Psychopharmacology Exam 2 Review Sheet

Psychopharmacology Exam 2 Review Sheet

Overview

  • Understanding the material related to exam points is crucial for organizing study time.

  • Some exam questions may reference material not explicitly addressed in the review sheet but need to be covered in lectures or readings.

  • Reading the relevant textbook materials is encouraged, particularly aligning with lecture topics.

  • Recommended readings include Ingersoll (Chapters 5, 7, 8, 9, 10, 11) and Patterson (Chapters 3, 4, 6, 8, 10).

Antidepressants

Definitions

  • Reactive Dysphoria: Emotional responses triggered by external events.

  • Grief: A natural response to loss, involving sorrow but is generally temporary.

  • Clinical Depression: A serious mood disorder marked by persistent feelings of sadness and the loss of interest in previously enjoyed activities.

Core Symptoms of Depression

  • Mood of sadness and emptiness.

  • Anhedonia: Inability to experience pleasure.

  • Low self-esteem.

  • Apathy, low motivation, and social withdrawal.

  • Excessive emotional sensitivity.

  • Negative and pessimistic thinking patterns.

  • Irritability.

  • Suicidal Ideation: Thoughts or considerations of ending one's life.

Facts About Depression & Antidepressants

  • Lifetime prevalence rate of depression is 17%, with a higher occurrence in females (2:1 ratio).

  • Antidepressants are among the most advertised and prescribed psychotropic medications.

  • Approximately 50-65% of individuals on antidepressants experience some symptom relief.

  • Clinicians must screen for bipolar disorder before prescribing antidepressants as they can induce manic episodes.

  • Some patients may stop responding to antidepressants after approximately 18 months.

  • Antidepressants require 4-6 weeks for full therapeutic benefit.

  • Issues like sexual side effects may lead individuals to discontinue medication.

  • Black Box Warning: Increased suicidality, particularly in children and adolescents.

Vegetative Symptoms of Depression

  • Sleep Disturbance: Problems include early morning waking, frequent awakenings, and sometimes hypersomnia.

  • Appetite Disturbance: Weight changes due to decreased or increased appetite.

  • Fatigue and decreased sex drive.

  • Restlessness, agitation, or psychomotor retardation.

  • Diurnal variations in mood: worse feelings in the morning.

  • Impaired concentration and forgetfulness.

  • Pronounced anhedonia.

Classes of Medication Covered
Monoamine Oxidase Inhibitors (MAOIs)

  • Mechanism: Disable monoamine oxidase (MAO), preventing the breakdown of neurotransmitters like norepinephrine and serotonin.

  • Irreversible Binding: MAO function returns to normal only after new enzymes are produced.

  • Tyramine Intolerance: Dietary restrictions are necessary to avoid foods high in tyramine (e.g., cheese, cured meats, beer, wine), as it can lead to severe cardiac events.

  • Uses: Effective for severe depression but not typically the first line due to side effects.

Side Effects of MAOIs

  • Orthostatic Hypotension: Drop in blood pressure related to changes in body position.

  • Nighttime insomnia.

  • Headaches, muscle cramps, weight gain, difficulty urinating.

  • Contraindications: History of liver or heart disease, drug abuse, hypertension, and dietary tyramine intake.

Tricyclic Antidepressants (TCAs)

  • Mechanism: Block reuptake transporter molecules affecting norepinephrine, serotonin, and dopamine. Additionally, block receptors on histamine, acetylcholine, and epinephrine neurons, leading to side effects.

Side Effects of TCAs

  • Anticholinergic Effects: Dry mouth, dizziness, constipation, difficulty urinating, blurred vision.

  • Adrenergic Effects: Sexual dysfunction, sweating, orthostatic hypotension.

  • Antihistaminic Effects: Sedation and weight gain.

Benefits and Drawbacks of TCAs

  • Benefits: No documented withdrawal; well-studied regarding interactions and metabolism.

  • Drawbacks: Variable onset, difficult side effects, overdose potential (cardiotoxicity), overall unreliable effectiveness.

  • FDA Approved Uses: Major Depressive Disorder and anxiety.

  • Off-label Uses: Insomnia, panic disorder, OCD, PTSD, fibromyalgia, generalized anxiety disorder (GAD), chronic pain, bulimia.

Second Generation Antidepressants: SSRIs

  • Mechanism: Block presynaptic serotonin reuptake process.

  • Available since the mid-1980s with multiple formulations and brands.

Withdrawal Symptoms (SSRIs)

  • Common symptoms include dizziness, gastrointestinal upset, lethargy, fatigue, chills, paresthesia, and insomnia.

Common SSRIs

  • Citalopram (Celexa)

  • Fluvoxamine (Luvox)

  • Escitalopram (Lexapro): Metabolite of Celexa.

  • Paroxetine (Paxil)

  • Sertraline (Zoloft)

  • Fluoxetine (Prozac)

FDA Approved Uses for SSRIs

  • Major Depressive Disorder (MDD)

  • Obsessive-Compulsive Disorder (OCD)

  • Dysthymia

  • Bulimia

  • Panic Disorder

  • Social Phobia

  • PTSD

Off-label Uses

  • Autism, ADHD, borderline personality disorder, premature ejaculation, chronic pain, others.

Side Effects of SSRIs

  • Headache, nausea, nervousness, diarrhea, insomnia, and weight gain.

  • Antidepressant Induced Sexual Dysfunction (AISD): Issues like anorgasmia, delayed ejaculation, decreased libido, impotence.

  • Strategies to address AISD:

    • Holiday Method: For planned sexual encounters, avoid taking the medication just before.

