Chapter 2 Psych Power Point

8/4/2019 Chapter 2 Psych Power Point

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Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 2

NeurobiologicTheories andPsychopharmacology

Chapter 2

NeurobiologicTheories andPsychopharmacology


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Great strides are being made inunderstanding the brain andmental illness, but much is stillunknown; nurses need to keep

abreast of developments toprovide effective teaching

Neurobiologic TheoriesNeurobiologic Theories


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Central Nervous SystemCentral Nervous System

Consists of:

Brain

o Cerebrum

o Cerebellum

o Brain stem

o Limbic system

Spinal cord

Nerves that control voluntary acts


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CerebrumCerebrum

Divided into 2 hemispheres with 4 lobeseach:

Frontal lobe (thought, body movement,memories, emotions, moral behavior)

Parietal lobe (taste, touch, spatialorientation)

Temporal lobe (smell, hearing, memory,emotional expression)

Occipital lobe (language, visual

interpretation)


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CerebellumCerebellum

Receives and integrates informationfrom all body areas to coordinatemovement and posture


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Brain StemBrain Stem

Midbrain

Pons

Medulla oblongata

Locus ceruleus

Cranial nerve nuclei 3 through 12


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Limbic SystemLimbic System

Above the brain stem and includes: Thalamus

Hypothalamus

Amygdala


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NeurotransmittersNeurotransmitters


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Neurotransmitters (contd)Neurotransmitters (contd)

Chemical substances manufactured in theneuron to aid in transmission of information.

Either inhibitory or excitatory


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Neurotransmitter DrugsNeurotransmitter Drugs

y Dopamine (control of complex movements,motivation, cognition, regulation ofemotional responses)

y Norepinephrine (attention, learning,memory, sleep, wakefulness, moodregulation)

Epinephrine (flight-or-fight response)

y Serotonin (food intake, sleep, wakefulness,temperature regulation, pain control, sexual

behaviors, regulation of emotions)


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Neurotransmitter Drugs (contd)Neurotransmitter Drugs (contd)

Histamine (alertness, control of gastric

secretions, cardiac stimulation, peripheralallergic responses)

Acetylcholine (sleep and wakefulness cycle,signals muscles to become alert)

Glutamate (an excitatory amino acid)

GABA (modulates other neurotransmitters)


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Brain Imaging TechniquesBrain Imaging Techniques

Computed tomography (CT)

Magnetic resonance imaging (

MRI)

Positron emission tomography (PET)

Single photon emission computed

tomography (SPECT)

We cannot yet diagnose mental illnesswith these techniques alone


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Axial PET Scan of a Male Patient WithAlzheimers DiseaseAxial PET Scan of a Male Patient WithAlzheimers Disease


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Causes of Mental IllnessCauses of Mental Illness

Genetics and heredity: play a role but alone

do not account for development of mentalillness

Psychoimmunology: a compromised immunesystem could contribute, especially in at-risk

populations

Infections, particularly viruses, may play arole


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PsychopharmacologyPsychopharmacology

Psychopharmacology and medicationmanagement are important in thetreatment of many mental illnesses

Approved uses

Off-label uses

Black box warnings


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Principles of PsychopharmacologyPrinciples of Psychopharmacology

y Principles that guide the use of medications include:

Effect on target symptom

Adequate dosage for sufficient time

Lowest dose needed for maintenance

Lower doses for the elderly

Tapering rather than abrupt cessation to avoidrebound or withdrawal

Follow-up care

Simplify the regimen for increased compliance


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Antipsychotic Drugs Conventionalonventional AtypicalAtypical NewNew GenerationGeneration

Antipsychotic Drugs Conventionalonventional AtypicalAtypical NewNew GenerationGeneration

Uses:

Schizophrenia, acute mania, psychoticdepression, drug-induced psychosis,and other psychotic symptoms

