Chapter 2 Psych Power Point

Chapter 2 Neurobiologic Theories and Psychopharmacology
Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Neurobiologic Theories Great strides are being made in understanding the brain and mental illness, but much is still unknown; nurses need to keep abreast of developments to provide effective teaching
Central Nervous System

Consists of: Brain o Cerebrum o Cerebellum o Brain stem o Limbic system Spinal cord Nerves that control voluntary acts
Cerebrum
Divided into 2 hemispheres with 4 lobes each: Frontal lobe (thought, body movement, memories, emotions, moral behavior) Parietal lobe (taste, touch, spatial orientation) Temporal lobe (smell, hearing, memory, emotional expression) Occipital lobe (language, visual interpretation)
Cerebellum
Receives and integrates information from all body areas to coordinate movement and posture
Brain Stem
Midbrain Pons Medulla oblongata Locus ceruleus Cranial nerve nuclei 3 through 12
Limbic System
Above the brain stem and includes: Thalamus Hypothalamus Amygdala
Neurotransmitters
Neurotransmitters (contd)
Chemical substances manufactured in the neuron to aid in transmission of information. Either inhibitory or excitatory
Neurotransmitter Drugs
y Dopamine (control of complex movements, motivation, cognition, regulation of emotional responses) y Norepinephrine (attention, learning, memory, sleep, wakefulness, mood regulation) Epinephrine (flight-or-fight response) y Serotonin (food intake, sleep, wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions)
Neurotransmitter Drugs (contd)

Histamine (alertness, control of gastric secretions, cardiac stimulation, peripheral allergic responses) Acetylcholine (sleep and wakefulness cycle, signals muscles to become alert) Glutamate (an excitatory amino acid) GABA (modulates other neurotransmitters)
Brain Imaging Techniques

Computed tomography (CT) Magnetic resonance imaging (MRI) Positron emission tomography (PET) Single photon emission computed tomography (SPECT) We cannot yet diagnose mental illness with these techniques alone
Axial PET Scan of a Male Patient With Alzheimers Disease
Causes of Mental Illness

Genetics and heredity: play a role but alone do not account for development of mental illness Psychoimmunology: a compromised immune system could contribute, especially in at-risk populations Infections, particularly viruses, may play a role
Psychopharmacology
Psychopharmacology and medication management are important in the treatment of many mental illnesses Approved uses Off-label uses Black box warnings
Principles 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 avoid rebound or withdrawal Follow-up care Simplify the regimen for increased compliance
Antipsychotic Drugs
Conventional onventional Atypical New Generation
Uses: Schizophrenia, acute mania, psychotic depression, drug-induced psychosis, and other psychotic symptoms Action: Treat psychotic symptoms, such as delusions and hallucinations, by blocking dopamine receptors
3 Antipsychotics Available in Depot Injection

Prolixin (decanoate fluphenazine) Duration of 7 to 28 days Haldol (decanoate haloperidol) Duration of 4 weeks Risperidone (Risperdal Consta) Duration of 2 weeks
Conventional Antipsychotic Drugs

Phenothiazines (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 (NMS)
Patient teaching Adhering to medication regimen Managing side effects Thirst Constipation Sedation
Atypical Antipsychotic Drugs

Clozaril, Risperdal, Zyprexa, Seroquel, Geodon
Side effects Fewer EPS Weight gain Agranulocytosis (Clozaril) Patient teaching Adhering to medication regimen Reduce sugar and caloric intake Clozaril Weekly WBC monitoring Discontinue med and seek care at first sign of infection
New Generation Antipsychotic Drugs

Aripiprazole (Abilify)
Side effects Headache Anxiety Nausea
Patient teaching Adhering to medication regimen
Antidepressant Drugs
SSRIs TCAs MAOIs
Uses: Major depression, panic disorder, other anxiety disorders, bipolar depression, psychotic depression Action: Interact with the monoamine neurotransmitter systems in the brain, particularly the neurotransmitters norepinephrine and serotonin
SSRI Antidepressant Drugs

Fluoxetine (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
TCA Antidepressant Drugs

