case notes section 2

7/23/2019 Case Notes Section 2

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HOW IS THE CNS DAMAGED?

• Neres can *e dama%ed thro$%h tra$ma and disease

• Nerve trauma may be incurred through motor vehicle accidents, severe falls,

lacerations, and typing. Traumatic nerve injury, such as carpal tunnel

syndrome, is caused by the compression of nerves. Other trauma, such as

falls and motor vehicle accidents, may lead to the severance of nerves.• Diseases that damage nerves include multiple sclerosis, diabetes, spina

bida, and polio. Multiple sclerosis, for example, causes the breado!n of

the insulating myelin surrounding axons.

WHAT ARE THE COMMON PATHOLOGICAL FEATURES OF THE CNS?

• Intracranial press$re chan%es& re!ers to hi%h or lo). cere*ral oedema&

aso%enic oedema& c#toto'ic oedema& interstitial oedema• Ne$ral t$*e de!ects . Spina *i+da& anencepal#& Arnold-chiari mal!ormation&

cere*ral pals#

NAME SOME CAUSES OF CENTRAL NERVOUS SYSTEM TRAUMA?

• The# can come $nder / headin%s&

• Penetratin% in0$ries& cr$sh in0$ries& acceleration1 deceleratin% in0$ries

NAME SOME OTHER CONDITIONS IN THE BRAIN THAT CAN BE DAMAGED?

• Cere*roasc$lar disease& stro2e& s$*arachnoid heamorraha%es& In!ections in

the *rain s$ch as menin%itis & intracranial a*secess& chronic

menin%oencephalitis

HOW DOES MYELIN DISORDERS ARISE?

• M#elin is inherentl# a*normal or )as neer !ormed appropriatel#

• Normal m#elin *rea2s do)n d$e to a patholo%ical ins$lt .MS3

NAME THE DEMYLINATION AND DEGENERATION CONDITIONS?

• M$ltiple scleroisis . dem#linations3

• De%eneratin%- Al"heimer disease& dementia& Pic2s disease.another !orm o!

dementia3

WHY CAN’T THE CNS REPAIR THESE?

• The central nervous system has limited ability to x its damaged nerves, in

contrast to the peripheral nervous system.

• "hen parts of the central nervous system are critically injured, the #N$

cannot generate ne! neurons nor regenerate ne! axons of previously

severed neurons.

• $evered #N$ tips initially try to gro!, but eventually abort and ultimately

completely fail to regenerate.



• %emarably, almost &'( of cells in the #N$ are not even neurons. %ather

they are glial cells, !hich play an important role in supporting neurons both

physically and metabolically.

GANGLIA IN CNS

WHAT ARE THE DIFFERENCE BETWEEN GANGLIA AND NUCLEI?

• In the central nervous system, a collection of neuron cell bodies is called anucleus. In

the peripheral nervous system, a collection of neuron cell bodies is called

a ganglion (plural: ganglia). The one exception to this rule that you may have encountered

is the basal ganglia in the brain.

• The preganglionic motor neuron cell body may originate from the CNS but the post

ganglionic is normally always in the PNS



DOPAMINE AND SCHIZOPHRENIA

WHAT ARE THE TWO TYPES OF RECEPTORS FOR DOPAMINE?

The D and D! receptors are members of the D1-like family of dopamine receptors,

whereas the D", D# and D$ receptors are members of the D2-like family.

There is at least ! subtypes

WHAT DOES THE D1 FAMILY RECEPTORS DO?

• %ctivation of D&li'e family receptors is coupled to the ( protein (s), which subsequently

activates adenylyl cyclase, increasing the intracellular concentration of thesecond

messenger cyclic adenosine monophosphate *c%+-.

• D1 is encoded by the Dopamine receptor D gene *DRD1-.

•

D5

is encoded by the Dopamine receptor D!

gene *DRD5

-.

WHAT DOES THE D2 FAMILY RECEPTORS DO?

D"&li'e family %ctivation of D"&li'e family receptors is coupled to the ( protein (i),

which directly inhibits the formation of c%+ by inhibiting the enyme adenylyl

cyclase. /y bloc'ing the excess

•

0hat antipsychotical drugs target is the D" receptor so less dopamine is made

1n the mesolimbic dopaminerigic pathway the positive side effects of schiophrenia

occur, therefore bloc'ing the excessive dopamine activity in the mesolimbic system. D" bloc'age at other sites contributes along with antagonism at other receptors

PSYCHOSIS

http://en.wikipedia.org/wiki/D1-like_receptor










http://en.wikipedia.org/wiki/G_protein


http://en.wikipedia.org/wiki/G(s)alpha


http://en.wikipedia.org/wiki/Adenylyl_cyclase


http://en.wikipedia.org/wiki/Second_messenger_system


http://en.wikipedia.org/wiki/Cyclic_adenosine_monophosphate


http://en.wikipedia.org/wiki/Dopamine_receptor_D1



http://www.genenames.org/data/hgnc_data.php?match=DRD1











http://en.wikipedia.org/wiki/Gi_alpha_subunit


http://en.wikipedia.org/wiki/Cyclic_AMP





















WHAT IS PSYCHOSIS?

• 4o$n% people o!ten )orr# that the# ma# *e 5%oin% mad6 )hen the# are !eelin%

stressed& con!$sed or er# $pset7 In !act& )orries li2e this are rarel# a si%n o!

mental illness7 5Ps#chosis8 is )hen #o$r tho$%hts are so dist$r*ed that #o$ lose

to$ch )ith realit#7 This t#pe o! pro*lem can *e seere and distressin%7

WHAT CAUSES PSYCHOSIS?

• 9hen #o$ hae a ps#chotic episode& it can *e a si%nal o! another $nderl#in%

illness7 4o$ can hae a ps#chotic episode a!ter a stress!$l eent li2e losin% a close

!riend or relatie7 It can also *e the res$lt o! a ph#sical illness . li2e a seere

in!ection3& the $se o! ille%al dr$%s .li2e canna*is3 or a seere mental illness

l.i2e schi"ophrenia or *ipolar disorder37 Sometimes it is di:c$lt to 2no) )hat

ca$sed the illness7

WHAT DOES MICHAEL HAVE?

Ps#chotic depression is characteri"ed *# not onl# depressie s#mptoms&

*$t also *# hall$cinations .seein% or hearin% thin%s that aren8t reall# there3

or del$sions .irrational tho$%hts and !ears37 O!ten ps#choticall# depressed

people *ecome paranoid or come to *eliee that their tho$%hts are nottheir o)n .tho$%ht insertion3 or that others can 5hear8 their tho$%hts

.tho$%ht *roadcastin%37WHAT IS THE TREATMENT FOR PSYCHOSIS?

• Medications called 5antips#chotics8 are an important part o! treatment7 The# ma#

need to *e ta2en !or a lon% time in order to sta# )ell7 As )ith medication o! an#

2ind& there can *e side-e;ects< the doctor #o$ see )ill *e a*le to adise #o$ on

these and )hat can *e done to help7

• I! the ps#chosis is related to dr$% $se or an $nderl#in% ph#sical illness& #o$ ma#

need speci+c help and treatment to mana%e this7

WHAT ALSO CAN PSYCHOTIC ILLNESSES CAUSED BY ?

Alcohol mis$se and dr$% mis$se can tri%%er a ps#chotic episode7

A person can also e'perience a ps#chotic episode i! the# s$ddenl# stop

drin2in% alcohol or ta2in% dr$%s a!ter $sin% them !or a lon% time7 This is 2no)n as

)ithdra)al7

It6s also possi*le to e'perience ps#chosis a!ter drin2in% lar%e amo$nts o! alcohol

or i! #o$6re hi%h on dr$%s7Dr$%s 2no)n to tri%%er ps#chotic episodes incl$de=

• cocaine

• amphetamine .speed3

• methamphetamine .cr#stal meth3• mephedrone .MCAT or miao)3

• MDMA .ecstas#3

• canna*is

• LSD .acid3

• psiloc#*ins .ma%ic m$shrooms3

• 2etamine

Go back over Bipolar which is in other book

DRUGS AND THEIR EFFECTS

http://www.rcpsych.ac.uk/expertadvice/problems/schizophrenia.aspx

http://www.rcpsych.ac.uk/expertadvice/problems/bipolardisorder.aspx

http://www.nhs.uk/conditions/Alcohol-misuse/Pages/Introduction.aspx

http://www.nhs.uk/Livewell/drugs/Pages/Drugshome.aspx

http://www.rcpsych.ac.uk/expertadvice/problems/schizophrenia.aspx

http://www.rcpsych.ac.uk/expertadvice/problems/bipolardisorder.aspx

http://www.nhs.uk/conditions/Alcohol-misuse/Pages/Introduction.aspx

http://www.nhs.uk/Livewell/drugs/Pages/Drugshome.aspx



Dr u

Specific drugs: Mechanism: Major

effects:

Side effects: Any medical

use:Subgroup: Examples:

S e d a t i v e

s

Benzodiazepin

es

Diazepam (Valium),

clonazepam (Klonopin),

lorazepam (Ativan),temazepam (estoril),

!lunitrazepam

(o"#pnol), triazolam

($alcion), alprazolam

(%anax)

Agonist at

benzodiazepin

e site on t"e&ABA'A

receptor

alm,

relaxed

muscles,sleep#

Drosiness,

!alls, impaired

coordination,impaired

memor#,

dizziness

Anxiet#,

insomnia,

epileps#, man#ot"er diseases

Benzodiazepin

e agonists

*olpidem (Ambien),

eszopiclone (+unesta),

zopiclone, zaleplon

(Sonata)

Same as above ainl# -ust

sleep#,

sometimes

"allucination

s and sleep'

li.e states

Same as

benzodiazepines

/nsomnia

Barbiturates 0"enobarbital,

pentobarbital, t"iopental

(sodium pentot"al,

sodium am#tal),

secobarbital

Agonist at

barbiturate site

on t"e &ABA'

A receptor

alm,

eup"oric,

sleep#

Same as

benzodiazepines

, plus breat"ing

suppressed,

terrible

it"draal,

deat"

Epileps#, ot"er

diseases in t"e

past and more

rarel# toda#

Alco"ol 1pens BK

potassium

c"annels("#perpolarizi

ng neurons),

closes SK

potassium

c"annels in

reard center

o! brain

(causing DA

release),

probabl# ot"er

e!!ects

alm,

eup"oric,

loss o! in"ibitions

(!acilitates

socializing,

tal.ing,

singing,

sex), relaxed

Same as

benzodiazepines

, plus nausea,vomiting,

breat"ing

suppressed,

terrible

it"draal

(including

ps#c"osis and

seizures), brain

damage, various

diseases, deat"

Alco"ol

it"draal

&amma"#drox#but#rate (&$B), &B+,

2,3'butanediol

Agonist at

&$B receptor

(ma#

desensitize it

or in"ibit

&ABA),

agonist at

&ABA'B

receptor

Eup"oric,

energetic,

sleep#, calm

(mix o!

stimulant

and sedative

e!!ects)

Same as

benzodiazepines

, plus nausea,

vomiting,

breat"ing

suppressed,

ps#c"osis,

seizures, deat"

4arcoleps#

(improves

cataplex#, not

simpl# a sleep

aid)



Amp"etamines Amp"etamine

(Adderall),

met"amp"etamine

(Desox#n),

met"#lp"enidate

(italin),

p"entermine, 3'

met"#laminorex,

p"enmetrazine

(0reludin),

met"cat"inone,

!en!luramine

(0ondimin, 5en'

0"en),

dex!en!luramine

(edux), pseudoep"edrine

(Suda!ed),

ep"edrine,

p"en#lpropanolam

ine (old

6riaminic),

p"en#lep"rine

(Suda!ed 0E)

/ncrease

release and

in"ibit

reupta.e o! 7'

$6, DA, and

4E8

Eup"oric,

energetic,

able to or.,

concentrate,

sta# aa.e8

educes

appetite8

Anxiet#,

paranoia,

ps#c"osis, "ig"

blood pressure,

"eart attac.,

stro.e, brain

damage "en

used excessivel#

AD$D,

narcoleps#,

obesit#, rarel#

depression

DA (ecstas#),

DA, DEA

+i.e above,

but releases a

lot more 7'$6

Eup"oric,

energetic,

deep and

unusual

t"oug"ts,

perceived

inspiration

and novelt#,

en"ances

sex, dancing,

music, art,

touc" and

senses8ontentment

8 onnection

to ot"er

people,

strong

emotions8

Same as

amp"etamine,

plus brain

damage,

con!usion,

agitation,

!re9uentl# deat"

due to

"#pert"ermia,

"eart attac.,

ater

intoxication,

and ot"er problems8

4one

ocaine /n"ibits 7'$6,

4E, and DA

reupta.e,

bloc.s

voltage'gated

sodium

Same as

amp"etamin

e (above)

Same as

amp"etamine,

plus a orse

ris. o! "eart

attac.

+ocal anest"esia

and bleeding

control,

diagnostic tests



S

t

i

m

u

l

a

n

t

s

c"annels

N ar c o t i c s

5ull opioid agonists orp"ine, "eroin

(diacet#lmorp"ine

), "#drocodone

(Vicodin),

ox#codone

(0ercocet,

1x#contin),

!entan#l,

Demerol, codeine,

opium,

"#dromorp"one

(Dilaudid),

ox#morp"one

(1pana),

met"adone

Activate all

opioid

receptors

completel#8

educe 4E

release8

Eup"oric,

pain relie!,

calm,

relaxed,

sleep#,

appetite

suppression

4ausea,

constipation,

vomiting,

drosiness,

breat"ing

suppressed

0ain relie!,

rarel#

depression and

diarr"ea

0artial, selective, or

mixed opioid

agonists

Buprenorp"ine

(Suboxone),

pentazocine,

nalbup"ine,

tramadol

(ltram),

ti!luadom

1nl# activate

certain

subt#pes o!

opioid

receptors,

and;or do not

activate t"em

!ull#, and;or

bloc. certain

subt#pes8

0ain relie!,

not 9uite as

eup"oric or

relaxing as

!ull agonists

(above)

4ausea,

constipation,

vomiting,

drosiness

0ain relie!,

rarel#

depression,

opioid addiction

C ann a b i s

Active ingredient is mostl#

tetra"#drocannabinol, some ot"er active

ingredients li.e cannabidiol in smaller

9uantities

Agonist at

cannabinoid

receptors

nusual

t"oug"ts and

!eelings,

sometimes

calm, "app#,

"ungr#,

en"anced

appreciation

o! art

emor#,

t"in.ing,

re!lexes, and

coordination are

impaired8 a#

contribute to

ps#c"osis in t"e

long term8

ig"t relieve

nausea,

vomiting, and

neuropat"ic

pain8 0ills

alread# legal,

ot"er !orms

under

investigation8



I nh al an t s

Diet"#l et"er (starter !luid), toluene,

gasoline, glue, paint, xenon, !reon,

"alot"ane, sevo!lurane

n.non,

probabl#

multiple

mec"anisms

alm,

relaxed,

eup"oric,

pain relie!,

"allucination

s, strange

sensations

(di!!erent

in"alants

cause

di!!erent

e!!ects !rom

t"is list)

an# diseases,

deat", nausea,

vomiting,

accidental

asp"#xiation,

!alls, varies

depending on

particular drug

&eneral

anest"esia

4itrous oxide n.non, but

opioid

pat"a#s are

necessar#

alm,

eup"oric,

pain relie!,

memor#

loss,

unconscious

ness

Similar to above &eneral or

partial

anest"esia

4itrites /soam#l nitrite,

isobut#l nitrite

Stimulate 41

s#stem (41 is

a

neurotransmitt

er)

<$ead rus"<,

muscle

relaxation,

dizziness

Dangerousl#

lo blood

pressure,

!ainting

$eart conditions

O t h e r

4icotine (tobacco) 4icotinic

acet#lc"oline

receptor

agonist

See =i.ipedia, 0ubed, &oogle

a!!eine (co!!ee, tea, ot"er plants) Adenosine

receptor

antagonist,

in"ibits some

0DE enz#mes

causing

increasedcA0

signaling

Alertness,

a.e!ullness

, energ#,

appetite

suppression,

"eadac"e

relie!

/nsomnia,

anxiet#,

"eadac"es on

it"draal,

diuresis

$eadac"es

DIAGNOSIS AND SPECIFIC ASSESSMENTS

• Chec2 !or co%nitie !$nction7 A patient ma# not interact )ith #o$o Does the patient hae si%ni+cant co%nitie impairment>

o Is there a medical ca$se>



o I! there is no o*io$s direct ca$se& is this dementia& deliri$m or

depression>

• ?o) to assess !or ps#chosis>

o @ind o$t i! the person is s$;erenin% !rom ps#chosis>

o I! so )hat is the ca$se o! ps#chosis>. co$ld *e ps#chiatric

pro*lem or co$ld *e or%anic pro*lem3o Ta2e ps#chosis histor#

o In!erein% that it is schi"ophrenia and other psc#hoses relies on

detailed eal$ation o! n$m*er o! s#mptoms and si%nso Also $sin% the patients appearance& *ehaio$r& mood& speech&

tho$%ht content& o) and possession o! tho$%ht& perception&

co%nition& insi%ht

• ?o) to assess !or depression>

o As2 releant B$estions s$ch as

o Does the patient thin2 the# are depressed>

o Identi!# past and c$rrent stressors in li!e>

o ?o) the patient has tried to cope>o Does the patient hae depressie or an'io$s traits in !amil#>

o Is there a !amil# histor# o! ps#chiatric disorder>

o 4o$ )o$ld then $se the MSE to assess the patient& e7%

appearance& *ehaio$r as mentioned a*oe

•

INTERDISCIPLINARY TEAM

• Most P#schiatric disorders are seen ad mana%ed i$n the %eneral practise& the

most common inole depression and s$*stance mis$se

• Other ps#chiatric patients are mana%ed *# pschiatrists and other patients are

seen in A and E as a res$lt o! sel! harm

• Also one third o! medical and s$r%ical o$tpatient clinic attendees hae a

ps#chiatric disorder7

HOW ELSE CAN PYSCHIATIC PROBLEMS BE CAUSED?

• Man# patients )ith medical conditions hae ps#chiatric disorders& e7% medical

conditions s$ch as c$shin% s#ndrome and h#perth#roidism

STAGES OF PATIENT CARE

,7 The decision to cons$lt the doctor7 Reco%ition *# the GP/7 Re!erral to ps#chiatrist

(7 Admission to hospital



HOW IS THE PATIENT MANAGED?

Mana%ement o! the ps#chiatric disorder is *ased on the %eneral principals .A3

attention to the patients medical condition and treatment .3 necessar# adaptation

to the medical settin%7

WHY DOES GP’S REFER ONTO THE PSYCHIATRISTS

• ReB$est !or a second opinion

• @ail$re o! +rst line mana%ement

• Need !or specialist treatment s$ch as ECT

• Serio$s s$icide ris2

• Presence o! a condition s$ch as ps#chosis reB$irin% specialist serices

• Seere s$*stance mis$se

• Need !or comp$lsor# treatment

STIGMA

Sti%ma di;ers !rom discrimination7 Discrimination is $n!air treatment d$e to a

person8s identit#& )hich incl$des race& ancestr#& place o! ori%in& colo$r& ethnic ori%in&

citi"enship& creed& se'& se'$al orientation& %ender identit#& %ender e'pression& a%e&

marital stat$s& !amil# stat$s or disa*ilit#& incl$din% mental disorder7 Acts o!

discrimination can *e oert or ta2e the !orm o! s#stemic .coert3 discrimination7

Under the Ontario Human Rights Code& eer# person has a ri%ht to eB$al treatment

)ith respect to serices& %oods and !acilities& )itho$t discrimination d$e to the

identities listed a*oe7

Sti%ma is the ne%atie stereot#pe and discrimination is the *ehaio$r that res$lts

!rom this ne%atie stereot#pe7 O!ten& indiid$als )ith a mental illness are !aced )ith

m$ltiple& intersectin% la#ers o! discrimination as a res$lt o! their mental illness and

their identit#7 @or e'ample& a )oman )ith a mental illness ma# e'perience

discrimination d$e to se'ism as )ell as her illness& and a raciali"ed indiid$al ma#

e'perience discrimination d$e to racism in addition to their mental illness7 In

addition& liin% )ith discrimination can hae a ne%atie impact on mental health7

MEDIA INFLUENCE ON PUBLIC ATTITUDES

Man# st$dies hae !o$nd that media and the entertainment ind$str# pla# a 2e# role

in shapin% p$*lic opinions a*o$t mental health and illness7 People )ith mental

health conditions are o!ten depicted as dan%ero$s& iolent and $npredicta*le7 Ne)s

stories that sensationali"e iolent acts *# a person )ith a mental health condition

are t#picall# !eat$red as headline ne)s< )hile there are !e)er articles that !eat$re

stories o! recoer# or positie ne)s concernin% similar indiid$als7 Entertainment

!reB$entl# !eat$res ne%atie ima%es and stereot#pes a*o$t mental health conditions&



and these portra#als hae *een stron%l# lin2ed to the deelopment o! !ears and

mis$nderstandin%7

IMPACT OF NEGATIVE PUBLIC ATTITUDES

There are si%ni+cant conseB$ences to the p$*lic misperceptions and !ears7

Stereot#pes a*o$t mental health conditions hae *een $sed to 0$sti!# *$ll#in%7

Some indiid$als hae *een denied adeB$ate ho$sin%& health ins$rance and 0o*s d$e

to their histor# o! mental illness7 D$e to the sti%ma associated )ith the illness& man#

people hae !o$nd that the# lose their sel!-esteem and hae di:c$lt# ma2in%

!riends7 Sometimes& the sti%ma attached to mental health conditions is so perasie

that people )ho s$spect that the# mi%ht hae a mental health condition are

$n)illin% to see2 help !or !ear o! )hat others ma# thin27 E'periences o! sti%ma and

discrimination is one o! their %reatest *arriers to a satis!#in% li!e7

WHAT YOU CAN DO TO STOP STIGMA AND DISCRIMINATION

Use the STOP criteria to reco%ni"e attit$des and actions that s$pport the sti%ma o!

mental health conditions7 It8s eas#& 0$st as2 #o$rsel! i! )hat #o$ hear=

• Stereot#pes people )ith mental health conditions .that is& ass$mes the# are

all ali2e rather than indiid$als3>

• Triiali"es or *elittles people )ith mental health conditions and1or the

condition itsel!>

• O;ends people )ith mental health conditions *# ins$ltin% them>

• Patroni"es people )ith mental health conditions *# treatin% them as i! the#

)ere not as %ood as other people>

I! #o$ see somethin% in the media )hich does not pass the STOP criteria& spea2 $p

Call or )rite to the )riter or p$*lisher o! the ne)spaper& ma%a"ine or *oo2< the

radio& T or moie prod$cer< or the adertiser )ho $sed )ords )hich add to the

mis$nderstandin% o! mental illness7 ?elp them reali"e ho) their )ords a;ect people

)ith mental health conditions7

Start )ith #o$rsel!7 e tho$%ht!$l a*o$t #o$r o)n choice o! )ords7 Use acc$rate andsensitie )ords )hen tal2in% a*o$t people )ith mental health conditions7

NOTES FROM PREVIOUS SESSION

Synthesis and Distribution 2eceptors 3linical



removal SignificanceA c e t yl ch ol i n e ( A ch )

4in' reaction to

produce acetyl

3o% which bindsto 3holine viaacetyltransferase,pac'aged intovesicles andexocytosed.

/ro'en down by

acytylcholinester

ase

/asal

5orebrain –

supplyneocortex,hippocampus, amygdala

Dorsolateraltegmentumof pons –basal

ganglia,

hypothalamus

m%3h& g

protein

coupled,morewidespread,found onsmoothmuscle andglands ofparasympathetic glands

n%3h –ionotropic,gangli atneuromuscular junction

/asal

5orebrain –

learning andmemory –limbic system,dementia andalheimers

Dorsolateral –sleep&wa'ecycle,

promotes 26+

in sleep cycle,controlselectricalrhythms of thehippocampusand modulatesits functions

Gl u t

am a t e

3onverted from

glucose via'rebs cycle, thenconverted toglutamine in glialcells, glutaminesynthetase, (47to (48 viaglutaminase

0idespread,

mostabundant 7Tin 37S.

$ trac's –corticospinal,3orticostriate,hippocampus, primary

afferents

7+D% – 7&

methyl&D& %spartate

9ainate

%+% –amino&methylisoxaole.

