Lecture 3: Biological Basis of MH and Psych Meds

mental health notes Lecture 3: 1/22 Biological Basis of MH and Psych Meds Function and Activities of the Brain Nervous System Aaintenance of homeostasis Central TS Regulation of wTS and hormones wutonomic TS Control of biological drives and behavior Peripheral TS Cycle of sleep and kaIefulness Conscious mental activity Aemory: Storing and recalling Neurons Social sIills: (nterpersonal relationships Specialized cells that transmit nerve impulses Physiological actions of neurons: Respond to stimuli Neurotransmitters Additional Neurotransmitters Conduct electrical impulses Chemical messengers; may be over 100 Release neurotransmitters Still learning about these and their eNects on the brain and body Neuro-regulation: One of the principal mechanisms for self-regulation of bodily functions wmino-wcid Teurotransmitters Gaba-aminobutyric acid (GABA): Primary inhibitory TM for CTS Psychiatric medications target TM action in the synaptic cleft +seful in medication to reduce an'iety and aggression Glutamate: Principal excitatory TM Monoamine Neurotransmitters Plays role in learning and memory Neuroplasticity Serotonin 5H-)M, (nxuences moodD sleepD hungerD painD aggressionD se'ual behavior Mhe tendency of neuronal structure to modifyD changeD and adapt (nvolved in depression and other mood disorders qelieved to have highest incidence during childhood and young adult years Eopamine 5Ew, Auscarinic wcetylcholine Teurotransmitters Acetylcholine (ACh): (nvolved in movement and neuromuscular activity wssociated kith PSTS Tok Inokn to continue throughout life wNects .ne muscle movementD integration of emotion and thoughtsD decision-maIing (nvolved in ParIinsonLs disease e'B dementia AotivationD learningD attentionD and memory Role of Psychiatric Nurse (nxuences wE)ED process disordersD and mood Patient assessment Stimulates the hypothalamus to regulate hormones Aedication education Torepinephrine 5TU, Baseline Assessment Uvery assessment is paired kith an intervention kithin your scope of practice Erug administration (nxuences moodD attentionD and arousal Aonitoring medication eNects and potential adverse eNects (nvolved in the STS response of .ght-or-xight e'B an'iety wdvocating for pt needsjpreferences )istamine 5), Serves to mediate activity necessary to maintain kaIefulnessD alertnessD and reaction time e'B narcolepsy /inIs kith inxammatory response and stimulates gastric secretion (dentify non-psychiatric diagnoses 5medical illnesses, combined kith psychiatric illness Mry to identify cause of symptoms (dentifying risI factors for non-adherence and korIing kith the treatment team to address them wssess for and record OMCjalternativej complementary remedies Participating in the interdisciplinary coordination of t' (dentify and t' any emerging drug side eNects wssess for and record Inokn allergies Prescriptive authority 5advanced practice, Mechanism of Action Medication Administration HK rights of medication administration Unsure correct doseD using dose schedule based on drug re2uirements Pharmacodynamics: Study of khat drugs do to the body and hok they do it Pharmacokinetics: Aovement of the drug throughout the body Right to refuse: Aaintaining patient as a true collaborator in managing medication regimen Agonist: Aimics eNects of the TM by binding to and stimulating the receptor site Eocumentation Antagonist: )as properties that blocI an TM and reducejobstruct action at its receptor Turse veri.es patient actually skalloks meds Medication Study Strategy Classi.cation: SSR(D STR(D STE(D mood stabilizersD antipsychotic 5and Inok the generations, Primary actions Aa3or adverse eNects Aedication name recognition Jnok F-Z most common Recognize the most high-risI Clozapine (Clozaril): wgranulocytosisD convulsions Lithium (Lithobid): /ok therapeutic inde'D electrolyte imbalance risIs St. John's Wort: Serotonin syndrome Lamotrigine (Lamictal): SVS Antidepressant Medications SSR(s: Selective Serotonin ReuptaIe (nhibitors Wluo'etine 5Prozac, General Antidepressant Principles Aa3or neurotransmitters: Serotonin and norepinephrine Aany also either primarily or secondarily act on EwD wChD and ) Wirst modern antidepressant Sertraline 54oloft, Aost antidepressants taIe minimally ↓- keeIs to