Neurotransmitters & Brain Pathways
Neurotransmitter most associated with decreased signaling in major depressive disorder.
What is Serotonin?
This medication class is considered first-line pharmacologic treatment for major depressive disorder.
What are SSRIs?
This psychiatric disorder often presents with fatigue, early-morning awakening, and loss of interest in usual activities, and may increase suicide risk in adults.
What is major depressive disorder?
A patient presents to the ED with a respiratory rate of 6/min, altered mental status, and pinpoint pupils.
What is an Opioid intoxication?
(Classic triad: coma, mitosis, and respiratory depression.)
A husband who is secretly harboring desires to have an affair constantly accuses his entirely faithful wife of cheating on him.
What is projection?
Dopamine pathway whose blockade causes extrapyramidal symptoms.
What is the Nigrostriatal Pathway?
This mood stabilizer is first-line treatment for bipolar disorder and is associated with tremor, hypothyroidism, and nephrogenic diabetes insipidus.
What is Lithium?
A patient with a history of major depression experiences auditory hallucinations and paranoia for 3 weeks during a period when her mood is completely normal and euthymic.
What is a Schizoaffective disorder?
(To diagnose schizoaffective disorder, there must be ≥ 2 weeks of psychosis in the ABSENCE of a major mood episode)
A teenager is brought to the clinic by his parents. He exhibits a markedly increased appetite, dry mouth, conjunctival injection (red eyes), and a distorted perception of time.
What is Cannabis intoxication?
A cancer patient begins to experience profound nausea and vomiting just by pulling into the parking lot of the clinic where they receive chemotherapy. According to classical conditioning, the parking lot represents this type of stimulus.
What is a conditioned stimulus?
Neurotransmitter whose activity is increased by benzodiazepines.
What is GABA?
This atypical antipsychotic is reserved for treatment-resistant schizophrenia and requires routine monitoring due to risk of agranulocytosis.
What is Clozapine?
A 24-year-old suddenly develops blindness after witnessing a traumatic event, but pupillary light reflexes, fundoscopy, and EEG are completely normal.
What is a Conversion disorder?
(Functional Neurological Symptom Disorder)
A combative patient is brought in by police. He is highly agitated, seemingly impervious to pain, and exhibits both horizontal and vertical nystagmus.
What is Phencyclidine (PCP) intoxication?
A hospital patient who was recently diagnosed with terminal cancer spends all day calmly researching the exact molecular mechanism of their tumor instead of addressing their emotional response or prognosis.
What is intellectualization?
(This is using intellect/facts to avoid experiencing uncomfortable emotions, whereas rationalization is making up logical excuses for bad behavior).
This dopamine pathway, when blocked by risperidone, leads to elevated prolactin levels causing galactorrhea and amenorrhea.
What is the tuberoinfundibular pathway?
This medication treats the skeletal muscle rigidity seen in neuroleptic malignant syndrome caused by dopamine antagonist therapy.
What is Dantrolene?
Personality disorder characterized by eccentric behavior, odd beliefs, "magical thinking," and social anxiety that does not decrease with familiarity.
What is a Schizotypal personality disorder?
A college student collapses at a rave with severe hyperthermia, jaw clenching, and hyponatremia due to drug-induced ADH secretion.
What is MDMA (Ecstasy) intoxication?
A patient with borderline personality disorder describes her morning nurse as "the most wonderful person in the world" but calls the afternoon nurse "completely incompetent and evil."
What is Splitting?
(Hallmark defense mechanism of BPD)
Negative symptoms of schizophrenia such as flat affect and avolition are associated with decreased dopamine activity in this pathway.
What is the mesocortical pathway?
This treatment reverses QRS widening in tricyclic antidepressant overdose by overcoming fast sodium channel blockade.
What is Sodium Bicarbonate?
A patient intentionally ingests rat poison to induce bleeding. When confronted, he admits he just wants to be a patient in the hospital and receive medical care. He seeks no external reward like money or time off work.
What is a Factitious disorder? (formerly Munchausen syndrome)
(Crucial Step 1 differentiator: Factitious disorder is motivated by the "sick role" / internal reward; Malingering is motivated by external reward).
The life-threatening complication of alcohol withdrawal that classically peaks 48 to 96 hours after the last drink, characterized by profound autonomic hyperactivity, tremors, and visual hallucinations.
The specific stage of sleep characterized by the presence of sleep spindles and K-complexes on an electroencephalogram (EEG).
What is Stage N2 sleep?
(N1 has theta waves, N2 has spindles/K-complexes, N3 has delta waves, and REM has beta/sawtooth waves).