Drugs for Psychoses & Degenerative Diseases of the Nervous System

Chapter 10

Introduction • Disorders associated

with emotional, unusual, or bizarre feelings are among the leading causes of mental health problems.

• Will cover behavioral/emotional disorders, mood disorders, and psychoses.

Introduction • Most psychoses have

no identifiable cause and require long-term drug therapy.

• Patients with psychoses often cannot tell what is and is not real.

• Delusions, hallucinations, illusions, disorganized behavior, difficulty relating to others.

Introduction •People with

psychosis are usually unable to function normally in society without lifelong drug therapy and ongoing visits with a healthcare provider.

Mood Stabilizers • is the major psychosis

—characterized by abnormal thoughts and thought processes, disordered communication, withdrawal from other people and the outside environment, and a high risk for suicide.

Mood Stabilizers •Characteristics

include: pg. 150 bulleted▫Delusions—false beliefs

or ideas▫Hallucinations—

experiencing something that is not really there.

▫Paranoia—feeling that someone is “out to get” one

Mood Stabilizers • Several theories—positive and

negative symptoms help determine type of medication.

• Positive—those that add on to normal behavior—hallucinations, delusions, and a disorganized thought or speech pattern.

• Negative—those that subtract from normal behavior—lack of interest, motivation, or responsiveness, and lack of pleasure in daily life

Mood Stabilizers •Antipsychotic

medication attempts to stabilize client with psychoses—AKA neuroleptics

•Conventional antipsychotics

•Atypical antipsychotics

Mood Stabilizers • Conventional antipsychotic—

Table 10.1 pg. 152.• More effective in treating positive

symptoms of schizophrenia• Extrapyramidal side effects—

reduce dose may go away• Neuroleptic malignant syndrome-

rare; with dosages; can be fatal• DP—chlorpromazine (Thorazine)

pg. 154

Mood Stabilizers • Atypical

antipsychotics—Table 10.4 pg. 158

• Treat both positive and negative symptoms of schizophrenia

• Fewer side effects• DP—clorozapine

(Clozaril) pg. 158.

Parkinsons Disease •Parkinsons disease

is a degenerative disorder of the CNS caused by death of neurons that produce the brain neurotransmitter dopamine.

•It is characterized by disturbances of muscle movement.

Parkinsons Disease •Symptoms

include:▫Tremors▫Muscle rigidity▫Bradykinesia▫Postural instability

Parkinsons Disease •Symptoms of

Parkinson’s disease result from dysfunction of Dopamine neurotransmitter between various parts of the brain.

Parkinsons Disease •Drug therapy for

Parkinson’s symptoms focuses mainly on dopamine and acetylcholine.

•Two major drug therapies are levodopa (Larodopa) and benztropine (Cogentin)

Parkinsons Disease •Extrapyramidal

symptoms (EPS)—symptoms where muscles become very rigid because of over-medication with anti-psychotics or by lack of dopamine function in the corpus striatium.

Parkinsons Disease •If Extrapyramidal

symptoms occur in the health care facility—Benadryl may be given

•If untreated can be fatal

Parkinsons Disease • Tardive dyskinesia—a movement disorder

often causing involuntary lip and tongue movements and less frequently causing involuntary movements of the trunk and extremities, is observed in client’s who have been given anti-psychotic drugs for an extended length of time.

• Anticholinergic med’s prescribed concurrently with anti-psychotics to discourage development of tardive dyskinesia or to treat it once it develops.

Parkinsons Disease •Dopaminergic

drugs –table 10.6 pg. 161▫Replace dopamine

or increase its action in the brain

▫Drug Profile Levodopa pg. 163.

Parkinsons Disease •Cholinergic

blocking drugs—Table 10.7 pg. 164▫Block effect of

acetylcholine in CNS

▫Used in clients who cannot tolerate levodopa

▫Drug profile—benztropine (Cogentin)– pg. 164

Alzheimers’s Disease • Alzheimer’s Disease

▫ Diagnosis only on autopsy—amyloid plaques & neurofibrillary tangles present

▫ Loss of cholinergic brain function especially in the hippocampus—an area of the brain responsible for learning and memory.

▫ Symptoms pg. 165

Dementia• Dementia is a progressive

and permanent loss of brain function.

• Two common types of dementia are Alzheimer’s disease and vascular dementia.

• Restorative drug therapies for dementia mainly focus on Alzheimer’s disease because this is the most common type of dementia.

Alzheimer’s Disease • Alzheimers drugs

Table 10.8 pg. 166.• Current medications

result in minor improvement of symptoms

• Attempt to slow memory loss

• Enhance action of acetylcholine in brain

• Drug profile—Aricept pg. 167.

Multiple Sclerosis • MS is an autoimmune

disorder of the CNS.• Antibodies target and

slowly destroy tissues in the brain and spinal cord.

• As tissues are damaged, inflammation of nervous tissue causes demyelination, or the loss of myelin, a fatty material that acts as a protective insulator of nerve fibers.

Multiple Sclerosis • Gradually disrupts the

ability of the nerves to conduct electrical impulses to and from the brain.

• Common s/s: fatigue, heat sensitivity, pain, spasticity (muscle cramps and spasms), cognitive problems, balance and coordination problems, and bowel and bladder symptoms.

Multiple Sclerosis • Two basic strategies

for treating MS.• One approach

attempts to reduce inflammation and prevent attacks on the nervous system.

• The other strategy emphasizes treatments to relieve symptoms.

• Drugs used for MS Table 10.9 pg. 169