achieve full e cacy for any given dose; modifying the brainLs use of serotonin Aay taIe -1F keeIs; purpose and goal of hospitalization Paro'etine 5Pa'il, Aost common eNects: Citalopram 5Cele'a, Escitalopram 5/e'apro, Positive: Mreats depressive and an'iety symptoms Wluvo'amine 5/uvo', Tegative: ~(D se'ualD anticholinergicD and C→ adverse eNects wpproved for OCE use →ortio'etine 5Mrintelli', STR(s: Serotonin Torepinephrine ReuptaIe (nhibitors Aight be more eNectiveD particularly for an'ietyD but have more adverse eNects General Antipsychotic Principles Aa3or neurotransmitter: Dopamine 5blocIade of dopamine, Aay also primarilyjsecondarily aNect H-)MD )D TUD and wCh Venlafaxine 5UNe'or, Eesvenlafa'ine 5Presti2, Duloxetine 5Cymbalta, /evomilnacipran 5Wetzima, STE(s: Serotonin-Torepinephrine Eisinhibitors wntipsychotics generally have a 2uicI onset of actionD regarding sedation and antipsychotic eNects 5usually kithin a fek days, F-↓ keeIs to see ma'imum bene.t Aost common eNects: Positive: Mreatment of psychosis Mirtazapine 5Remeron, Mypically 2uicIer in altering mood Aonoamine O'idase (nhibitors 5AwO(s, Oldest antidepressants; numerous side eNects Isocarboxazid 5Aarplan, Phenelzine 5Tardil, Tegative: SedationD anticholinergic eNects 5constipation,D eNects of Ew reduction in diNerent pathkays of the brain qlocIing EF receptors can lead to involuntary movements and motor abnormalities Inokn as e'trapyramidal symptoms 5EPS, (nvolves the nigrostriatial pathkays qlocIage of Ew G * pituitary secretion of prolactin Eietary restrictionsD prevent )MT crisis Selegiline 5UASwA, wntagonizing TU G →asodilationD & BP qlocIing ) receptors G Sedation and weight gain Tranylcypromine 5Parnate, Mricyclic wntidepressants 5MCws, Aany used outside of psychiatry 5e'B migraines,D but many side eNect risIsB Tot generally recommended in older adults or for patients kith C→ concernsB Tortriptyline 5Pamelor, Antipsychotic Medications Mypical wntipsychostics 5Wirst ~eneration, Amitriptyline 5Ulavil, Strong dopamine antagonists (mipramine 5Mofranil, qind to D2 receptorsD blocI attachment of EwD & dopaminergic transmission Others wntagonizes receptors for wChD TUD and ) Buproprion 5↑ellbutrinj4yban,: Torepinephrine and dopamine Aild amphetaminejstimulant Mrazodone 5EesyrelD Oleptro,: Serotonin Aost common eNects: Positive: Mreats psychosisD maniaD aggressionD sedation Sedation lokers aggression in a psychotic state Often used for sleep but acts as an antidepressant at higher doses Tegative: U'trapyramidal eNects 5w(AS scale,D keight gainD sedation qoth inhibit reuptaIe and act as an agonist at certain receptor sites e'B xuphenazine 5Proli'in,D haloperidol 5)aldol,D chlorpromazine 5Mhorazine, qre'anolone: wtypical wntipsychotics 5Second and Mhird ~eneration, wpproved for post-partum depression Dopamine and serotonin antagonists wlso blocI receptors for ) and muscarinic receptors 5wCh, Produce fewer e'trapyramidal side eNects 5EPS, wIathisiaD parIinsonismD tardive dysIinesia General Mood Stabilizer (Anticonvulsants) Principles Aa3or neurotransmitters: )ypothetical action glutamate andjor GABA Other possible AOw: wlter electrical conductivity in membranes Possibly through voltage sensitive sodium channels Mhought to be altered in mood destabilization disorders 5e'B qPwE, wnticonvulsants have varying applicability to psychiatry Some are more eNective mood stabilizersD others are mild Aost common eNects: Margets both negative and positive symptoms Tegative: Removes from baseline 5e'B cognitive sloking, Positive: Adds to baseline 5e'B hallucinations, Often chosen as Orst-line treatment Aost common eNects: Positive: Mreats psychosisD maniaD bipolar depressionD sedation Tegative: Aetabolic side eNects 5e'B keight gain and q~ issues,D sedationD elevated prolactinD loker but potential for UPS Second generation: Positive: Aood stabilizationD raises seizure threshold wsenapine 5SaphrisjSecuado, Tegative: MremorD sedation Clozapine 5Clozaril, 99 Causes agranulocytosisD monitor neutrophils (loperidone 5Wanaptj4omaril, Anticonvulsant Medications →alproate and →alproic wcid 5Depakote, /evel and CqC monitoring Aay be easier to monitor than lithium (ncreases serum levels of lamotrigine 5SVS risI, Tegative eNects: MremorD keight gainD sedationD hepatic failureD