Untitled Flashcards Set

Hypotensive side/ priapism effect from antipsychotic

Alpha-1 adrenergic receptor blockade

Constipation/ dry mouth side effect from antipsychotic

(smooth muscle)

M3 receptor blockade

Sedation side effect (+ a bit of weight gain)

H1 receptor antagonism

Neuroleptic Malignant Syndrome from antipsychotic/ Irregular period

D2 receptor blockade

Weight gain side effect

5HT2C receptor antagonism

*mirtazapine

Sexual dysfunction from SSRI

5-HT2C receptor agonism

*Mirtazapine 5-HT2C receptor antagonist (treatment as adjunct)

Gastrointestinal side effects

5-HT3 receptor agonism

Sexual arousal 

cGMP (neuromediator)

Tiagabine (anticonvulsant)

Inhibition of GAT-1 (inhibitor of GABA uptake)

Caffeine

Adenosine receptors

Carbamazepine

Prolonged sodium and calcium channel activation

Topiramate

Inhibition of kainate mediated conductance at AMPA glutamate receptor 

Valproate

Against Carnitine metabolism - depletes

Lamotrigine

Rash 

Methadone

Preference in pregnancy

Lofexidine

used to help with the physical symptoms of opioid withdrawal; treat HTN

Naltrexone

Alcohol dependence prevention - selective competitive antagonist at mu opioid receptors 

Acamprosate

GABA-like drug that acts on the same glutamatergic NMDA receptor system affected by chronic alcohol use

Oxazepam

Preferred choice in cirrhosis 

Buprenorphine

Partial opioid agonist acting at the mu opioid receptors 

  • Reduces cravings for heroine

Clozapine

Serotonin dopamine agonist with rapid dissociation from D2 

  • Treatment for tardive dyskinesia (sensitive to striatal dopamine receptors)


Greater risk of seizure above 600 (effective 250 - 550)

Inverse agonist

Opposite reaction to full agonist

Partial agonist

Buspirone - 5HT1A partial agonist

Aripiprazole - partial dopamine agonist

Buprenorphine - partial opioid agonist

Second messenger system

Lithium

Allosteric modulator/ non-competitive antagonist

Binds to a receptor at a site distinct from active site

GABA receptor

Post-synaptic nerve terminal, ligand gated ion channel/ inotropic receptor

NMDA receptor (glutamate)

Excitatory neurotransmitter; activates ligand gated ion channel

Muscarinic receptors 

G-coupled protein receptors involved in the parasympathetic nervous system

Partial nicotinic agonist 

E.g. varenicline (Chantix)

Enhance cognition of schizophrenia (negative symptoms)

Corticotropin releasing factor

Excessively found in depression

Orexin

neuropeptide produced in the hypothalamus that regulates the sleep-wake cycle and autonomic functions in the brain.

Found more in narcolepsy

BDNF

neurotransmitter modulator, and participates in neuronal plasticity, which is essential for learning and memory.

Amisulpride 

D2/D3 antagonists

Raclopride SPECT

Norepinephrine 

Located in locus coeruleus (upper dorsolateral pontine tegmentum) 

Major role in arousal, attention and stress response 

Recall bias

Cases and control recall differently

Rumination bias/ Search for meaning

People with disease will think harder about their prior exposures than disease free people

Attrition bias

selective dropout of some participants who systematically differ from those who remain in the study

E.g. cannabis use drop out quicker than schizophrenia

Berkson’s bias

when hospital controls are used in a case-control study - more likely sampling bias

Neyman bias

a selection bias where the very sick or very well (or both) are erroneously excluded from a study

E.g. people smoking dies early thus difficult to see the correlation with Alzehimer

Selection bias

the selection of individuals, groups, or data for analysis in such a way that proper randomization is not achieved

OCD side effects

5HT1D stimulation

Ventral Tegmental Area (VTA)

Reward system/ addiction - dopaminergic neurons


Neurons rich in dopamine project from this area to the nigrostriatal pathway


When doing nothing, dopamine neurons in VTA activated and projected to nucleus accumbens  -> increased dopamine in NA = mesolimbic pathway

Anterior Cingulate Function 

Detection of errors, anticipation/ preparation before task performance, regulation of emotions 

