Chapter 2 Neurobiologic Theories & Psychopharmacology Flashcards
Psychopharmacology
The use of meds to treat mental illness
What does the brain consist of?
Cerebrum
Cerebellum
Brain stem
Limbic System
Cerebrum
Divided in 2 hemispheres
- All lobes & structures are in both hemispheres expect pineal gland
Further divided into 4 lobes: frontal, parietal, temporal, & occipital
Pineal Gland
An endocrine gland that influences the activities of the pituitary gland, islets of Langerhans, parathyroids, adrenals, & gonads
Corpus Callosum
A pathway connecting the LT & RT hemispheres & coordinating their functions
What is the LT hemisphere responsible for?
Controls the RT side of the body & Center for logical reasoning & analytical functions
- Reading
- Writing
- Mathematical tasks
What is the RT hemisphere responsible for?
Controls the LT side of the body & Center for:
- Creative thinking
- Intuition
- Artistic abilities
Frontal Lobe
Controls the organization of thought, body movement, memories, emotions, and moral behavior
Integration of all this information regulates arousal, focuses attention, and enables problem-solving and decision-making
Abnormalities in the Frontal Lobe are Associated w/:
- Schizophrenia
- Attention-deficit/hyperactive disorder (ADHD)
- Dementia
Parietal Lobe
Interpret sensations of taste and touch and assist in spatial orientation
Temporal Lobe
Centers for the senses of smell and hearing and for memory and emotional expression
Occipital Lobe
Assist in coordinating language generation and visual interpretation, such as depth perception
Cerebellum
Located below the cerebrum
Center for coordination of movements and postural adjustments
Receives & integrates info from all areas of the body, such as the muscles, joints, organs, and other components of the CNS
Inhibited transmission of dopamine to this area-> Parkinson’s disease, dementia (lack of smooth coordinated mvmnts)
Brain Stem
Includes the midbrain, pons, and medulla oblongata and the nuclei for cranial nerves III through XII.
Medulla: Located at the top of the spinal cord
- Contains vital centers for respiration and cardiovascular functions.
Pons: Above the medulla and in front of the cerebrum
- Bridges the gap both structurally and functionally, serving as a primary motor pathway
Midbrain: Connects the pons and cerebellum with the cerebrum
- Measures only 0.8 in (2 cm) length and includes most of the reticular activating system and the extrapyramidal system.
The reticular activating system influences motor activity, sleep, consciousness, and awareness. The extrapyramidal system relays information about movement and coordination from the brain to the spinal nerves.
The locus coeruleus, a small group of norepinephrine-producing neurons in the brain stem, is associated with stress, anxiety, and impulsive behavior
Limbic System
An area of the brain located above the brain stem that includes the thalamus, hypothalamus, hippocampus, and amygdala
Hippocampus & amygdala are involved in emotional arousal & memory
Disturbances in the limbic system are implicated in mental illnesses:
- Memory loss w/dementia
- Poorly controlled emotions & impulses seen w/ psychotic & manic disorder
Thalamus
Regulates activity, sensation, & emotion
Hypothalamus
Involved in:
- Temperature regulation
- Appetite control
- Endocrine function
- Sexual drive
- Impulsive behavior associated w/: anger, rage, or excitement
Neurotransmission
Occurs when neurons communicate info w/ each other by sending electrochemical messages from neuron to neuron
Neurotransmitters
Chemical substances manufactured in the neuron that aid in the transmission of information throughout the body
Necessary in just the right proportions to relay messages across the synapses.
Studies are beginning to show differences in the amount of some neurotransmitters available in the brains of people w/ certain mental disorders compared with those who have no signs of mental illness
Excitatory Neurotransmitters
Either excite or stimulate action in the cells
Inhibitory Neurotransmitters
Inhibits or stop action
Steps of Neurotransmission
1) Neurotransmitters fit into specific receptor cells embedded in the membrane of the dendrite
- Like a key into lock
2) Neurotransmitters are released into the synapse
- Relay message to receptor cells
3a) Reuptake: Transported back from the synapse to the axon to be stored for later use
3b) Metabolized and inactivated by enzymes, primarily monoamine oxidase (MAO)
Dopamine
A neurotransmitter located primarily in the brain stem
Involved in the control of complex movements, motivation, cognition, and regulation of emotional responses
Generally excitatory and is synthesized from tyrosine
Abnormal Increase is associated w/:
- Schizophrenia
- Mania
Abnormal Decrease is associated w/:
- Parkinson’s
- Depression
Antipsychotic medications work via blocking dopamine receptors and reducing dopamine activity
Norepinephrine
Located primarily in the brain stem (Excitatory)
Plays a role in changes in attention, learning and memory, sleep and wakefulness, and mood regulation
Excess is implicated in:
- Several anxiety disorders;
- Schizophrenia
- Mania
Deficits may contribute to memory loss, social withdrawal, and depression
Epinepherine
Derivative of Norepinephrine (Excitatory)
Controls fight-or-flight response
Serotonin
Controls food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions (Inhibitory)
Decrease: Depression
Histamine
Controls alertness, gastric secretions, cardiac stimulation, peripheral allergic responses (Neuromodulator)
Acetylcholine
Controls sleep and wakefulness cycle; signals muscles to become alert (Excitatory/Inhibitory)
Gamma-Aminobutyric Acid (GABA)
Modulates other neurotransmitters (Inhibitory)
- Reduces aggression, excitation, anxiety
Decrease:
- Anxiety disorders
- Schizophrenia
- Mania
Increase:
- Reduction of anxiety
Computed Tomography (CT) Scan
A procedure in which a precise x-ray beam takes cross-sectional images (slices) layer by layer
Can visualize the brain’s soft tissues, so it is used to diagnose primary tumors, metastases, and effusions and to determine the size of the ventricles of the brain.
