition and types of psychotherapeutic drugs used to treat mental disorders (e.g., antipsychotics, antidepressants, mood stabilizers).

• Effectiveness and limitations of chemical treatments in managing mental illness symptoms.

• Impact of psychotherapeutic drugs on neurotransmitter levels and brain chemistry.

• Considerations for approaching mental disorders with drugs, including the importance of a comprehensive treatment plan.

Mental Illness, Substance Use, and Treatment Models:

• Prevalence of mental illness and substance use disorders in Canada.

• Link between addiction and mental illness, including its impact on treatment adherence and outcomes.

• Influence of substance abuse on exacerbating mental illness and hindering recovery.

• Key components of the Medical Model and its strengths/criticisms.

• Framework of the DSM-5 in diagnosing mental disorders.

• Impact of media portrayal on the perception of mental illness.

Anxiety Disorders:

• Diagnostic criteria (DSM-5) and symptoms of panic disorder, specific phobia, and generalized anxiety disorder (GAD).

• Historical context and evolution of drug-based approaches to anxiety.

Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD):

• Diagnostic criteria (DSM-5) and symptoms of OCD and PTSD.

Psychosis and Schizophrenia:

• Definition and symptoms of psychosis, distinguishing between organic and functional psychosis.

• Diagnostic criteria for schizophrenia (DSM-5).

Mood Disorders:

• Differentiating between bipolar disorder and major depressive disorder.

• Diagnostic criteria for manic, hypomanic, and major depressive episodes.

Historical and Modern Treatments for Mental Disorders:

• Historical treatments for mental disorders before the 1950s (e.g., malaria therapy, insulin shock therapy, ECT).

• Role of chlorpromazine in revolutionizing the treatment of psychosis.

• Differences between first-generation (FGAs) and second-generation antipsychotics (SGAs), including side effects.

• Mechanism of action and side effects of antipsychotics.

• Evolution of antidepressants (MAOIs, TCAs, SSRIs) and their mechanisms of action.

• Link between antidepressants and suicidal behavior.

• Lithium's discovery and use as a mood stabilizer in bipolar disorder.

• Challenges with lithium treatment, including noncompliance and side effects.

Consequences of Drug Treatments for Mental Illness:

• Impact of psychopharmaceuticals on deinstitutionalization and community-based care.

• Challenges associated with community mental health services and involuntary commitment.

• Stigma surrounding mental illness and its impact on treatment and social acceptance.

• Influence of psychopharmaceuticals on incarceration and homelessness rates among individuals with mental illnesses.

• Government and community initiatives to address mental illness in prisons and among homeless populations.

Alcohol:

• Historical and cultural role of alcohol.

• Fermentation and distillation processes.

• Types of alcoholic beverages (beer, wine, distilled spirits) and their production methods.

• History of the Temperance Movement and Prohibition.

• Cultural influences on drinking patterns.

• Social and ecological frameworks influencing alcohol use.

• Alcohol consumption trends in Canada.

• Absorption, distribution, metabolism, and excretion of alcohol in the body.

• Mechanisms of action of alcohol on the central nervous system (CNS).

• Effects of alcohol on behavior, including lowered inhibitions, impaired judgment, and alcohol myopia.

• Impact of alcohol on driving, sexual behavior, crime, and violence.

• Short-term and long-term health consequences of alcohol consumption.

• Canadian guidelines for low-risk drinking.

• Fetal Alcohol Spectrum Disorder (FASD).

• Alcohol withdrawal symptoms and treatment.

• Theories of alcohol dependence, including the disease model, cognitive theories, and genetic influences.

II. Quiz: Short Answer Questions

Answer each question in 2-3 sentences, demonstrating your understanding of the key concepts.

1. Describe the main difference between psychological and physical dependence on sedative-hypnotics, and give an example of a drug more likely to cause each.

2. What are some of the dangers associated with inhalant abuse, and why are younger populations particularly vulnerable?

3. Explain the role of GABA receptors in the mechanism of action of CNS depressants like benzodiazepines.

4. What are the major criticisms of the Medical Model of mental illness?

5. Outline the key diagnostic criteria for Generalized Anxiety Disorder (GAD) according to the DSM-5.

6. What are the primary differences between first-generation and second-generation antipsychotics, and why are second-generation antipsychotics often preferred?

7. Describe the historical significance of chlorpromazine in the treatment of mental illness.

8. What are the main risks associated with the use of MAOIs, and how do they differ from SSRIs in terms of side effects?

9. Explain the mechanism by which alcohol affects the central nervous system, and how this leads to its depressant effects.

10. Briefly explain Fetal Alcohol Spectrum Disorder (FASD).

III. Quiz Answer Key

1. Psychological dependence involves a strong desire or craving for the drug due to its rewarding effects, often seen with rapid-acting drugs like diazepam (Valium). Physical dependence occurs when the body adapts to the drug, leading to withdrawal symptoms upon cessation; shorter-duration drugs cause this.

