Chapter 2 MH

frontal -> thought, body movement, memories, emotions, moral behavior
parietal -> taste, touch, spatial orientation
temporal -> smell, hearing, memory, emotional expresion
occipital -> language, visual, interpretation such as depth preception
damage to one part of lobe will tell you what issue (temporal = smell or memory issues)

below cerebrum
center for coordination of movements and postural adjustments
reception, integration of information from all body areas to coordinate movement and posture
coordination issues

midbrain -> reticular activating system (motor activity, sleep, consciousness, awareness) and extrapyramidal system
pons -> primary motor pathway
medulla oblongata -> vital centers for cardiac, respiratory function
nuclei for cranial nerves III through XII
locus coeruleus -> norephinephrine producing neuron (stress, anxiety, impulsive behavior)

above brain stem
thalamus -> activity, sensation, emotion
hypothalamus -> temperature regulation, appetite control, endocrine function, sexual drive, umpulse behavior)
hippocampus and amygdala -> emotional arousal, memory

chemical substances which facilitate neurotransmission
important in right proportions to relay messages; studies showing differences in brains of people with some mental disorders
play role in psychiatric illness and psychotropic meidcations, including their actions and side effects

excitatory neurotransmitter
complex movements, motivation, cognition, regulation of emotional response

excitatory neurotransmitter
attention, learning, memory, sleep, wakefulness, mood regulation

excitatory neurotransmitter
fight-or-flight response
adrenaline

excitatory neurotransmitter
too high level = neurotoxicity

inhibitory neurotransmitter
seretonin receptors in brain and gut
food intake, sleep, wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions

major inhibitory neurotransmitter; modulation of others neutrotransmitters

excitatory or inhibitory neurotransmitter
sleep-and-wakefulness cycle; signals muscles to become alert

histamine, neuropeptides

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

use of readioactive substances; expense of equipment; client's inability to tolerate technique
changes in disorders nondetectable with current techniques
MRI -> may have metal plate, people could be clostrophobic, very expensive so usually do based on signs and symptoms

genetics and heredity: play role along with nongenetic factors -> twin, adoption (biologial vs adoptive family memb), and family studies (1st degree relatives vs distant)
psychoimmunology: compromised immune system possibly contributing, especially in genetically at-risk populations, mild encephalitis = severe mental disorder
infections: theories include viruses that alter human genes, viruses during fetal development -> pregnant and get infection can cause child to develop schizophrenia

nature vs nurture

ensure all clients and families are well informed
help distinguish between facts and hypotheses
explain if or how new research may affect client's treatment or prognosis
provide information and answer questions

off-label use (drug may be effective for treating a diseease different from one invovled in original testing)
black box warning (serious or life-threatening side effects)

effect on target symptoms
adequate dosage for sufficient time
lowest effective dose
lower doses for older adults
tapering rather than abrupt cessation or avoid rebound, recurrence of symptoms or withdraw
follow-up care
simple regimen to increase compliance

Conventional or first generations (FGA) -> have lots of side effects
Aytpical or second generation (SGA)
Third generation

to treat psychosis symptoms like delusions and hallucinations
positive symptoms -> hallucinations and delusions = shouldn't be there but are 1st generation better to treat
negative symptoms -> apathy, lack of pleasure form things- lack of pleasure in anything 3rd generation better to treat

block dopamine receptors

caused by excess dopamine
Extrapyaramidal symptoms (EPS)
Neuroleptic malignant syndrome (NMS)
Anticholinergic side effects

serious neurological symptoms, major side effects of antipsychotic drugs
acute dystonia-> torticollis (next twists), opisthotonus (tightness in entire body w headback and arched neck), oculogyric crisis (eyes rolled back in locked position)
treatment for dystonia -? anticholingeric drugs or diphenhydramine
pseudoparkinsonism-> stooped posturem masklike facies, shuffiling gate)
akathisia-> restlessness, anxiety, agitation

tardive dyskinesia -> permanent involuntary movements
idiosyncratic reaction
later sign

can't see
can't spit
can't pee
can't shit

increased prolactin levels
weight gain (2nd gen drug)
metabolic syndrome
cardiovascular adverse effects
lengthening of QT interval
agranulocytosis

adherence to regimen
management of side effects
thirst / dry mouth -> sugar free candy, liquids)
constipation -> dietary fiber, excercise
sleepiness / drowsiness -> safety measures
actions for a missed does = take dose if within 4 hours of usual time

thioridazine

major depressive illness, anxiety disorders, depressed phase of bipolar disorder, psychotic depression

tricyclic and cyclic compounds -> first med for depression w lots of side effects
selective seratonin reuptake inhibitors (SSRIs)
monoamine oxidase inhibitors (MAOIs)
other antidepressants

precise is not known
major interaction is with monoamine neurotransmitter systems -> norepinephrine and seratonin