Action: Treat psychotic symptoms, such as

delusions and hallucinations, byblocking dopamine receptors


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3Antipsychotics Available inDepot Injection

3Antipsychotics Available inDepot Injection

Prolixin (decanoate fluphenazine)

Duration of 7 to 28 days

Haldol (decanoate haloperidol)

Duration of 4 weeks

Risperidone (Risperdal Consta)

Duration of 2 weeks


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Conventional Antipsychotic DrugsPhenothiazines (Thorazine, Prolixin, Mellaril, Stelazine),

Navane, Haldol, Loxitane, Moban

Conventional Antipsychotic DrugsPhenothiazines (Thorazine, Prolixin, Mellaril, Stelazine),

Navane, Haldol, Loxitane, Moban

Side effects

Extrapyramidal side effects(EPS)

Pseudoparkinsonism

Dystonia

Akathisia

Anticholinergic side effects

Tardive dyskinesia (TD)

Neuroleptic malignant

syndrome (NM

S)

Patient teaching

Adhering to medicationregimen

Managing side effects

Thirst

Constipation

Sedation


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Atypical Antipsychotic DrugsClozaril, Risperdal, Zyprexa, Seroquel, Geodon

Atypical Antipsychotic DrugsClozaril, Risperdal, Zyprexa, Seroquel, Geodon

Side effects

Fewer EPS

Weight gain

Agranulocytosis(Clozaril)

Patient teaching

Adhering to medicationregimen

Reduce sugar and caloricintake

C

lozaril Weekly WBC monitoring

Discontinue med andseek care at first sign ofinfection


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New Generation Antipsychotic Drugs

Aripiprazole (Abilify)

New Generation Antipsychotic Drugs

Aripiprazole (Abilify)

Side effects

Headache

Anxiety Nausea

Patient teaching

Adhering tomedication regimen


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Antidepressant Drugs SSRIs TCAs MAOIs

Antidepressant Drugs SSRIs TCAs MAOIs

Uses:

Major depression, panic disorder,other anxiety disorders, bipolardepression, psychotic depression

Action:

Interact with the monoamineneurotransmitter systems in thebrain, particularly theneurotransmitters norepinephrineand serotonin


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SSRI Antidepressant DrugsFluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft),

Citalopram (Celexa), Escitalopram (Lexapro)

SSRI Antidepressant DrugsFluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft),

Citalopram (Celexa), Escitalopram (Lexapro)

Side effects

Anxiety

Agitation

Akathisia

Nausea

Insomnia

Sexual dysfunction(anorgasmia/impotence)

Patient teaching

Take in the morning

Take with food

Propranolol given for

akathisia


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TCAAntidepressant DrugsImipramine (Tofranil), Desipramine (Norpramin),

Amitriptyline (Elavil), Doxepin (Sinequan),Clomipramine (Anafranil)

TCAAntidepressant DrugsImipramine (Tofranil), Desipramine (Norpramin),

Amitriptyline (Elavil), Doxepin (Sinequan),Clomipramine (Anafranil)

Side effects

Anticholinergic (blurredvision, urinary retention,dry mouth, constipation)

Orthostatic hypotension

Sedation

Weight gain

Tachycardia

Sexual dysfunction

Patient teaching

Take in the evening

Use caution whendriving


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MAOI Antidepressant DrugsPhenelzine (Nardil), Tranylcypromine (Parnate),

Isocarboxazid (Marplan)

MAOI Antidepressant DrugsPhenelzine (Nardil), Tranylcypromine (Parnate),

Isocarboxazid (Marplan)

Side effects

Sedation

Insomnia

Weight gain

Dry mouth

Orthostatic hypotension

Sexual dysfunction

Hypertensive crisis withexcessive tyramine orsympathomimetic drugs

Patient teaching

Follow tyramine-freediet (avoid agedcheeses, aged meats,beer and wine,sauerkraut, soy)

