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) Precontemplation Contemplation Preparation Action Maintenance

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 substance Difficulty controlling substance taking (onset, termination, levels of use) Withdrawal symptoms Tolerance developing Neglect of alternative pleasures/interests Use 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

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

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, Name 3 non pharmacological interventions for depression. (3) CBT Counselling Light therapy Exercise ECT (Gold Standard) TMS Nick 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 H 1 receptor antagonist A 1 adrenoreceptor antagonist M 1 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 sandwich b) A fig sandwich c) A cheese, marmite and red wine sandwich d) A broccoli sandwich e) 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!