SSRIs
no risk of lethal overdose
first 2 weeks need to be very careful bc can become discouraged and tired of waiting to feel better and feel like they can carry out their plan

cyclic compounds
MAOIs

block the reuptake of seratonin
2-3 weeks to be effective

blocks more than just seratonin like norepinephrine
4-6 weeks ot be effective

interfere w enzyme metabolism
goes back in to be recycled
2-4 weeks to be effective

anxiety, agitation, akathisia, nausea, insomia, sexual dysfunction
weight gain

anticholinergic effects
orthostatic hypotension, sedation, weight gain, tachycardia
sexual dysfunction

daytime sedation, insomia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction
hypertensive crisis with foods containing tyramine

sedation, headaches (nefazodone, trazadone)
loss of appetite, nausea, agitation, insomnia (bupropion, venlafaxine_
priapism (trazodone)

can kill you so pt HAS to tell you what else they take
drug interaction with MAOI + SSRI can cause
one drug must clear system before initiation of therapy with other drug

agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia (reflex test overreactive)
coma, death (extreme reactions)

actions for a missed dose = take SSRI up to 8 hours after missed dose, take cyclic within 3 hours of missed dose or omit the day's dose
safety measures -> w suicidal thoughts
dietary resitriction with MAOI -> tyramine causes vadoconstriction and increased bp

cheese
aged meats
italian breads
all tap beers and microbrewery beers
saukraut, soy sauce or soybean
yogurt, sour cream, peanuts (MSG)

treatment of bipolar illness
generally for mania preventing highs and lows

lithium
anticonvulsants

poorly understood
normalizes reuptake of certain neurotransmitters

increase the levels of GABA

inhibit the kindling process

nausea, diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic taste in mouth, fatigue, lethargy

weight gain and acne

severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination

0.6-1.2 mEq/L
must know therapeutic levels
blood drawn when 1st start to make sure in therapeutic range

drowsiness, sedation, dry mouth, burred vision

rash, orthostatic hypotension, agranulocytosis

weight gain, alopecia, hand tremor, hepatic failure

used for migranes
dizziness, sedation, weight loss

periodic monitoring of blood levels, 12hrs after last dose taken
trough = lowest level in blood, peak = at its highest level in blood
taking medications with meals
safety measures

treatment of anxiety and anxiety disorders, obsessive-compulsive disorders (OCD), depression, posttraumatic stress disorder, alcohol withdraw

benzodiazepines = very highly addictive with bad withdrawa
buspirone

mediation of GABA
binds to specific site on GABA receptor
always calms

partial agonist activity at seratonin receptors

physical, psychological deppendence
central nervous system (CNS) depression = everything slows down including breathing
hangover effect
tolerance

safety measures with the driving
avoidance of alcohol = increases CNS depression
avoidance of abrupt discontinuation = rebound anxiety

treatment of attention-deficit / hyperactivity disorder (ADHD) in children and adolescents, residual attention-deficit disorder in adults, narcolepsy

amphetamines

causes release of norepinephrine, dopaine, seratonin presynaptically
block reuptake of neurotransmitters

atomoxetine

anorexia, weight loss, nausea, irritability
growth and weight suppression

drug holiday
having period of time not having to take medications

dose after meals
avoidance of caffeine, sugar, chocolate
proper storage: out of reach of children

aversion therapy for alcoholism

inhibition of enzyme invovled with alcohol metabolism
adverse reaction with alcohol ingestion

fatigue, drowsiness, halitosis, tremor impotence

drug interactions with phenytoin, isoniazid, warfarin, barbiturates, long-acting benzodiazepines

avoidance of alcohol, including common products that may contain it
shaving cream, deodorant, over-the-counter cough preparations

genetic differences rather than racial or ethnic background are likely to cause slower drug metablism
in the future, a person's genes may be linked with th emost efficacious treatment
avoid making assumptions based on race or ethnicity
ask patient about own past experiences
ask about family history with meds

St. John's Wort can interact with SSRIs and cause seratonin syndrome
Kava
Valerian
Ginkgo biloba

clients and families need more than factual information; they need simple and thorough explanations
view chrinoic mental illness as having remissions and exacerbations, just as chronic physical illnesses do
remain open to new ideas that may lead to future breakthrough
understand that medication noncompliance is often a result of faulty thinking and reasoning relation to the illness and not willful behavior