Psychiatric Disorders Flashcards
Neurotransmitters
- Released from the nerve terminal and one of three things can happen
~ Bind to receptors
> Interaction is by chance
~ Inactivated by enzymes
~ Reputake into nerve terminal
> Released again
> Broken down by monoamine
oxidase (MAO)
Major Depression
- Mood disorder diminishing person’s ability to function
~ Tied to decreased serotonin and/or
norepinephrine activity - Symptoms are measured but serotonin should be measured instead of
~ Very difficult because it can’t cross the
BBB
Major Depression: Antidepressant Drugs
- Most drugs related to serotonin or norepinephrine.
~ Norepinephrine and serotonin are
related to mood.
> Many parts of the brain
responsible for mood are
stimulated by both serotonin and
norepinephrine.
Antidepressant Drugs: Tricyclic Antidepressants (TCAs)
- Ex: Elavil
- Mechanism
~ Block reputake of norepinephrine and
serotonin
> Increases chance of receptor
binding, enhances effects of
neurotransmitter
Antidepressant Drugs: Tricyclic Antidepressants (TCAs) Adverse Effects
- Many adverse effects.
- In addition to effect on norepinephrine and serotonin
~ Block alpha-adrenergic receptors
~ Block cholinergic receptors
(Anticholinergics) - Sexual Dysfunction
~ Overactive serotonin - Alpha-adrenergic Block
~ Receptor activation causes
vasoconstriction.
> Block does not allow
vasoconstriction.
• Orthostatic Hypotension
* Body can’t increase BP =
fainting
Antidepressant Drugs: Tricyclic Antidepressants (TCAs) Anticholinergic Effects
- Blurred Vision
- Constipation
- Decreased Sweating
- Dry Mouth
- Throat Irritation
- Pupil Dilation
- Urinary Hesitancy/Retention
Antidepressant Drugs: Selective Serotonin Reputake Inhibitors (SSRI)
- Ex: Prozac, Laxapro, Zoloft
- Mechanism
~ Block reputake of serotonin
Antidepressant Drugs: Selective Serotonin Reputake Inhibitors (SSRI) Adverse Effects
- Fewer than TCAs
~ Don’t block alpha-adrenergic
receptors
~ Not Anticholinergic - Sexual Dysfunction
- Nausea/Vomiting
- Headache
- Restlessness
- Anxiety
~ Due to increased serotonin in a
specific part of the brain
Antidepressant Drugs: Monoamine Oxidase Inhibitors (MAOIs)
- Ex: Marplan, Nardil, Parnate
- Mechanism
~ Inhibit MAO which increases
availability of serotonin and
norepinephrine - Used most often when TCAs or SSRIs do not work.
- Not first line because of adverse effects and food/drug interactions associated with MAOIs.
Antidepressant Drugs: Monoamine Oxidase Inhibitors (MAOIs) Adverse Effects
- Sexual Dysfunction
- Alpha-adrenergic
~ Orthostatic Hypotension - Anticholinergic Effects
~ Blurred Vision
~ Constipation
~ Decreased Sweating
~ Dry Mouth
~ Throat Irritation
~ Pupil Dilation
~ Urinary Hesitancy/Retention
Monoamine Oxidase Inhibitors (MAOIs) Adverse Effects: Hypertensive Crisis
- Increased BP from excess norepinephrine (due to it not being broken down because MAO was inhibited)
~ Norepinephrine activates alpha-
adrenergic receptors. - Combining MAOls with TCAs.
- Combining with sympathomimetic.
- Combining with foods high in tyramine
~ Tyramine increases norepinephrine
release.
Antidepressant Drugs: Serotonin/Norepinephrine Reputake Inhibitors (SNRIs)
- Ex: Cymbalta, Effexor
- Mechanism
~ Block reputake of serotonin and
norepinephrine
~ Similar to TCAs but don’t block alpha-
adrenergic receptors and are not
Anticholinergic
Antidepressant Drugs: Serotonin/Norepinephrine Reputake Inhibitors (SNRIs) Adverse Effects
- Sexual Dysfunction
- Nausea
- Constipation
- Headache
- Weight Loss
- Nervousness
- Sweating
- Insomnia
- Hypertension
Serotonin Syndrome
- Excess serotonin levels
~ Happens most often when combing
drugs that increase serotonin levels
> TCAS, MAOIS, SSRIs, SNRIs.
~ Some OTC drugs, illegal drugs and
dietary supplements can also increase
levels.
~ Reaction can be severe resulting in
death.