2. Inhalant abuse can lead to brain damage, kidney damage, respiratory issues, and suffocation due to the toxic chemicals in volatile solvents, aerosols, gases, and nitrites. Younger populations are more vulnerable because inhalants are easily accessible and inexpensive, often leading to experimentation and addiction.

3. GABA receptors are the primary inhibitory neurotransmitter receptors in the brain, and CNS depressants like benzodiazepines enhance GABA's inhibitory effects. Benzodiazepines bind to the GABAA receptor, increasing chloride ion influx, which leads to hyperpolarization and neuron inhibition, resulting in sedation and reduced anxiety.

4. The Medical Model of mental illness faces criticism because it can oversimplify complex behavioral symptoms into a physical disease framework. Some argue that mental illness is a description of behavior rather than a physical disease, as diagnosis is based on symptoms without definitive diagnostic tests like those used for infectious diseases.

5. The DSM-5 diagnostic criteria for Generalized Anxiety Disorder (GAD) involve excessive worry occurring more days than not for at least 6 months about events or activities. Additional symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances, causing significant distress or impairment in functioning.

6. First-generation antipsychotics (FGAs) primarily target dopamine receptors and are effective for positive symptoms but have a higher risk of movement disorders. Second-generation antipsychotics (SGAs) target both dopamine and serotonin receptors, leading to fewer movement-related side effects and efficacy for both positive and negative symptoms, making them often preferred despite side effects like weight gain and metabolic issues.

7. Chlorpromazine was the first phenothiazine found effective in reducing psychotic symptoms and was a major catalyst for deinstitutionalization in mental health care. Its introduction in the 1950s led to the development of modern antipsychotic medications and revolutionized the treatment of hospitalized patients.

8. MAOIs pose risks due to their irreversible inhibition of monoamine oxidase, requiring careful management to avoid hypertensive crises from food interactions (e.g., aged cheeses) and serotonin syndrome from drug interactions. SSRIs, on the other hand, selectively inhibit serotonin reuptake and are generally safer with fewer dietary restrictions, though they may still have side effects and potential suicide risks.

9. Alcohol depresses the central nervous system (CNS) by enhancing GABA's inhibitory effects and inhibiting glutamate's excitatory action. Alcohol enhances GABA's effects at the GABAA receptor, leading to sedation and impaired function, while blocking NMDA receptors affects cognition and reward areas in the brain.

10. Fetal Alcohol Spectrum Disorder (FASD) is a range of disabilities and disorders, which occur due to alcohol exposure during pregnancy. Key diagnostic criteria for FASD include growth suppression before/after birth and abnormal facial features, such as small eyes, a flattened nose bridge, a short nose, and philtrum flattening, as well as cognitive, behavioral, and physical disabilities.

IV. Essay Questions

These essay questions require you to synthesize information from multiple sections of the provided material. While answers are not provided, these questions should help you to assess your ability to analyze and connect key concepts.

1. Discuss the historical progression of treatments for mental illness, focusing on the shift from early methods (e.g., insulin shock therapy, ECT) to the introduction of psychopharmacological drugs. What factors contributed to these changes, and what were the consequences of deinstitutionalization?

2. Compare and contrast the mechanisms of action, benefits, and risks associated with the major classes of psychotherapeutic drugs (antipsychotics, antidepressants, mood stabilizers). In what ways have these drugs revolutionized the treatment of mental disorders, and what are the ethical considerations surrounding their use?

3. Analyze the social, cultural, and psychological factors that contribute to alcohol use and dependence. How do cultural norms, individual expectations, and genetic predispositions interact to influence drinking patterns and the development of alcohol use disorder?

4. Evaluate the strengths and limitations of the medical model in understanding and treating mental illness. How does this model influence diagnosis, treatment, and societal perceptions of mental disorders, and what alternative perspectives might offer a more comprehensive understanding?

5. Discuss the challenges associated with mental illness in marginalized communities. How does stigma, cultural differences, and socio-economic factors contribute to disparities in access to care and treatment outcomes?

V. Glossary of Key Terms

• Agonist: A substance that binds to a receptor and activates it, producing a biological response.

• Agranulocytosis: A severe and dangerous leukopenia (lowered white blood cell count).

• Alcohol Dehydrogenase (ADH): An enzyme in the liver that metabolizes alcohol into acetaldehyde.

• Alcohol Myopia: The concentration on the here-and-now details, and losing the perception of long-term consequences.

• Amygdala: A brain region involved in processing emotions, particularly fear and anxiety.

• Anxiolytic: A medication used to reduce anxiety.

• Antagonist: A substance that binds to a receptor and blocks or inhibits its activity, preventing a biological response.

• Anticonvulsant: A medication used to prevent or control seizures.

• Antidepressant: A medication used to treat depression by affecting neurotransmitter levels in the brain.

• Antipsychotic: A medication used to treat psychotic disorders by reducing symptoms like delusions and hallucinations.

• Atypical Antipsychotics: Newer antipsychotic medications that target both dopamine and serotonin receptors, reducing movement-related side effects.