Hippocampus

Memory

Amygdala

emotions/ emotional behaviour/ motivation

Lateral geniculate nucleus 

Part of thalamus 

Involved in visual processing 

Medial geniculate nucleus 

Involved in auditory processing 

Ventromedial thalamus 

Satiety and hunger

Lateral nucleus hypothalamus 

Hunger and thirst 

Hypothalamus

Laughing seizure 

Orbitofrontal cortex

Disinhibited/ impulsive 

Medial frontal cortex

Akinetic mutism 

Dorsolateral cortex

Deficits in executive function (frontodemporal)

Thalamus 

Sensory/ pain

Inferior olivary nuclues (of cerebellum)

Finger to nose test

Subcortical leukoencephalopathy/ white matter hyperintensities  

Associated with late life depression

A small vessel vascular dementia 

Schizophrenia

Reduced phospholipids 

Anxiety

Increased activity in insula and amygdala

Mood disorder

Medial pre frontal cortex dysfunction

Autism

Increased brain volume/ cortical surface area

Eating disorder

Increase in 5-HT1a (stress/ anti-aggression) and decrease in 5-HT2a (active coping/ cognitive flexibility)

OCPD - anankastic

HSE abnormalities

Spike and slow or periodic sharp wave patterns over temporal lobes/ diffuse slowing delta waves

Subacute Sclerosing Pan Encephalitis (SSPE)

Periodic high amplitude delta waves

Absence seizures

Generalised 3Hz spike and wave complexes

Anti-NMDA encephalitis

Associated with ovarian tumours

Neurosyphilis

Foot drops, absent light pupil reflex

CSF VDRL

Huntington

Dysphoria (poor mood), ataxia, tremor

SPECT - caudate and putamen hypometabolism

Hyperprolactinaemia/ prolactinoma 

MRI Sella Turcica 

Multiple sclerosis 

Confusion, asymmetrical lateral gaze, ataxia, numbness

FLAIR (more sensitive than T2) - detection of periventricular plaques

MRI T2 weighted - hyperintense lesions

vCJD

MRI Pulvinar nuclei of thalamus - high intensity signal bilaterally

Alzheimer 

Dopamine transporter scan - differentiates from Lewy Body 


Major cholinergic site involved in cerebral cortex - Nucleus basalis of Meynert (reduced in Alzheimer)

Parkinson

Hypokinesia 

Lewy body

Asymmetric resting tremor 

Kluver Bucy Syndrome

Bilateral lesions of anterior temporal lobe

Visual agnosia, excessive oral tendency, hypermetamorphosis, loss of normal fear response, hypersexuality, changes in eating behaviour

Persecutory spiral 

If the therapist himself feels persecuted by the patient and 'responds by overt and covert attack'

Senile chorea

Gradual onset of generalised and symmetric chorea with slow progression

Parkinson’s disease

Associated with SSRI use

Tardive dyskinesia

Orobuccolingual, truncal, appendicular/ limbs, choreiform movements (writhing movements)

Tardive dystonia

Sustained stereotyped muscle spasms of twisting or turning character (e.g. blinking, cramping of foot, pulling of neck)

  • Treatment: dopamine depleting agents (amantadine, tetrabenazine)

Tardive akathisia 

inner sense of restlessness or unease

Hemiballismus 

Swinging movements - sub thalamic nucleus 

Rapid eye movement sleep disorder

REM 

Active arousal during sleep associated with vocalisation/ complex motor behaviours

  • Clonazepam effective

  • mirtazapine/ venlafaxine can worsen

  • L-Dopa for RBD associated w PD 

Restless leg syndrome

Treatment

  • Dopaminergic agents (Pramiprexole, Ropinirole, bromocriptine, Ldopa-Carbidopa)

  • Anticonvulsants (Gabapentin, pregabalin)

  • Clonazepam

  • Clonidine (Alpha 2agonists)

Wernicke’s aphasia/ receptive aphasia 

Impaired comprehension, normal speech, repetition impaired 

Broca’s aphasia 

Unable to speak fluently, repetition impaired

  • Premotor cortex

Conduction aphasia 

Comprehension intact and normal speech Repetition impaired 

Transcortical motor aphasia 

Wernicke’s + normal repetition, prominent echolalia 

Anosognosia

Lack of awareness of disease

Hemiasomatognosia

Feels like one side of limbs missing

Involvement of parietal lobe

Associative visual agnosia

Perception intact but does not recognise the object (the purpose)

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