Mental Health: Brain, Neurotransmitters and Genetics

- Cerebrum
- Cerebellum
- Brain Stem
- Limbic System

- Frontal
- Parietal
- Temporal
- Occipital

- Coordinates movements and body posture
- Receives information from all areas of the body

- Midbrain
- Pons
- Medulla Oblongata

Major respiratory and cardiovascular center

- Thalamus
- Hypothalamus
- Hippocampus
- Amygdala

1) Messages pass from dendrites of sending neuron
2) Moves through cell body
3) Down the axon
4) Across the synapses as neurotransmitters
5) To the dendrites of the receiving neuron

A chemical substance that aids in the transmission of information throughout the body.

- Excitatory: Stimulate an action
- Inhibitory: Stop an action

- Excitatory
- Pleasure

- Excitatory
- Concentration

- Inhibitory
- Mood

- Either excitatory or inhibitory
- Learning

- Excitatory
- Memory

- Inhibitory
- Calming

- Computer tomography (CT)
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
- Single-photon emission computed tomography (SPECT)

- Use of radioactive substances
- Cost
- Claustrophobia
- Changes in the molecular level cannot be visualized

1. Genetics and heredity
2. Stress and the immune system
3. Infection

There is a genetic component to mental disorders

- The immune system can specifically influence neurotransmitters and their activity
- Compromised immune system is known to contribute to a variety of illnesses

it is under investigation as a possible cause

- Antipsychotics
- Antidepressants
- Mood Stabilizers
- Anxiolytics
- Stimulants

The maximal therapeutic effect that a drug can achieve

The amount of drug needed to achieve the maximum effect, or efficacy

The amount of time it takes for half of a drug to be removed from the bloodstream

When an FDA-approved drug is effective and prescribed for a disease that differs from the one involved in the original testing and FDA approval

Issued by the FDA when a drug is found to have serious or life-threatening side effects, even if they are rare

1. Medication selected based on effect on target symptoms
2. Must be given in adequate doses for adequate time
3. Lowest effective dose
4. Older adults require lower doses
5. Tapered off to avoid rebound, recurrence, withdrawal
6. Follow-up is mandatory to ensure compliance, adjust, manage side effects
7. Compliance is increased when regiment is simple

Treatment of the symptoms of psychosis such as delusion and hallucination

- Schizophrenia
- Manic phase of bipolar disorder

- Conventional/ First-Generation
- Atypical/ Second-Generation
- Third-Generation

Block dopamine receptors

Block D2, D3, and D4 receptors

D2

Second-generation because they are weak D2 receptor blockers.

Capsule, tablet, or liquid

- Post-injection delirium/ sedation syndrome
- Causes sedation, confusion, disorientation, agitation, and cognitive impairment that can progress to convulsions, weakness, and hypertension leading to arrest
- Monitor patients for 3 hours after injection

Six

- Extrapyramidal symptoms
- Treated by lowering the dosage, changing to a different antipsychotic, or administering an anticholinergic medication

- Acute dystonia: muscle rigidity and cramping that can lead to more serious complications
- Pseudoparkinsonism: Stiff/stooped posture, masklike face, shuffling gait with small steps, cogwheel rigidity, drooling, course pill-rolling movements.
- Akathisia: Intense need to move about, client is restless and anxious

IM benxtropine mesylate (Cogentin)

- Extrapyramidal Symptoms (EPSs)
- Neuroleptic Malignant Syndrome (NMS)
- Tardive Dyskinesia (TD)
- Anticholinergic Effects

- Potentially fatal reaction to antipsychotic drugs
- Rigidity, high fever, autonomic instability, confusion, elevated enzyme levels such as creatinine phosphokinase

Discontinue the antipsychotic and provide supportive care

- A syndrome of permanent involuntary movements such as unnecessary facial grimacing, lip smacking, and tongue thrusting.
- Irreversible and caused by long-term use of conventional antipsychotics

- Keeping dosage as low as possible
- Change medications
- Monitoring the patient

- Oral: 1-3 mg 2x daily
- IV/IM: 1-2 mg
- Anticholinergic

- Orthostatic hypotension
- Dry mouth
- Constipation
- Urinary retention
- Blurred near vision
- Dry eyes
- Nasal congestion
- Decreased memory

These effects generally reduce in severity w/in 3-4 weeks of beginning treatment, but do not disappear entirely.