Imipramine (Tofranil), Desipramine (Norpramin), Amitriptyline (Elavil), Doxepin (Sinequan), Clomipramine (Anafranil) Side effects Anticholinergic (blurred vision, urinary retention, dry mouth, constipation) Orthostatic hypotension Sedation Weight gain Tachycardia Sexual dysfunction
Patient teaching Take in the evening Use caution when driving
MAOI Antidepressant Drugs

Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan)
Side effects Sedation Insomnia Weight gain Dry mouth Orthostatic hypotension Sexual dysfunction Hypertensive crisis with excessive tyramine or sympathomimetic drugs
Patient teaching Follow tyramine-free diet (avoid aged cheeses, aged meats, beer and wine, sauerkraut, soy) Avoid sympathomimetic drugs Use caution when driving
Mood Stabilizing Drugs

Lithium; Anticonvulsant Medications (CarbamazepineTegretol); Valproic Acid (Depakote); Lamotrigine (Lamictal); Gabapentin (Neurontin)
Uses: Bipolar disorder Action: Normalizes the reuptake of certain neurotransmitters and reduces the release of norepinephrine
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 be drawn 12 hours after last dose (maintain therapeutic levels between 0.51.5 mEq/L)
Antianxiety Drugs
Benzodiazepines; Buspirone (BuSpar)
Uses: Anxiety disorders, insomnia, OCD, depression, PTSD, and alcohol withdrawal Action: They moderate the actions of GABA
Antianxiety Drugs (contd)

Side effects Tolerance and dependence Drowsiness Sedation Poor concentration Impaired memory Clouded sensorium Patient teaching Caution during driving due to slower reflexes and response time Never discontinue abruptly as withdrawal can be fatal Avoid alcohol
Stimulant Drugs
Methylphenidate (Ritalin), Pemoline (Cylert), Dextroamphetamine (Adderall)
Uses: ADHD, residual ADD in adults, and narcolepsy Action: Cause release of neurotransmitters
Stimulant Drugs (contd)

Side effects Anorexia Weight loss Nausea Irritability Patient teaching Avoid caffeine, sugar, and chocolate Take after meals Longterm-use can cause dependency
Disulfiram (Antabuse)
Uses: Aversion therapy for treatment of alcoholism Action: Causes an adverse reaction when alcohol is ingested
Disulfiram (contd)
Side effects Fatigue Drowsiness Halitosis Tremor Impotence Patient teaching Avoid alcohol (including products such as shaving cream, aftershave, cologne, many OTC medications) Family should never administer without the person's knowledge
Cultural Considerations
Ethnic backgrounds influence responses to some psychotropic medications: African Americans respond more rapidly to antipsychotic and tricyclic antidepressant medications than do whites and have a greater risk of side effects Asians metabolize antipsychotic and tricyclic antidepressants more slowly, requiring lower doses to produce the same effects Hispanics require lower doses of antidepressants than whites to achieve desired effects Asians and African Americans require lower doses of lithium than whites to produce desired effects
Self-Awareness Issues
yViewing chronic mental illness as having
remissions and exacerbations, just as chronic 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

Chapter 2 Psych Power Point

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 2 Psych Power Point

Uploaded by

Copyright:

Available Formats

Chapter 2 Neurobiologic Theories and Psychopharmacology

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Central Nervous System

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Neurotransmitter Drugs (contd)

Brain Imaging Techniques

Axial PET Scan of a Male Patient With Alzheimers Disease

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Causes of Mental Illness

3 Antipsychotics Available in Depot Injection

Conventional Antipsychotic Drugs

Atypical Antipsychotic Drugs

New Generation Antipsychotic Drugs

Side effects Headache Anxiety Nausea

Patient teaching Adhering to medication regimen

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

SSRI Antidepressant Drugs

TCA Antidepressant Drugs

Patient teaching Take in the evening Use caution when driving

MAOI Antidepressant Drugs

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mood Stabilizing Drugs

Mood Stabilizing Drugs (contd)

Antianxiety Drugs (contd)

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stimulant Drugs (contd)

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

You might also like