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All the study questions of psychopharmacology
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Study questions psychopharmacologyStudy questions per lecture – weeks 1 & 2, lectures 1, 2 & 3
Per lecture study questions have been formulated, that summarise the important
points from the material for that subject, and which can be used for studying the
required reading for that lecture.
The answers to the study questions may come from the book ‘Psychopharmacology’ or the
‘Handbook’, depending on the material assigned for the lecture in question. The study questions
about the clinical lectures from the ‘Handbook’ are also intended to summarise the exam material.
Together with the book ‘Psychopharmacology’ by Kenemans (the book in its entirety is material for
the exam), and the lectures, the answers to these study questions make up the material for the final
examination. This means that, from the chapters in the ‘Handbook’, only those aspects covered in
the study questions make up the material for the examination.
You will have to answer the study questions yourself based on the reading
material for the lectures. It is recommended that you try to answer the questions
while reading the material for each lecture. If any questions are unclear, you will
have the opportunity during the lectures to ask the lecturer questions about the
relevant material. A discussion board on Blackboard has been set up for any
questions that are still not clear, or which remain unclear to you after the lecture.
Make good use of the help that other students may offer on the board. The
lecturers will check the board at least once a week to see if there are any
questions that students have not been able to answer amongst themselves.
In the first work group some of the study questions related to the lectures in
weeks 1&2 will be applied to a specific pharmacon that you have been assigned
for assignment 1. These are marked with ‘ WG’. Read the documents about
assignment 1 that can be found on Blackboard under ‘Assignments’ for further
details.
Lecture 1: Introduction
- Which two overarching classes of psychoactive substances can
be discerned based on their use?
Recreational drugs and medicinal drugs. The first is that people
themselves administer the drugs because the substance has a
rewarding effect. This rewarding effect increases the likelihood that
someone will take them again when a next opportunity arrives. This
depends on the availability as well as the satiating effect the drug has.
Most of the time drugs that don’t have satiating effect will lead to
repeated self-administration and thus increases the likelihood of
addiction (this is in comparison to drugs and it’s sedative effect).
Medicinal drugs are used to reduce, change or otherwise control
problematic behavior. Its problematic if the individual experiences
dysfunctions from this or the people surrounding them.
,- What are the different names that are given to medications once they
become available for prescription, and what is the difference
between these names?
WG question 1
It’s the brand name of the pharmaceutical, so for a common SSRI its Prozac
but the generic name is fluoxetine. The first has a name the patent holder
created, when the patent expires it’s also sold under the generic name (and
usually less expensive).
- What is pharmacokinetics and pharmacodynamics? Describe these
terms and understand their difference.
Pharmacokinetics= how a substance moves through the body. So how long does
it take to work? Where in the body does it exerts its effects? Does it arrive in the
brain and how so? Etc.
Pharmacodynamics= the kind of interactions this has with neurotransmitters. To
what receptors does the substance bind? What effect does the substance have on
the receptor?
The difference is the focus on how the substances work, in pharmacokinetics the
focus is on the body as a whole, while pharmacodynamics specifically focusses
on the interaction with neurotransmitter (e.g. the brain).
- Medications have a certain indication, meaning the illness, symptoms
or disorder for which they are prescribed. In general, within which
area do the indications for psychoactive substances fall?
WG question 2
See assignment 1!
- Describe the most common mechanisms of modulation of
neurotransmission along which psychoactive substances exert their
influence on the brain.
WG question 3
See assignment 1!
- Many of the currently used psychoactive substances have been
discovered by serendipity, but once every so often new medications
are developed on purpose through hypothesis-driven research lines.
Describe in broad terms the (pre)clinical development phases which a
new medicine has to pass before it can be made available to patients.
The steps for preclinical phase are:
1. Basic knowledge i.e. literature
2. Clinical knowledge
3. Production of the drug
4. Chemical/biological synthesis along with laboratory research
5. Development of administration methods
6. Preclinical research with rodents
The steps for clinical phase:
,- Is the substance safe? Healthy volunteers are subjected to the chemical
and they see if they tolerate the substance.
- Does it work? They test the drugs on sick people (target population).
