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Prs psychopharm lecture 2

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Reviews several biopsychosocial theories of depression.

Reviews several biopsychosocial theories of depression.

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  • 1. Psychopharmacholog y Lecture 2 – Pharmacodynamics, Pharmacokenetics, Stress and Emotions in the Brain S
  • 2. Pharmacokenetics and PharmacodynamicsS Pharmacokenetics– What the body does to the drug.S Pharmacodynamics – What the drug does to the body.
  • 3. Inside the CellS Biovisions Project HarvardS Research in the biological sciences often depends on the development of new ways of visualizing important processes and molecules. Indeed, the very act of observing and recording data lies at the foundation of all the natural sciences. The same holds true for the teaching and communication of scientific ideas; to see is to begin to understand. The continuing quest for new and more powerful ways to communicate ideas in biology is the focus of BioVisions at Harvard University.S http://multimedia.mcb.harvard.edu/
  • 4. Pharmacokenetics - ADMES Absorbtion (A) – How the body takes in the drug (stomach, lungs, patches, intestines).S Distribution (D) – How the body is transported through out the body.S Metabolism (M) – How the body transforms the medication and for many psychiatric medicaitons this occures in the liver.S Excretion (E) – How the body eleminates the medication.
  • 5. Paxil – Pharmacokenetic Data Bioavailability Completely absorbed from GI, but extensive first-pass metabolism in the liver; Tmax 4.9 (with meals) to 6.4 hours (fasting) Protein binding: 93–95% Metabolism: Extensive, hepatic (mostly CYP2D6-mediated) Half-life: 24 hours (range 3–65 hours) