Mechanism of Action
What is the mechanism of action of drugs like fluoxetine, paroxetine, and sertraline?
SSRIs-block reuptake of the presynaptic neuron to increase the amount of serotonin in the synaptic cleft
What neurotransmitter is involved in voluntary muscle movements?
Acetylcholine (Ach)
A patient believes people are either amazing or terrible. What personality disorder might this person have? What ego defense are they using? What therapy would you use for them?
Cluster B, Borderline Personality Disorder
Splitting
DBT
An alcoholic says they are quitting "cold turkey".
What are they at risk for?
Alcohol Withdrawal
Your roommate whom you dislike keeps playing music super loud in their room. You in turn bake them cookies.
Reaction Formation (immature defense)
What is the mechanism of action of TCAs like amitryptiline.
What adverse effects might this drug/class produce?
Works similarly to SSRI/SNRI. In addition, it can have a HAM block like Histamine H1-R, alpha1-R, muscarinic-R.
What are catecholamines and where are they produced?
Class of hormones/NTs made in adrenal medulla (NE, Epi, DA)
A patient comes in with attention-seeking behavior, dramatic speech and emotional expression, shallow emotions, and is sexually provocative.
What cluster and personality disorder might they have?
Cluster B, Histrionic Personality Disorder
A patient with a history of schizophrenia comes into the ED. They are on risperidone. The attending says the patient is exhibiting "lead pipe" rigidity and has also developed a fever.
What is going on?
Neuroleptic malignant syndrome (NMS)
My dad yelled at me and so when I go to school I yell at my teacher.
Displacement (immature defense)
What is the mechanism of action of benzodiazepines? (Be specific)
Benzos activate GABA-A receptors by binding to the BZ2 portion of the receptor. They work as positive allosteric modulators and they increase the affinity of the receptor for GABA and when GABA binds it increases the chloride coming into the cell which hyperpolarizes the cell membrane-making it more difficult to depolarize and cause an action potential.
This neurotransmitter is also an amino acid that serves as the precursor for GABA and is the main excitatory NT in the brain.
Glutamate
What is the difference between a Factitious disorder and a somatic disorder?
Factitious disorders the patient consciously creates physical or psychological symptoms in order to assume the "sick role" and to get medical attention and sympathy. (primary, internal gain)
Somatic disorders the patient has physical symptoms causing significant distress and impairment, symptoms are not intentionally produced or feigned.
A patient has been taking fluoxetine for a year to treat their depression. It helped initially, but they now think they need something in addition. The physician prescribes amitriptyline. The patient now takes both fluoxetine and amitriptyline.
A few days later they come in with clonus, hyperreflexia, hypertonia, tremors, and altered mental status.
What happened?
Serotonin syndrome due to increase serotonin via the mechanisms of both fluoxetine and amitriptyline
A man with homosexual impulses accuses another man of being attracted to him.
Projection (immature defense)
How are the mechanisms of action different in typical (1st gen) antipsychotics vs. atypical (2nd gen) antipsychotics?
Typical antipsychotic agents have more side effects and block usually more than just dopamine receptors. Atypical block primarily D2 receptors and 5-HT2A-R.
Give at least two characteristics about the NT Serotonin.
-Also called 5-HT
-Decreased in depression
-Tryptophan is the amino acid needed to create serotonin
-Involved in feelings of satiety
What are the criteria for Generalized Anxiety Disorder (GAD)?
What could the diagnosis be if these criteria are not met?
At least 6 months of 3 or more of the following: Restlessness, irritability, sleep disturbance, fatigue, muscle tension, difficulty concentrating.
If not met: other specified or unspecified anxiety disorder
A patient is taking a mood stabilizer medication and seems to be working well; however, they have developed a red rash and some blisters on their body.
What medication are they taking and what adverse syndrome might they be developing?
Lamotrigine
Stevens-Johnson Syndrome
"It's okay I got into that car accident. It taught me to be more careful."
Rationalization (immature defense)
What is the mechanism of action of Lithium? What is Lithium used to treat?
Lithium is a mood stabilizer used to treat Bipolar disorder. The mechanism is not well understood but it is hypothesized it has something to do with inhibiting the Gq pathway
Compare and contrast the NT changes seen in anxiety, depression, and schizophrenia
Anxiety: decreased GABA, decreased serotonin, increased NE
Depression: decreased dopamine, decreased serotonin, decreased NE
Schizophrenia: increased dopamine
A 22-year old female comes into the clinic for her annual physical. She tells you she has been hearing voices and believes aliens are coming to abduct her this weekend. She has had these thoughts and has heard these voices for 4 months.
What is a likely dx
Schizophreniform (1 month-6 month)
A patient is taking drug X and comes in with Nephrogenic diabetes insipidus, Nausea, vomiting, slurred speech, hyperreflexia, seizures.
What is drug X?
Lithium. This is an example of Lithium toxicity
Name the four types of mature ego defense mechanisms and give an example of each.
SASH
Sublimation
Altruism
Suppression
Humor