teratogenicity /umateperone 5Caplyta, /urasidone 5/atuda, Qlanzapine 54ypre'a, Paliperidone 5(nvega, Risperidone 5Risperidal, uetiapine 5Sero2uel, 4iprasidone 5~eodon, Mhird generation: /amotrigine 5Lamictal, Wirst-line treatment for bipolar depression Aripiprazole 5wbilify, Tot eNective to treat acute mania Cariprazine 5→raylar, MaIes keeIs to months to taIe eNect qre'iprazole 5Re'ulti, Aonitor for SVS 99 /umateperone 5Caplyta, Report changes in sIin Aodulates glutamate and aspartate Tegative eNects 5typically at higher doses than used in psychiatry,: SedationD confusion Others General AnCiolytic/Hypnotic Principles Aa3or neurotransmitter: GABA Tot as eNective Primary inhibitory TM in the CTS Mopirmate 5Mopama', Relatively 2uicI but varying time to onset of action kith varying lengths of action Carbamazepine 5Megretol, (nteracts kith numerous other medications Lithium wll less than F↓ hours Wek long-term bene.tsjnot typically treatment for underlying disorder qetter used in acute instances 5e'B panic attacIs, Mhought to inxuence electrical conductivity by regulating sodium and calcium channelsD alloking it to help kith mood stabilization U'act AOw is unInokn /ithium is a naturally-occurring salt )ypothesized to be bene.cial in loker doses for less acute mood concerns +sed in higher doses in the inpatient setting; must be monitored Aost have addictive potential 5~wqw inhibitionD similar to alcohol, Psychological and physical dependence Aost common eNects: Positive: Reduced an'iety 5an'iolytics,D sedation 5an'iolytics and hypnotics, Tegative: Aotor and cognitive impairmentD amnesiaD disinhibition qPwE: XQ00-1F00 mg 2d Re2uires lab korI before taIingD after startingD and every si' months /ok therapeutic inde' Mrough levels H-" days after dose changes and periodically otherkise Patient education: Stable hydration and salt intaIe 5include J and salt sub, Aay cause hypothyroidism in long-term use AnCiolytic/Hypnotic Medications Buspirone 5quspar, Aedication is uni2ue to the classi.cation of an'iolytics (ncreases serotonin release in presynaptic cell Aost common eNects: Positive: Eecreases an'ietyD may treat se'ual side eNects from antidepressants 5often used alongside,D not addictive Tegative: (ncreased qP and )RD Tj→D )jw Lithium Adverse Exects Tot used as kidely because of higher re2uired doses for therapeutic eNects System Adverse E ects Tervous 7 muscular MremorD ata'iaD confusionD convulsions (ncrease GABA activity Eigestive Tj→jE Aost common eNects: Cardiac wrrythmias Wluid 7 electrolyte PolyuriaD polydipsiaD edema Undocrine ~oiter and hypothyroidism wn'iolytics: Benzodiazepines Positive: Reduced an'ietyD sedation Tegative: /ong-term memoryjcognitive issuesD decreased inhibitionD and motorjcognitive impairment 5similar to alcohol, qenzodiazepines that reduce an'ietyD have anticonvulsant eNectsD rela' muscles Eiazepam 5Valium, Clonazepam 5Jlonopin, omplementary/Alternative Medicine ( AM) oncerns Mreatment and health 6uality Control →ariable sources →ariable bioavailability →ariable absorption Possibility of wdverse Chemical Reactions ↑ith other substances ↑ith conventional medications Patient wssessment 8qesides medication and therapyD khat else are you doing to help relieve your symptoms 8↑here did you learn about those strategies 8 Patient Uducation 8↑here do you get information about your health 8 qe prepared to direct to vetted sources wlprazolam 5?ana', Lorazepam 5wtivan, qenzodiazepines kith WEw approval for t' of insomnia having predominantly hypnotic 5sleep-inducing, eNects Wlurazepam 5Ealmane, Memazepam 5Restoril, Mriazolam 5)alcion, Ustazolam 5ProSom, 6uazepam 5Eoral, )ypnotics: 4-Erugs (ncrease ~wqw activity but no an'iolytic eNect; seem to help kith sleep wddressjtreat underlying cause; 4-drugs are for more acute management Aost common eNects: Positive: Sedation Tegative: wmnesiaD ata'iaD sleepkalIingjeatingjdriving 4olpidem 5Ambien, Only one kith evidence for long-term use 4aleplon 5Sonata, Neuromodulation (nvolves alteration of nerve activity by delivering electrical impulses directly to a target area ECT: Ulectroconvulsive therapy TMS: Mranscranial magnetic stimulation 5not usually inpatient, DBS: Eeep brain stimulation Aay be employed as a means to address psychiatric disorders Uszopicione 5Lunesta,