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Sigs Unit 8 Cases 8-15
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Discuss splitting, transference, and countertransference in Borderline Personality Disorder (Sigs 8.8b)
S: only good v. bad w/ no in between; T: subconscious associat. person in present w/ a past relationship; C: responding in present w/ thoughts/feelings of past
Compare the MOA & indications of lamotrigine, risperidone, and fluoxetine (Sigs 8.8b)
L: inhibits voltage-sensitive Na channels-> modulate release presynaptic excit; R: decr dopaminergic & serotonergic via 5-HT2Ar-> decr symptoms; F: SSRI
Identify the brain structures involved in attention. Relate the changes in neurotransmitter(s) in ADHD to the utility of methylphenidate in treating the disorder. Include in your answer the mechanism of action of the medication. (Sigs 8.8a)
Dopamine and norepinephrine in appropriate amounts required for optimal functioning of prefrontal cortex, subcortical structures, and cerebellum
Explain the approach to both diagnosis and monitoring of ADHD. Name the two core symptom domains in ADHD and list six examples of each. (Sigs 8.8a)
use valid rating scales; inattention & hyperactivity-impulsivity; careless mistakes, poor organization, losing items, fidgeting, moving, excess talking
Describe the mechanism of action of naloxone for opioid overdose. (SIGS 8.7b)
competitive inhibitor of mu opoid receptor-> blocks/reverses action of narcotics; prevent acute withdrawal syndrome (narcotic antagonist)-> restore ventilation
Explain the major differences between the use of methadone and buprenorphine in opioid use disorder. (SIGS 8.7b)
methadone:acute withdrawal +long-term maintenance;full agonist, also inhibits NMDA, synthetic;bupre: mu partial agonist, prevent relapse, less potent, synthetic
Describe the mechanism of action of buprenorphine for the treatment of opioid use disorder. (SIGS 8.7b)
mu partial agonist, narcotic analgesic, morphine type (synthetic); used to prevent relapse
Describe the clinical presentation of opioid withdrawal. (SIGS 8.7b)
Somatic:piloerection, pupil dilation, yawning, lacrimation, rhinorrhea, flu-like; behavior/mood: dysphoric, anxiety, irritability, restless, agitation, insomnia
Explain the role of benzodiazepines in the management of alcohol withdrawal. (SIGS 8.7b)
binds "benzodiazepine receptors" between alpha and gamma subunits of GABA-A-> incr freq. of chloride channel opening -> incr inhibitory effect of GABA
Describe withdrawal seizures. (SIGS 8.7a)
onset 8-48 hours after cessation/reduction alcohol; usually brief, generalized tonic-clonic seizures; often single episode
Define delirium tremens. (SIGS 8.7a)
persistant alteration of consciousness and sympathetic hyperactivity due to alcohol withdrawal
List the symptoms of alcohol withdrawal and the timing of their presentation. (SIGS 8.7a)
tremors, vomiting, anxiety, sweating tachycardia-> gen. tonic-clonic seizures-> transient hallucinations-> delirium tremens
Describe the brain circuits implicated in the symptoms of schizophrenia. (SIGS 8.6b)
Mesolimbic Tract: + symp; Mesocortical tract: - symp and cog/affect symp
Describe how atypical antipsychotics treat symptoms of schizophrenia AND list adverse effects associated with these medications. (SIGS 8.6b)
transiently occupy D2 recep and rapidly dissociate to allow normal dopamine transmission; 2nd gen less potent D2 antagonists + antagonize 5HT2 recep to decr AE
Describe neurochemical changes thought to underlie the symptoms of schizophrenia. (SIGS 8.6b)
+ symp: incr subcortical release dopamine-> augments D2 recp activation&nucleus accumben;- symp: reduced D1 recp activation prefrontal cortex & nucleus caudatus
Explain why the therapeutic effects of SSRIs are delayed. (SIGS 8.6a)
reuptake inhibition initially, but may require additional "downstream" effects to produce full therapeutic effect; modifies serotonergic receptors over weeks
Describe the mechanism of action of SSRIs and SNRIs. (SIGS 8.6a)
SSRI: inhibit 5-HT reuptake; SNRI: inhibit 5-HT & NE reuptake
Identify risk and protective factors for suicide. (SIGS 8.6a)
risk: previous attempt, mental illness, social isolation, financial/legal/health problems, substance use, impulsive; protect: coping, religion, social support
List the DSM-5 criteria for diagnosing PTSD. (SIGS 8.5b)
traumatic situation-> reliving experience, avoidance, emotional detachment, incr. arousal, decr daily fx, >1 month
Explain the role of sertraline in treating PTSD. (SIGS 8.5b)
(Zoloft)1st line monotherapy SSRI;inhibit serotonin reuptake via inhibition of SERT->incr. synaptic concentration serotonin CNS->enhanced serotonergic neurotran
Describe the four main symptom clusters of PTSD. (SIGS 8.5b)
Criterion B: intrusion symp.; Criterion C: avoidance symp.; Criterion D: negative cognitions & mood; Criterion E: arousal & activity changes
Explain the risk of seizure and rationale for the use of fosphenytoin for seizure prophylaxis following TBI. (Sigs 8.5a)
H20-soluble prodrug metabol by plasma esterases->phenytoin->binds voltage-sensitive Na channel neuron->inhibit high-frequency repetitive action potentials
Discuss the use of imaging in diagnosing head trauma and differentiate subdural from epidural hematoma (Sigs 8.5a)
non-contrast CT 1st; epidural: bright convex disc; subdural: crescent-shaped hemorrhage
Rationalize the use of mannitol in acute TBI. (SIGS 8.5a)
osmotic diuretic-- non-reabsorbable solute filtered by glomerulus causing water retention in PCT & dLoH-> alter Starling forces-> H20 leaves cells->decr ICP


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