Your 16-year-old son is thrilled when he wins the 100-meter dash in an important high school competition. This “natural high” is most likely associated with inducing dopamine release in his mesolimbic pathway and in his

An excitatory signal is received at the dendrite of a pyramidal glutamate neuron. When the signal is released from the incoming presynaptic dopaminergic axon, it is received as an inhibitory signal. However, this signal is not integrated properly with other incoming signals to that neuron. Which is the most likely site at which the error of integrating this signal with other incoming signals occurred?

Harold, a 74-year-old patient, is brought to your office by his daughter, who reports that her father has been exhibiting several concerning symptoms over the past year. Comprehensive questioning reveals that his symptoms are: trouble remembering familiar things, such as telephone numbers commonly dialed; not recognizing some close family members who visit often; and difficulty performing writing tasks. The patient’s motor function appears to be unaffected. Although not definitive, these symptoms are most likely indicative of which type of dementia?

Peter, a 35-year-old stockbroker, has been advised by his supervisor to come and see you, the company mental health consultant. His supervisor is complaining that he often comes to appointments late, is inappropriately fidgety, interrupts people during meetings, has been offensive towards coworkers, and has been known to party excessively on weeknights. Peter asserts that he is just fine; he has a lot of projects on his mind and is simply standing up for himself when speaking with others. He likes to go out in the evenings to unwind. Recognizing probable attention deficit hyperactivity disorder (ADHD), you interview both the patient and his work buddy, who is a longtime friend. How would you start your questions?

A 24-year-old male initially presents with acute auditory hallucinations and is treated with medication. Four days later he arrives at your office for evaluation. You observe that he is neatly dressed, avoids eye contact, and gives very short answers to your initial questions. Which of the following questions would be most beneficial for determining his degree of negative symptoms?

A 25-year-old woman has recently been diagnosed with bipolar disorder, 6 years after her symptoms began. She has had no mood stabilizing treatment in that time. According to the kindling model and allostatic load hypothesis, what progressive pattern of illness would you expect this patient to have exhibited over the course of the last 6 years?

Denise is a 32-year-old patient with shift work disorder who reports that she is having difficulty in her job as a pastry chef due to excessive sleepiness during her shift. Which of the following is a potential therapeutic mechanism to promote wakefulness?

A 26-year-old woman began treatment for a major depressive episode 8 months ago. Two months into her treatment she began to experience noticeable symptom improvement, and for the last 5 months she has been mostly symptom free, except for persistent cognitive dysfunction. Which of the following statements regarding cognitive dysfunction in depression is most accurate?

A 35-year-old female presents to your office and begins to divulge her frequent worries: ever since she was young, she was worried someone close to her would die in a freak accident. As she grew older, this worry was exacerbated by the fear that she would pass away without telling her friends and family how important they are to her. Additionally, once she had children, she became so worried for their safety that she rarely lets them leave the house. Furthermore, she has constant worries about how things will work out for her in the future, and recently experienced a panic attack. Based only on what you know here, how might you currently diagnose this patient?

This chapter will provide a brief overview of chronic pain conditions associated with different psychiatric disorders and treated with psychotropic drugs. Included here are discussions of the symptomatic and pathophysiological overlap between disorders with pain and many other disorders treated in psychopharmacology, especially depression and anxiety. Clinical descriptions and formal criteria for how to diagnose painful conditions are only mentioned here in passing. The reader should consult standard reference sources for this material. The discussion here will emphasize how discoveries about the functioning of various brain circuits and neurotransmitters – especially those acting upon the central processing of pain – have impacted our understanding of the pathophysiology and treatment of many painful conditions that may occur with or without various psychiatric disorders. The goal of this chapter is to acquaint the reader with ideas about the clinical and biological aspects of the symptom of pain, how it can hypothetically be caused by alterations of pain processing within the central nervous system, how it can be associated with many of the symptoms of depression and anxiety, and finally, how it can be treated with several of the same agents that can treat depression and anxiety. The discussion in this chapter is at the conceptual level, and not at the pragmatic level. The reader should consult standard drug handbooks (such as Stahl’s Essential Psychopharmacology: the Prescriber’s Guide) for details of doses, side effects, drug interactions, and other issues relevant to the prescribing of these drugs in clinical practice.

Attention deficit hyperactivity disorder (ADHD) is not just a disorder of “attention,” nor does it have to include “hyperactivity.” Paradigm shifts are altering the landscape for treatment options across the full range of ADHD symptoms, from inattention to impulsivity to hyperactivity, as well as across all the waking hours and across the whole lifespan, from young children through adulthood. This chapter will provide an overview of the psychopharmacology of ADHD, including only short discussions of the symptoms of ADHD. The mechanism of action of treatments classically called stimulants and nonstimulants for ADHD will be emphasized. Information on the full clinical descriptions and formal criteria for how to diagnose and rate ADHD and its symptoms should be obtained by consulting standard reference sources. The discussion here will emphasize the links between various brain circuits and their neurotransmitters with the various symptoms and comorbidities of ADHD and how these are linked to effective psychopharmacological treatments. The goal of this chapter is to acquaint the reader with ideas about the clinical and biological aspects of attention, impulsivity, and hyperactivity. For details of doses, side effects, drug interactions, and other issues relevant to the prescribing of drugs for ADHD in clinical practice, the reader should consult standard drug handbooks (such as Stahl’s Essential Psychopharmacology: the Prescriber’s Guide).

Modern psychopharmacology is largely the story of chemical neurotransmission. To understand the actions of drugs on the brain, to grasp the impact of diseases upon the central nervous system, and to interpret the behavioral consequences of psychiatric medicines, one must be fluent in the language and principles of chemical neurotransmission. The importance of this fact cannot be overstated for the student of psychopharmacology. This chapter forms the foundation for the entire book, and the roadmap for one’s journey through one of the most exciting topics in science today, namely the neuroscience of how disorders and drugs act upon the central nervous system.