Case Studies on Depression, Dopaminergic Effects, Multiple Sclerosis and Traumatic Brain Injury

Question 1: Depression and Treatment with Escitalopram and Lorazepam

Answer each question separately:
Question 1) Shaun, 43, lost his job in March due to a work restructure. Unable to find something suitable he has become increasingly worried about finances and feels stressed most of the time, with bouts of insomnia, accompanied with an inability to get out of bed. Having experienced a period of depression once before in his 20s, when these feelings continued for two months, he sought help from his local doctor. Shaun's doctor diagnosed him with depression. He prescribed escitalopram, and also gave him a two-week prescription for lorazepam to help with his insomnia. 

1.From this case study discuss Shaun's circumstances and symptoms with what you know of depression. 
2.Describe the mechanism of action of these two medications and their major adverse effects. 
3.Evidence shows that antidepressants take weeks to work. Discuss this mechanism of action. You should include information on neuroplasticity. 

Question 2) Dopamine-associated drugs are used in the treatment of schizophrenia and Parkinson's disease. For these two disorders, in your own words, discuss the presentation, anatomical and pharmacological mechanisms underlying the observed dopaminergic-adverse effects. 

Question 3) Norah, a 26-year-old female living in Tasmania, first noticed her symptoms in the summer of 2019. She experienced blurring of vision in one eye which then turned into vision loss. This was accompanied by excessive fatigue and some clumsiness. All symptoms dissipated after 4 days. Her GP sent her for some tests including an MRI. The MRI scan findings revealed a plaque in her corpus callosum; the physician classified her event as a "clinically isolated syndrome" of multiple sclerosis (MS). 

Approximately 10 months later, Norah's symptoms resurfaced: she experienced the same fatigue, vision disturbances and numbness in her arms and legs. A second MRI revealed three more plaques; prompting a diagnosis of relapsing-remitting MS (RRMS). Over the next year Norah has been prescribed interferon 1a, glatiramer and fingolimod. 

One of Norah's friends suggested she try hash brownies (chocolate brownie çakes with marijuana cooked inside) to help calm her symptoms. Norah was unsure how this would work and worried that this would be addictive. 
1.Compare the three drugs that Norah is taking in terms of their mechanism of action and how this is related to the pathology we see in MS. 
2.Discuss the use of marijuana recreationally, and as a potential treatment in MS. You should address Norah's concems about addiction. 

Question 4) Robert, 62, was involved in a car-bicycle collision three years ago where he unfortunately suffered a serious head injury despite wearing a bicycle helmet. Eyewitnesses reported that he lost consciousness upon impact, suffering from convulsions involving his arms and legs that lasted a few minutes. Robert was administered midazolam and then transported by ambulance to a local emergency department where he underwent a scan of the head that showed no skull fracture but an area of intracranial haemorrhage (a brain bleed). Robert's recovery from this traumatic brain injury (TBI) was slow but steady. He was however diagnosed with post-traumatic epilepsy after two incidences of tonic-clonic seizures. Doctors prescribed carbamazepine and valproate. 

Now three years after the accident Robert's wife partner reports he is becoming forgetful and confused. With a clear association between previous TBI and the risk of dementia it is suggested that he may be suffering with vascular dementia. 
1.Compare and contrast the medications used to control Robert's seizures that occurred directly after the accident, and in the longer term. You should include their pharmacological mechanism of action, medical use and any adverse effects that would be relevant to Robert's recovery 
2.Discuss why this kind of dementia is being suggested as the diagnosis and the potential treatment options for Robert.