• Barbiturates: A class of CNS depressant drugs used historically for sedation, sleep, and seizure control, now largely replaced by safer alternatives.

• Benzodiazepines: A class of CNS depressant drugs used for anxiety, insomnia, and muscle relaxation, enhancing GABA activity in the brain.

• Black-Box Warning: A safety warning from regulatory agencies, like the FDA, included on a medication's package insert to highlight significant risks associated with its use.

• Blood Alcohol Concentration (BAC): The concentration of alcohol in the bloodstream, used to measure intoxication.

• Central Nervous System (CNS): The brain and spinal cord, responsible for controlling bodily functions and responses.

• Chlorpromazine: The first antipsychotic drug, discovered in the 1950s, which revolutionized the treatment of psychosis.

• Cirrhosis: A chronic liver disease characterized by irreversible scarring and liver dysfunction, often caused by long-term alcohol abuse.

• Congeners: Substances produced during fermentation and distillation that contribute to the taste and aroma of alcoholic beverages.

• Cross-Dependence: A phenomenon where tolerance or dependence on one drug reduces the effect of another drug.

• Deinstitutionalization: The process of discharging patients from long-term mental hospitals into community-based mental health services.

• Delirium Tremens: A severe form of alcohol withdrawal characterized by confusion, hallucinations, tremors, and autonomic instability.

• Dependence (Physical): A state in which the body has adapted to a drug, and withdrawal symptoms occur upon cessation.

• Dependence (Psychological): A state characterized by a strong desire or craving for a drug due to its rewarding effects.

• Distillation: The process of heating an alcohol solution, collecting vapors, and condensing them into liquid to increase alcohol concentration.

• DSM-5: The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, a standardized tool for diagnosing mental disorders.

• Electroconvulsive Therapy (ECT): A treatment for severe mental disorders that involves inducing brief seizures through electrical stimulation.

• Fermentation: The process of converting sugars into alcohol and carbon dioxide by yeasts.

• Fetal Alcohol Spectrum Disorder (FASD): A range of conditions, including physical, behavioral, and cognitive disabilities, caused by prenatal alcohol exposure.

• First-Generation Antipsychotics (FGAs): Older antipsychotic medications that primarily target dopamine receptors and have a higher risk of movement disorders.

• GABA (Gamma-Aminobutyric Acid): The primary inhibitory neurotransmitter in the brain, involved in reducing neuronal excitability.

• GHB (Gamma-Hydroxybutyric Acid): A CNS depressant with sedative and euphoric effects, often associated with drug-facilitated sexual assault.

• Glutamate: The primary excitatory neurotransmitter in the brain, involved in learning and memory.

• Hallucinations: Sensory experiences that occur without an external stimulus, such as hearing voices or seeing things.

• Hypnotic: A medication used to induce sleep.

• Inhalants: Volatile substances that are inhaled for their psychoactive effects, including solvents, aerosols, and gases.

• Lithium: A mood-stabilizing drug used to treat bipolar disorder.

• Major Depressive Disorder (MDD): A mood disorder characterized by persistent feelings of sadness, loss of interest, and other symptoms lasting at least two weeks.

• Mania: A state of abnormally elevated mood, energy, and activity, often associated with bipolar disorder.

• Monoamine Oxidase Inhibitors (MAOIs): A class of antidepressant drugs that inhibit the enzyme monoamine oxidase, increasing neurotransmitter availability in the brain.

• Mood Stabilizer: A medication used to treat mood disorders, such as bipolar disorder, by stabilizing mood swings.

• NMDA Receptor: A glutamate receptor involved in learning and memory.

• Obsessions: Recurrent and persistent thoughts, urges, or images that cause distress or anxiety.

• Panic Disorder: An anxiety disorder characterized by recurrent, unexpected panic attacks.

• Placebo Effect: A beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that treatment.

• Post-Traumatic Stress Disorder (PTSD): A mental health condition triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

• Proof: A measure of alcohol content, equal to twice the percentage of alcohol by volume.

• Psychosis: A mental state characterized by a loss of contact with reality, including delusions and hallucinations.

• Psychotherapeutic Drugs: Medications used to treat mental disorders, such as antipsychotics, antidepressants, and mood stabilizers.

• Second-Generation Antipsychotics (SGAs): Newer antipsychotic medications that target both dopamine and serotonin receptors, reducing movement-related side effects.

• Sedative: A medication used to reduce anxiety and promote calmness.

• Selective Serotonin Reuptake Inhibitors (SSRIs): A class of antidepressant drugs that selectively inhibit the reuptake of serotonin in the brain.

• Specific Phobia: Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals).

• Tardive Dyskinesia: A movement disorder characterized by repetitive, involuntary movements, often caused by long-term use of antipsychotic medications.

• Tolerance: A state in which the body requires increasing doses of a drug to achieve the desired effect.

• Tricyclic Antidepressants (TCAs): A class of antidepressant drugs that inhibit the reuptake of norepinephrine, dopamine, and serotonin in the brain.

• Withdrawal: A set of symptoms that occur when a person abruptly stops using a drug to which they have become dependent.