Aim is to test if the drugs really work. Most often this is with a small
sample
- Does it work and is it better (or as good as) than other existing drugs?
Usually done in larger trials and compared to a placebo group and then
against existing treatments.
- What are the effects in the long term? Mostly focusses on side effects in
the long term or researches the optimal treatment duration. But the
medicine is also tested for its effets on other diseases as well. This
phase is important because major side effects usually do not come to
light until this phase. It constitutes of searching for the most optimal
application so the lowest dose with maximal therapeutic effect and/or
highest dose with side effects at placebo level.
- In the development of new medicines, there are many bottle necks.
What are the most important conceptual bottle necks (think for
example of brain mechanisms that cause the disorder)? And what are
the most important practical hindrances (for example, think of
pharmacokinetic properties)? And what are financial hindrances?
One of the conceptual bottlenecks is that relatively little is known about the
specific brain mechanisms underlying disorders. The goal of scientific research
is to explain phenomena and to make them predictable. But usually the
working properties are discovered by accident. The goal is often to to
determine wether the drugs has the desired effect in a specific group of
patients, without explaining why it has that effect. Another bottleneck is that
many people may share the same diagnosis, but symptoms may differ, so the
therapeutic effects may also differ. The last type of bottleneck is that 2/3
usually benefit from the drug, but 1/3 remains ill.
Also the rewarding/wanted effect depends on the substances reaction with
various types of proteins in the brain. This can cause unwanted side effects in
addition to the desired effects. So you have to untangle on which protein the
substances causes the desired effect and which protein causes the undesired
effects.
Financial hindrances are that making the drugs is very expensive, usually
because it takes such a long time to develop.
- There are various reasons why most psychoactive substances not
only exert their main (intended) effect, but also unwanted side-
effects. Describe the two most important reasons.
WG question 4 [questions 5 and 6 are below under Lecture 2]
See assignment 1!
, First the potency and efficacy of a drug cannot be considered separately from
the undesirable side effects of a specific dose. With drugs its usually the case
that low doses exert wanted effects such as a cheerful mood, but increasing
the dose often leads to other effects that begin to dominate. The balance
differs from individual to individual. In practice this means that in recreational
drug use (such as alcohol) the rewarding effect of the first dosage will lead to
a reward that leads to repeated intake. And this is where the unwanted side
effects come in to play, because more consumption of a substance will
increase the probability of (unwanted) side effects. Let’s take alcohol as an
example again; with the first drink you feel happy and cheerfull, so you’re
more inclined to take another drink. The repeated intake will eventually lead
to drowsiness, something you didn’t want.
Second most psychoactive substances interact with neurotransmitters that
also interact with other neurotransmitters or their processes. So you may get
the desired effect, for example less impulsive behaviour in ADHD, but also the
undesired effects such as less appetite. In principle the higher the dose the
higher the side effects.
To a certain extent there is also a similar relationship for the desired effect
where the increasement of the desired effect becomes undesirable.
Kijk nog een keer naar de laatste alinea op p.20
They do not selectively bind! Most substances bind to more than just he receptor
that you want them to bind to. So it can also alter other systems/mechanisms in the
brain, and even the body. For example excess serotonin not only affects your
mental state but also has an effect on your gastric intestinal system.
o The receptors are “all over the body ”→you have them in your brain, stomach,
kidneys, etc. → side effects
- Describe the golden standard in executing (psycho)pharmacological
research: placebo –controlled and double-blind. Why are these
aspects of importance?
In a placebo controlled study you compare the group of people that have
taking the drugs with a placebo group (so a pill that has no active substances
in it). In a double blind study nobody, not even the researches know to which
group the people belong. This is important because otherwise their might be a
bias in the researcher as well as in the patients.
- Which result will allow the conclusion that a placebo (fake pill)
medicine may be useful in treatment?
if the treatment group has more of the desired effect in comparison to
the placebo group, you can conclude that the drugs themselves actually
work. So both groups need to experience effects.
- What is an active placebo?
It’s a drug that produces noticeable side effects that may convince the
person being treated that they are receiving a legitimate drug.
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