    • Augmentation: Consider switching to wellbutrin, using low doses of BuSpar or Trazodone for sleep.

    • Sildenafil (Viagra) for erectile dysfunction.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

  • Duloxetine (Cymbalta): Emphasizes physical pain associated with depression.

  • FDA approved for generalized anxiety disorder (GAD).

Side Effects of SNRIs

  • Nausea, drowsiness, dizziness, headache, weight gain, anxiety, increased sweating, sore throat, and AISD.

Third Generation Antidepressants: Norepinephrine Dopamine Reuptake Inhibitors (NDRIs)

  • Bupropion (Wellbutrin/Zyban): A dual action antidepressant impacting norepinephrine and dopamine levels.

  • Less often associated with sexual side effects and cholinergic effects.

Side Effects of Bupropion

  • Slight risk of seizure, contraindicated in seizure disorders, head injury, anorexia, and bulimia.

General Discontinuation Syndrome

  • Antidepressant Discontinuation Syndrome (ADS): Symptoms like nausea, insomnia, fatigue, and achiness can occur particularly when stopping suddenly after prolonged use.

Addiction / Substance Use Disorder
Definitions of Addiction

  • Addiction typically involves three components:

    1. Regular, repeated, and habitual use of a substance.

    2. Compulsion beyond voluntary control.

    3. Potential or actual adverse consequences.

Co-occurring Disorders

  • Self-Medication Hypothesis: The theory that individuals may use substances to cope with mental health symptoms, although data show that substance choice is more influenced by social factors than by mental health conditions.

  • Genetic Vulnerability: Individuals may have genetic predispositions that increase risks for both substance use disorders and other mental illnesses.

    • Epigenetics: Substance use can activate genes linked with mental health disorders.

Neurocognitive Vulnerabilities

  • Impairment in self-regulation, high impulsivity, or cognitive control issues.

Developmental and Environmental Factors

  • Exposure to substances early may heighten risks for developing mental health symptoms or disorders, with factors such as abuse, trauma, and poverty influencing outcomes.

Diagnosing Co-occurring Disorders

  • Symptoms present before substance use onset point to independent disorders.

  • Persisting symptoms after withdrawal can signify a separate mental health issue.

  • Symptoms exceeding expected levels relative to substance use also indicate independent disorders.

Psychopharmacological Intervention in Substance Use Disorders
Purposes

  • Address multiple components: withdrawal management, decreasing substance use, lowering cravings, and maintaining abstinence.

  • Benzodiazepines: Commonly used to manage withdrawal symptoms through a medically supervised detox process.

AUD (Alcohol Use Disorder) Treatments
Common Medications

  • Antabuse (Disulfiram): Blocks enzymes necessary for alcohol metabolism, leading to unpleasant reactions when alcohol is consumed.

  • ReVia (Naltrexone): Antagonizes opioid receptors to reduce cravings and pleasurable effects of alcohol.

  • Prozac (Fluoxetine): An SSRI beneficial for alcohol-dependent patients.

  • Acamprosate (Capral): Reduces withdrawal symptoms by regulating glutamate levels.

  • Naloxone: Treats opioid overdose by blocking effects of opioids.

  • Dolophine (Methadone): A long-acting synthetic opioid used in OUD treatment.

Mood Disorders: Bipolar 1
Symptom Clusters (No details needed, summary)

  • Manic, mood and behavior symptoms.

  • Dysphoric and other mood symptoms.

  • Psychotic symptoms.

  • Cognitive symptoms.

Dopamine and Serotonin in BP1

  • Dopamine: Associated with mania.

  • Serotonin: Diminished function relates to dysregulation in mood.

Diagnostic Considerations

  • Screening for bipolar disorder is crucial before prescribing antidepressants due to the risk of inducing manic episodes.

  • Bipolar 1 has notable suicide risks; 60% of individuals with BP1 also struggle with Substance Use Disorder (SUD).

Lithium Overview

  • Effective in treating manic episodes and as prophylaxis.

  • Response often seen within 1-4 weeks, but sudden discontinuation can lead to re-emergence of mania.

  • Mechanism: Enhances serotonin release, downregulates serotonin receptors, stabilizes neuronal function.

Lithium Side Effects

  • Common side effects include gastrointestinal upset, weight gain, renal implications, polydipsia, poluria, and tremors. Regular monitoring of blood levels is necessary due to the proximity of therapeutic to toxic levels.

Valproate Uses

  • Approved for mania, effective for both mixed and rapid cycling states.

  • Mechanisms of Action: Slows down GABA metabolism, inhibits reuptake, and may affect sodium channels.

Antidepressants in Children/Adolescents
Comorbidity and Polypharmacy Challenges

  • High rates of comorbidity necessitate careful monitoring and advocacy for effective communication regarding medicated children. Regular monitoring of dosage adherence and overall treatment efficacy is essential.

ADHD in Children

  • Diagnosis can be complex; stimulant medications (e.g., methylphenidate, amphetamines) show improvements for attention and behavior management.

  • Side effects of ADHD medications can include insomnia, weight loss, headaches, and impacts on growth.

Anti-Psychotics
Symptoms of Schizophrenia

  • Positive Symptoms: Hallucinations, delusions, disorganized thinking, abnormal motor behavior.

  • Negative Symptoms: Flat affect, alogia, avolition, anhedonia, asociality.

Mechanism of Action for Anti-Psychotics

  • First-generation anti-psychotics primarily block D2 dopamine receptors, treating primarily positive symptoms. They carry risks of extrapyramidal side effects and agranulocytosis.