Serotonin Syndrome Symptoms
- Hyperthermia
- Agitation
- Seizures
- Tremor
- Confusion
- Sweating
- Tachycardia
- Hypertension
- Anxiety
Schizophrenia
Chronic disturbances of perception, mood and cognitive function
Schizophrenia Cause
- Multiple factors but brain chemistry may be one
- Dopamine: Excitatory
~ Efficient Movement
~ Pleasure/Reward
~ Memory
~ Focus
~ Cognition - Serotonin
~ Mood
Schizophrenia: Positive Symptoms
- Exaggeration of normal function
- Hallucinations: Experiencing something not present.
~ Sight
~ Sound
~ Taste
~ Smell - Delusions: Strong belief despite evidence to the contrary.
- Paranoia: Belief that others are hostile without supporting evidence.
- Psychomotor Agitation/Hyperactivity
Schizophrenia: Negative Symptoms
- Diminished normal function
- Social/Emotional Withdrawal
- Apathy
- Loss of Drive
- Psychomotor Depression
Schizophrenia: Antipsychotic Drugs - Typical/First Generation
- Ex: Ex. Thorazine, Haldol
- Block receptors for dopamine
Schizophrenia: Antipsychotic Drugs - Atypical/Second Generation
- Ex: Abilify
- Generally less blocking of dopamine (helps w/ + symptoms)
- May increase glutamate levels (helps w/ - symptoms)
~ Glutamate is excitatory to neurons of
the brain - Fewer adverse effects
Schizophrenia: Antipsychotic Drugs Adverse Effects
- Movement Disorders
~ Dystonia
~ Pseudo Parkinsonism
~ Tardive Dyskinesia - Orthostatic Hypotension
~ Alpha-adrenergic receptors are
blocked - Anticholinergic Effects
~ Blurred Vision
~ Constipation
~ Decreased Sweating
~ Dry Mouth
~ Throat Irritation
~ Pupil Dilation
~ Urinary Hesitancy/Retention
Bipolar Disorder
- Mood disorder alternating between periods of major depression and mania
~ Mania
> Elevated Mood
> Unrealistic Optimism
> Hyperactivity
> Decreased Need for Sleep
> Poor Attention
> Poor Judgement
> Hallucinations/Delusions - Antipsychotic drugs are used along w/mood stabilizers to treat mania
Mood Stabilizers: Lithium
~ Initially used for gout
~ Mechanism (not well understood)
> Appears to decrease the function of
dopamine and glutamate receptors
both at which are excitatory to
neurons
Mood Stabilizers: Lithium Adverse Effects
- Can cause toxicity even at therapeutic levels
~ May result in seizure, coma, or death - Early S&S
~ Nausea
~ Diarrhea
~ Confusion
~ Muscle Weakness
~ Headache
~ Polyuria
~ Polydipsia
~ Fine Hand Tremor
Mood Stabilizers: Valproic Acid
- Initially used for epilepsy.
- Just as effective as lithium with fewer adverse effects.
- Mechanism (Not well understood)
~ Appears to increase Gamma-
Aminobutyric Acid (GABA) levels
> GABA is inhibitory to neurons
Mood Stabilizers: Valproic Acid Adverse Effects
- Nausea/Vomiting
- Diarrhea
- Indigestion
- Tremor
- Sedation
Mood Stabilizers: Carbamezpine
- Initially used for epilepsy
- Mechanism
~ Inhibits neurons
> Decreases influx of Na
• helps neurons to depolarize =
less activity
> Inhibits glutamate release
Mood Stabilizers: Carbamezpine Adverse Effects
- Nausea/Vomiting
- Diarrhea
- Sedation
- Confusion
- Headache
- Blurred Vision
- Slurred Speech
Anxiety Disorders
Stressful situation that creates a sense of uncertainty making one fearful or apprehensive.
Anxiety Disorders: Generalized Anxiety Disorder
Excessive and uncontrollable worry about several events or activities.
Anxiety Disorders: Panic Disorder
Sudden onset of fear with racing heart, sweating, dyspnea, chest pain, nausea.
Anxiety Disorders: Social Anxiety Disorder
Fear of social or performance situations.
Drugs for Anxiety Disorders: Benzodiazepine
- Ex: Xanax, Librium, Valium
- Mechanism
~ Enhances the action of GABA
> Binds to a portion of the GABA
receptor and that binding causes
changes to the GABA receptor
• Makes receptors more
sensitive to GABA
Drugs for Anxiety Disorders: Benzodiazepine Adverse Effects
- Physical dependence
- Sedation
- Amnesia
Drugs for Anxiety Disorders: Buspirone
- Slower acting than benzodiazepine, but fewer adverse effects.
~ Does not cause dependence. - Ex: BuSpar
- Mechanism (Not well understood)
~ High serotonin levels in some areas of
the brain increase feelings of fear/
anxiety
> Appears to block serotonin
receptors in these areas
Drugs for Anxiety Disorders: Buspirone Adverse Effects
- Headache
- Dizziness
