Module 3: Understanding the Biological Components of Mental Illness

Question 1

Prefrontal cortex

Answer 1

front part of brain; very important for executive functioning; take in the environment; prioritize; make decisions

Question 2

Amygdala, hippocampus, hypothalamus

Answer 2

very important for regulation of emotions and behavior

Question 3

Function of Brainstem

Answer 3

• Core–regulates internal organs and vital functions
• Hypothalamus–basic drives and link between thought and emotion and function of internal organs
• Brainstem–processing center for sensory information coming from all areas of the body

Question 4

Function of Cerebellum

Answer 4

• Regulates skeletal muscle

- Coordination and contraction of major muscle groups

Question 5

Functions of Cerebrum

Answer 5

• At very base of brain–responsible for mental activities.
• Conscious–sense of being
• Emotional status
• Memory
• Control of skeletal muscles–movement
• Language and communication–difficulties with cerebrum will affect patients language.

Question 6

Dendrites within the brain

Answer 6

• network of neurons
• neurons: smallest component of nerves within brain
• pass signals to various areas of brain
• neurotransmitters: vehicle for passing these signals

Question 7

Neuronal cleft

Answer 7

• presynaptic membrane at top
• postsynaptic membrane at bottom
• neurotransmitters lie in the neuronal cleft where signals are transferred from neuron to neuron
• at times there is a lack of neurotransmitters within the cleft (one of the major theories of depression)

Question 8

Neurotransmitters

Answer 8

• vehicles responsible for carrying signals for neuron to neuron
• GABA: responsible for psychotic thoughts
• Serotonin: responsible for depression and depressive disorders (lack of serotonin in neuronal cleft)
• Norepinephrine
• Dopamine

Question 9

Anti-anxiety Medication

Anxiolytics

Answer 9

1. Benzodiazepines (Ativan, Klonopin, Valium)–very short half life; can create tolerance = risk of abuse.
2. Buspar (non-benzodiazepine)–takes 2-4 wks to start working; useful for patients with chemical dependency issues who can’t take benzos and for children on autism spectrum.
3. Antidepressants–used as anti-anxiety med for patients with long-standing and chronic anxiety; SSRIs (prozac, paxil, zoloft)

Question 10

Pharmacodynamics

Answer 10

understanding medications impact on the body

Question 11

Pharmacokinesics

Answer 11

understanding the impact of the individuals body on the medication

Question 12

Treating the elderly

Answer 12

• complicated livers
• slowed metabolism
• break up of medication in liver slowly

Question 13

Anti-depressants

Answer 13

• SSRI (selective serotonin reuptake inhibitors)–introduced as first non-tricyclic antidepressant; Prozac, zoloft, paxil, celexa (lexapro)
• Tricyclic–older generation; a lot of side effects; not used as much anymore; Amitryptaline, imipramine, nortryptyline
• Venlafexine–blocks reuptake of serotonin and norepinephrine; newer generation; fewer side effects

Question 14

Side Effects of Anti-depressants

Answer 14

• TCAs (tricyclic)–sedation, dry mouth, orthostatic hypotension
• SSRIs–weight gain (esp. Paxil), sedation, sexual dysfunction (men: erectile dysfunction; women: inorgasmia)
• Venlafaxine (Effexor)–anxiety, nausea, dry mouth
• Buproprion (Wellbutrin)–contraindicated in individuals w/ seizure hx because it lowers seizure threshold.

Question 15

Mood Stabilizers

Answer 15

• First introduced in 1970s
• Lithium
• Anticonvulsant drugs (depakoate, tegretol, lamictal)

Question 16

Lithium

Answer 16

• mood stabilizer
• metabolized and excreted through kidneys
• people with Lithium toxicity will have damage to their kidneys
• important to educate patients about salt intake, dehydration that can lead to lithium toxicity

Question 17

Anticonvulsant drugs

depakoate, tegretol, lamictal

Answer 17

• often used for bipolar 1 manic depressive d/o w/ mania (depakoate and tegretol)
• mood stabilizer for patients of bipolar 2 (lamictal)
• serious side effects
• stevens johnson syndrome (necrotizing skin condition; patient looks sunburnt, sloughing off of skin)
• educate when beginning medication
• look for rashes that appear on trunk and face (esp. within 1st 8 wks)

Question 18

Antipsychotics

Answer 18

• Conventional Antipsychotics

- Atypical 2nd generational, 3rd generational

Question 19

Conventional Antipsychotics

Answer 19

-Phenothiazines
(Thorazine–rarely used now, Haldol, Prolixin)
-Strong blockers of dopamine, ACH, norepinephrine, and histamine–important to consider when talking about side effects

Question 20

Side Effects for Conventional Antipsychotics

Answer 20

1. Dopamine blocade = motor disturbances
   (TD–tardive dyskinesia–permanent reaction to med; dyskinesia–sudden onset of spasms of muscles–psychiatric emergency, treat w/ benadryl; parkinsonism–pt has mask like face, shuffling gait; akathesia–feeling that you just can’t sit still)
2. Anticholinergic blockade = ACH side effects
   (blurred vision, dry mouth, constipation)
3. Norepinephrine blockade = vasodilation, orthostatic hypotension
4. H1 receptor blockade = sedation, weight gain

Question 21

Atypical/Second Generation Antipsychotics

Answer 21

• bind with dopamine in the limbic system vs. basal ganglia
• largest and most problematic side effect–weight gain and metabolic syndrome (weight gain, increased abdominal girth, diabetes type 2, hypercholesterolemia)

Question 22

Clozapine

Answer 22

atypical/3rd generation antipsychotic

• side effect = agranulocytosis (elimination of WBCs)
• used as a last resort
• tightly regulated
• 2 wk supply dispensed with WBC counts every 2 wks

Question 23

Zyprexa

Answer 23

side effect of excessive weight gain