- Increased prolactin levels
- Increased weight gain (More common w/ 2nd generation)
- Increased risk of hyperglycemia and diabetes
- Metabolic syndrome: 3 or more of these (obesity, increased BP, high blood sugar, high cholesterol) which can lead to type 2 diabetes and cardiac disease

- Major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, and psychotic depression.
- Off label: Chronic pain, migraines, sleep apnea, panic disorder

Norepinephrine and Serotonin

- Tricyclic Antidepressants (TCAs)
- MAO Inhibitors (MAOIs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Others

- First available and first line treatment
- Serious side effects: sedation, orthostatic hypotension, and anticholinergic effects
- Can be lethal in an overdose

- Do not carry risk of sedation and anticholinergic effects
- Carry risk of severe hypertensive crisis if patient ingests tyramine
- Lethal in overdose

- 1st line treatment of depression
- Equal in efficacy and fewer side effects

- Patients must be assessed for potential suicide risk
- They may feel more energized at the beginning of treatment making them more likely to act on suicidal thoughts
- It may take several weeks for treatment to take its full effect

- Not fully understood
- Primarily interacts with norepinephrine and serotonin

Blocking the reuptake of serotonin, leaving a greater amount circulating within the brain

Blocks the reuptake of norepinephrine, as well as block some reuptake of serotonin​

Interferes with enzyme metabolism

Avoid foods containing tyramine to prevent hypertensive crisis

- Serotonin Syndrome: May occur when the meds are taken concurrently or too close together
- Agitation, sweating, fever, tachycardia, hypotension, rigidity, may progress to coma or death

Treatment of bipolar disorder

- The most established mood stabilizer
- First-line treatment for bipolar disorder​

- Normalizes the reuptake of serotonin, norepinephrine, acetylcholine, and dopamine
- Reduces the release of norepinephrine

- By patient response, as well as carefully monitoring serum lithium levels​
- Serum lithium level should be around 1 mEq/L and monitored weekly while the patient is on their therapeutic dose

- Weight gain and acne may occur later in lithium therapy and lead to noncompliance
- Lithium Toxicity: severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination

STOP lithium immediately​

- Anxiety and anxiety disorders
- Insomnia
- OCD
- Depression
- PTSD
- Alcohol withdrawal​

Anxiolytics

- Benzodiazepines
- Alternative: Buspirone

Mediate the actions of GABA

- Physical dependence and discontinuation symptoms
- CNS depression: drowsiness, sedation, poor coordination, impaired memory​

- Avoid alcohol
- Determine root of anxiety
- Use caution when driving
- Do not abruptly discontinue​

- ADHD in children and adolescents
- Residual ADD in adults
- Narcolepsy

- Methylphenidate (Ritalin)
- Amphetamine (Adderall)
- Dextroamphetamine (Dexedrine)​

- Causes the release of norepinephrine, dopamine, and serotonin from presynaptic nerve terminals
- Blocks the reuptake of these neurotransmitters​

Varies on the child and the medication prescribed​

- Anorexia
- Weight loss
- Nausea
- Irritability​

- Caffeine
- Sugar
- Chocolate

- Causes an adverse reaction when mixed with alcohol
- Used to deter clients from drinking alcohol
- Patient must be motivated to abstain from alcohol and must not be impulsive

- Within 5-10 min of drinking alcohol, the client will produce symptoms such as flushing, headache, sweating, dry mouth, nausea, dizziness​
- Symptoms can last from 30 min to 2 hours

- Client education
- Do not give to clients who are in a state of alcohol intoxication or without the client's full knowledge​

Increase the risk of death in elderly patients with dementia-related psychosis​.

Contraindicated in patients with a known history of QT prolongation, recent MI, or uncompensated heart failure​.

May lengthen the QT interval, leading to life-threatening dysrhythmias or cardiac arrest.

May cause agranulocytosis; need baseline WBCs, weekly throughout treatment, and 4 weeks after discontinuing treatment​.