chapter 2 psych power point
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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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