BY MATT AND TOM

A bit of Addiction - But mainly Depression

What are the 3 approaches to treating addiction? (3)

Abstinence based approach (e.g. detoxification, rehabilitation)

Harm reduction approach (e.g. reducing risk of drug use – needle exchange)

Recovery oriented approach (e.g. opioid substitution for heroin)

The late, great Ms Winehouse famously once said “They tried to make me go to rehab, but I said no, no, no”. What type of addiction treatment was

she refusing? (1)

Abstinence based treatment

*For the less streetwise amongst you, “rehab” is Cockney Rhyming slang for rehabilitation

The late, great Ms Winehouse famously once said “They tried to make me go to rehab, but I said…well I’ll take a leaflet and have a think…” What stage of the

transtheoretical model of change was young Amy in? (1)

PrecontemplationContemplationPreparationActionMaintenance

It could be argued that Gollum was dependent on the Ring. Three or more features over the previous year must be present to diagnose “dependence”

based on ICD guidelines. Name three of the features? (3)

Strong desire to take substanceDifficulty controlling substance taking (onset, termination,

levels of use)Withdrawal symptomsTolerance developingNeglect of alternative pleasures/interestsUse of substance despite awareness of harm

DEPRESSION

Nick Clegg comes into the clinic with suspected mild depression. What symptoms are required to make a clinical diagnosis? (3)

Key Symptoms:– persistent sadness or low mood; and/or– marked loss of interests or pleasure

Plus 3 of:– disturbed sleep (decreased or increased

compared to usual)– decreased or increased appetite and/or

weight– fatigue or loss of energy– agitation or slowing of movements– poor concentration or indecisiveness– feelings of worthlessness or excessive or

inappropriate guilt– suicidal thoughts or acts

http://nickclegglookingsad.tumblr.com/

What areas of Nick’s brain are going to show increased and decreased activity during a depressive episode? (2)

Increased Hypothalamus Amygdala

Decreased Pre-frontal cortex Hippocampus

http://nickclegglookingsad.tumblr.com/

Nick Clegg was well happy when he got made deputy PM, then realised he was getting screwed over all the time, so he was really sad. He kept going happy,

sad, happy, sad every week. What pattern of depression was Nick showing? (1)

Bi Polar (also known as Manic Depression)

On a recent business trip to India, Nick got really into ayervedic (aka CAMS) treatments and thus shunned our “western pharmacological voodoo”, Clegg, 2015.

Name 3 non pharmacological interventions for depression. (3)

CBT

Counselling

Light therapy

Exercise

ECT (Gold Standard)

TMSNick Clegg is this one

Serotonin is released into the synaptic cleft.Under normal circumstances, some of this serotonin

is re-uptaken into the pre-synaptic nerve ending.SSRIs inhibit this re-uptake pump.Therefore serotonin levels are increased.And more serotonin binds to Serotonin receptors

Explain the MoA of SSRIs. (4)

• Fluoxetine – Et, was really sad cos he couldn’t go home. But then he got a flying Ox (instead of a flying bicycle) and was able to fly home. Therefore he was happy. ET, Flew home, on an Ox. Fluoxetine

• Paroxetine – Et was really sad. So you played golf with him…and his Ox. And he got par. Par. Ox. Et. Paroxetine

• Citalopram – If a baby’s height is depressed, then they have to sit, in a pram, that is low down. They Sit, in a Low Pram. Citalopram.

Name some SSRIs

What are the side effects of SSRIs? (5)

Remember the 5 S’s Slow onset Sleep problems Sickness (nausea) Sex problems Serotonin syndrome

What are the 5 receptors TCAs work on? (5)

NA reuptake blocker 5HT reuptake blocker H1 receptor antagonist A1 adrenoreceptor antagonist M1 receptor antagonist

Also used to treat neuropathic pain e.g Amitriptyline (Amy couldn’t feel anything after she tripped out from taking a line of cocaine)

Briefly, what is the MoA of monoamine oxidase inhibitors type A? (1)

They increase serotonin/noradrenalin levels by inhibiting enzymatic breakdown

Which of the following foods should be avoided when on MAOI-As? (1)

a) A pickle sandwichb) A fig sandwichc) A cheese, marmite and red wine sandwichd) A broccoli sandwiche) A carrot sandwich with cumin

And why?Cheese, marmite and red wine all contain tyramine. Monoamine oxidises usually break down tyramine, so a resultant excess of tyramine causes the deadly “cheese reaction”/hypertensive crisis

QUESTIONS!