-Some people with schizophrenia have been shown to have enlarged ventricles -> poorer prognosis and marked negative symptoms
Must lie motionless on a stretcher-like table for about 20 to 40 mins as the stretcher passes through a tunnel-like “ring” while the serial x-rays are taken
Benzodiazepines
Antianxiety Meds
Advantages: Fast acting, effective
Disadvantages:
- Drowsiness
- Sedation
- CNS depressant
- Decrease vitals
- Dependence
- Withdrawal
Examples of Benzodiazepines
Alprazolam
Chlordiazepoxide
Clonazepam
Clorazepate
Diazepam
Flurazepam
Lorazepam
Temazepam
Triazolam
Nonbenzodiazepines
Antianxiety
Advantages: None of the disadvantages of benzodiazepines
Disadvantage: Takes 2-6 weeks to take effect
Examples of Nonbenzodiazepines
Buspirone
SSRI’s
SNRI’s
TCA’s
Beta Blockers
Antihistamines
SSRI’s
Antidepressants
Advantage: Effective
Disadvantage:
- Sexual side effects
- CNS stimulation: insomnia, agitation, anxiety
- Serotonin Syndrome
Examples of SSRI’s
Fluoxetine
Fluvoxamine
Sertaline
Citalopram
Escitalopram
Paroxetine
Vilazodone
Serotonin Syndrome
Excess serotonin
Occurs 2-72 hrs after start of treatment
S/s: Confusion, agitation, disorientation, anxiety, poor concentration
Resolves spontaneously when med is w/drawn
Black Box Warning: SSRIs
Risk of suicide may increase especially w/ initial/early treatment
Tricyclic Antidepressants (TCA’s)
Disadvantages: Cardiotoxic (tCa = cardiotoxic)
Lethal in overdose
Examples of TCA’s
Imipramine
Desipramine
Trimipramine
Notriptyline
Amitriptyline
Monoamine Oxidase Inhibitors (MAOI’s)
Antidepressant
Disadvantages: HTN crisis possible if foods w/tyramine are eaten
Tyramine Foods
Aged Cheese
Pepperoni
Salami
Avocado
Figs
Bananas
Smoked fish
Some beers
Red wine
Fava beans
Examples of MAOI’s
Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline transdermal patch
Lithium
Mood Stabilizer
Therapeutic Level 0.5- 1.5
Side effects: GI, tremors
Na+2 & Lithium have an inverse relationship
- Inform patient NOT to change salt intake
- NO LOW SODIUM DIET (will increase the lithium levels)
Lithium Toxicity
- N/V
- Diarrhea
- Confusion
- Poor coordination
Side Effects of Mood-Stabilizing Drugs
Carbamazepine: Rash, orthostatic HTN
Valproic Acid: Wt gain, alopecia, hand tremor
Topiramate: Dizziness, sedation, wt loss
Lamotrigine: Black Box Stevens-Johnson Syndrome
Stevens-Johnson Syndrome
Rash
1st Generation/Typical/Conventional Antipsychotic Meds
Advantages: Inexpensive
Disadvantages: Increased chance of EPS (Extrapyramidal Symptoms/Side Effects)
Extrapyramidal Symptoms/ Side Effects
Akathisia: Feeling restless like you can’t sit still. You may have the urge to tap your fingers, fidget, or jiggle your legs.
Dystonia: When your muscles contract involuntarily. It can be painful.
Parkinsonism: Symptoms are similar to Parkinson’s disease. You may have a tremor, difficulty finishing thoughts or speaking, and stiff facial muscles. But while a loss of nerve cells causes Parkinson’s disease, the medication causes Parkinsonism.
Tardive dyskinesia: Facial movements happen involuntarily. You may make a sucking or chewing motion with your mouth, stick out your tongue, or blink your eyes a lot
Examples of 1st Generation Antipsychotic Meds
Haloperidol
Fluphenazine
Loxapine
Thioridazine
Thiothixene
Perphenazine
2nd Generation Antipsychotics/Atypical/Unconventional Antipsychotic Meds
Advantages: Less EPS
Disadvantages: Expensive, increased risk of metabolic syndrome
Metabolic Syndrome
BMI Increase
Blood glucose increase
BP & cholesterol increase
Examples of 2nd Generation Antipsychotics
Clozapine, Risperidone, Asenapine, Iloperidone
Self Awareness Issues
Clients and families need more than factual information; they need simple and thorough explanations.
View chronic mental illness as having remissions and exacerbations, just as chronic physical illnesses do.
Remain open to new ideas that may lead to future breakthroughs.
Understand that medication noncompliance is often part of faulty thinking and reasoning related to the illness, not willful misbehavior.