Avoidsympathomimeticdrugs

Use caution whendriving


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Mood Stabilizing DrugsLithium; Anticonvulsant Medications (Carbamazepine-

Tegretol); Valproic Acid (Depakote); Lamotrigine(Lamictal); Gabapentin (Neurontin)

Mood Stabilizing DrugsLithium; Anticonvulsant Medications (Carbamazepine-

Tegretol); Valproic Acid (Depakote); Lamotrigine(Lamictal); Gabapentin (Neurontin)

Uses:

Bipolar disorder

Action: Normalizes the reuptake of certain

neurotransmitters and reduces therelease of norepinephrine


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Mood Stabilizing Drugs (contd)Mood Stabilizing Drugs (contd)

Side effects (lithium)

Nausea

Diarrhea

Anorexia

Fine hand tremor

Polydipsia

Polyuria

Fatigue

Weight gain

Acne

Patient teaching (lithium)

Take with food

Monthly blood levels to bedrawn 12 hours after last dose(maintain therapeutic levelsbetween 0.51.5 mEq/L)


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Antianxiety DrugsBBenzodiazepines; Buspirone (BuSpar)enzodiazepines; Buspirone (BuSpar)

Antianxiety DrugsBBenzodiazepines; Buspirone (BuSpar)enzodiazepines; Buspirone (BuSpar)

Uses:

Anxiety disorders, insomnia, OCD,depression, PTSD, and alcohol

withdrawal Action:

They moderate the actions of GABA


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Antianxiety Drugs (contd)Antianxiety Drugs (contd)

Side effects

Tolerance anddependence

Drowsiness

Sedation

Poor concentration

Impaired memory

Clouded sensorium

Patient teaching

Caution during driving dueto slower reflexes andresponse time

Never discontinueabruptly aswithdrawalcan be fatal

Avoid alcohol


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Stimulant Drugs

Methylphenidate (Ritalin), Pemoline (Cylert),Methylphenidate (Ritalin), Pemoline (Cylert),DextroamphetamineDextroamphetamine (Adderall)(Adderall)

Stimulant Drugs

Methylphenidate (Ritalin), Pemoline (Cylert),Methylphenidate (Ritalin), Pemoline (Cylert),DextroamphetamineDextroamphetamine (Adderall)(Adderall)

Uses:

ADHD, residual ADD in adults, andnarcolepsy

Action:

Cause release of neurotransmitters


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Stimulant Drugs (contd)Stimulant Drugs (contd)

Side effects

Anorexia

Weight loss

Nausea Irritability

Patient teaching

Avoid caffeine, sugar,and chocolate

Take after meals

Longterm-use cancause dependency


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Disulfiram

(Antabuse)

Disulfiram

(Antabuse)

Uses: Aversion therapy for

treatment of alcoholism

Action: Causes an adverse reaction

when alcohol is ingested


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Disulfiram (contd)Disulfiram (contd)

Side effects

Fatigue

Drowsiness

Halitosis

Tremor

Impotence

Patient teaching

Avoid alcohol (includingproducts such as shavingcream, aftershave, cologne,many OTC medications)

Family should neveradminister without theperson's knowledge


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Cultural ConsiderationsCultural Considerations

Ethnic backgrounds influence responses to somepsychotropic medications:

African Americans respond more rapidly toantipsychotic and tricyclic antidepressant medicationsthan do whites and have a greater risk of side effects

Asians metabolize antipsychotic and tricyclicantidepressants more slowly, requiring lower doses to

produce the same effects

Hispanics require lower doses of antidepressants thanwhites to achieve desired effects

Asians and African Americans require lower doses oflithium than whites to produce desired effects


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Self-Awareness IssuesSelf-Awareness Issues

yViewing chronic mental illness as having

remissions and exacerbations, just aschronic physical illnesses do

y Remaining open to new ideas that may

lead to future breakthroughs

y Understanding that medication

noncompliance is often part of the illness,not willful misbehavior

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