QotM (Question of the Moment):
What is the most common cause of hallucinations in the hospital setting?
Answer to previous QotM:
Lithium (in addition to its cutaneous side effects of acne and alopecia). Beta blockers can also exacerbate psoriasis.
Questions of the Moment are derived from notes created by S. Hinds, M.D.
This post has nothing to do with psychiatry…except for perhaps noting that having antisocial traits is almost de regieur for “moving up” in the corporate world. It often gives people the edge to their ambitions. However, those same traits can manifest themselves in truly selfish fashions. So maybe this post is about human nature.
After receiving $45 billion in government bailout funds, Citigroup executives had gone ahead with plans to buy a new $50 million, twelve-seat corporate jet. The New York Post broke the news on January 26. Apparently, officials from the Obama administration contacted Citigroup and told them to “fix it.” That part made me smile.
The part that saddens me is how people of a certain character and socioeconomic status can lose their “common sense.” Really? A jet? Are you people hearing about people losing their homes? But maybe in their minds buying a jet would be like me buying a camcorder during these difficult economic times. Of course, I didn’t receive any bailout money.
From The Huffington Post.
QotM (Question of the Moment):
Which mood stabilizer is most commonly implicated in the exacerbation of psoriasis?
Answer to previous QotM:
Secondary narcissism.
Questions of the Moment are derived from notes created by S. Hinds, M.D.
QotM (Question of the Moment):
What does an individual choosing to associate with individuals like himself exhibit?
Answer to previous Question of the Moment (QotM):
Deficit Model.
Questions of the Moment are derived from notes created by S. Hinds, M.D.
Shouldn’t this be old news? But I still run across clinicians who have not considered using a second generation antipsychotic to augment treatment for depression. Only now, with the approval of Seroquel for the treatment of bipolar depression and Abilfy as an adjunct for the treatment of major depression (not to mention the bombardment of commercials regarding Abilify), are people starting to become comfortable with using an antipsychotic in depression. However, there have been numerous studies over the years, as well as clinical reports, of people with depression benefiting from antipsychotics. Many with depression complain of a disordered thought process. In addition, some with severe depression develop a preoccupation with negative beliefs that becomes almost (or fully) delusional.
QotM (Question of the Moment):
Weakened or absent psychic structures causing psychopathology is characteristic of what model of psychological illness in psychodynamic psychotherapy?
Answer to previous Question of the Moment (QotM):
REM sleep.
Questions of the Moment are derived from notes compiled by S. Hinds, M.D.
Like mirtazapine, bupropion’s mechanisms of action are a bit convoluted.
Although it has relatively mild binding affinities for dopamine and norepinephrine reuptake pumps (at usually prescribed doses), bupropion is postulated to have its antidepressant effect through the antagonism of these pumps. Binding at other sites is even lower. Bupropion’s side effects of tremors and sweating are consistent with increased levels of dopamine and norepinephrine.
It appears, therefore, that bupropion’s metabolites play a role in its pharmacologic activity. Bupropion has several active metabolites, and their clearance is slower. The total concentration of bupropion with its metabolites likely accounts for the overall effect of increasing dopamine and norepinephrine.
With information from: Bupropion: What Mechanism of Action? Sheldon H Preskorn, MD. Journal of Practical Psychiatry and Behavioral Health, January 2000, 272-276.
So I always get confused about the details of mirtazapine’s mechanisms of action. I’m not sure what my mental block is. Time to review.
Mirtazapine’s likely antidepressant action is due to antagonism of the presynaptic alpha-2 adrenergic receptors. This should allow for the greater release of serotonin and norepinephrine.
However, mirtazapine’s most potent activity is antagonism of histamine-1 receptors (thus, the sedation). At higher doses, mirtazapine also blocks 5HT2A, 5-HT2C, and 5-HT3 receptors. Antagonism of alpha-2 receptors actually comes last with increasing dosage.
Interestingly, agonism of 5-HT2A, 5-HT2C, and 5-HT3 receptors may be related to the adverse effects of SSRIs: sleep disturbance (5-HT2A), anxiety and weight gain (5-HT2C), and nausea/loose stools/vomiting (5-HT3). Therefore, the antagonist effects of mirtazapine at these sites may mitigate some of the adverse effects of the SSRIs.
With information from: Imipramine, Mirtazapine, and Nefazodone: Multiple Targets. Sheldon H Preskorn, MD. Journal of Practical Psychiatry and Behavioral Health, March 2000, 97-102.
QotM (Question of the Moment):
Paroxysmal hemicrania, a type of unilateral vascular headache, usually occurs during which sleep cycle?
(Answer will be posted in the next QotM post.)
Questions of the Moment are derived from notes created by S. Hinds, M.D.
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