m(lu

9etamine and

ecstasy bloc'7+D%,affecting shortterm memory

Degenerationof neurones inanterior horncells can leadto %4S



GABA

Synthesisedfrom glutamateby glutamate

decarboxylase inorder to crossthe ///

2emoved byreupta'e *seeglutamate-

%lso convertedinto succinate

and feeds into'rebs cycle

+ajorinhibitoy

:yperpolaris

es axons

(%/%a –ionotropic

(%/%b &

metabotropic

Target fordrugs

Gl y ci n e

See glutamate 1nhibitory inspinalcolumn,retina andgrey matter

1onotropic Tetanus toxinpreventsrelease ofglycine frominhibitoryneurons,

muscularspasmN or a d r en al i n e

3atecholaminesynthesis, seelecture diagram

2emoval –actively reupta'en

Degradation &

+%; and 3;+T

3eruleannucleus onfloor of$th ventricle

7S – 7+<ofsympathetic

%7S

%lpha andbeta –7orad doesnot act onbeta "

(&protein

(ated

Times ofstress,increasedcortisol,increasedtransmission of norad in locus

coeruleusaffecting theamygdalaaffecting thehypothalamus,temperature,feeding, sleepand the limbicsystem, mood

etc and thecerebral cortex



Adrenaline

8pper part of medullaoblongata

due tolocation ofphentolamine

n&methyltransferase enyme

Dopamine

+ajortransmitter in

connections

betweenbasoganglia

5ound inpathwaysaffecting thelimbic system

roduced in

substia nagraand =T%

Dexcitatory

D" inhibitsc%+

ar'inson>s,schiophrenia,

effects of

antipsychoticmedication

Seratonin

See lecturediagram

2aphe 7ucleiproject intothe cerebralcortex andspinal cord

3audal

system

%ll !:T are( roteincoupled

Serotoninwor's on allbut !:T#,

ligand gatedion channel

" and $excitatory,the restinhibitory

=egetativebehaviour

%typicalantipsychotics

ineal gland,

implicated incircadian

rhythm

• athologies and management?

• Depression

•

# 3ore• %nhedonia



• 4ow mood

• %nergia

• @ %ssociated

• 2educed concentration

• 2educed self confidence• (uilt and unworthiness

• essimistic

• 1deas or acts of self harmAsuicide

• 7ot eatingAsleeping

• ;ther symptoms

• 4oss of libido

• Diurnal variation

•

0eight loss *!B in one month-• sychomotor agitation

• 8nder activity of monoamine transmitters eg. serotonin,

theory based on drug action

• %utoreceptor sensitivity theory, inhibit upta'e of

transmitter, has negative feedbac' of production

• SS21>s, bloc's transport proteins, and reduces the

number of receptors, increasing the firing rate of the neuron

• 3ushings syndrome, decreased serotonin C increased

cortisol hippocampal damage C severe depression• /rain derived neutrophic factor

• 2is' factors

• (ender – 5emales –post natal and post&

menopausal

• 3hronic illness

• 3hronic substance abuse

• 4ac' of social support

• /ereavement

• Stress

• :ypothyroidism

• %nxiety – @B of those depressed have anxiety

• Treatment

• 3/T – E month waiting list, expensive

• Tal'ing to change the way you thin' and

behave

• +ore on how you act not feel

•

+indfulness



• sycho education – understand condition more,

reduce stigma

• 6lectroconvulsive therapy –last resort, electrodes

induce an epileptic fit, free from serious side effects,

minor temporary memory loss and muscle soreness• harmacology

• SS21>s

• 1nhibit the rate of firing by action on !:Ta,

longer term exposure, down regulation of the!:Ta receptors, and a dis inhibition of serotoninrelease. Finhibiting the inhibitor>. 1ncreasedserotonin on the post synaptic membrane

• 1nhibits the reupta'e

• roac – fluoxetine• 3italopram

• /etter tolerated than other drugs

• Side effects – Fhangover>, bleeding, dry

mouth, constipation, serotonin syndrome –overdose, synergistic effect with St. <ohn>s wart

• S721>s

• 8sed when SS21>s don>t wor', next level of

treatment

• T3%>s• 1nhibit the upta'e of monoamines by

competitively binding with the monoamine %T&ase pump

• +ore side effects, arrhythmias and weight

gain

• 7ot first line due to side effects

• %mitriptyline, 1myprymine *also anti

epileptics-

• +%;1

• +onoamine oxidase inhibitors, early ones

irreversible, now they are reversible

• %void certain foods, cheese and red wine,

due to tyramine

• 3an increase blood pressure significantly

• Diiness

• 3arry round an +%;1 card due to

interactions with other drugs



• 0ithdrawal syndrome if ta'en of them too

quic'ly

• heneleine

case notes section 2

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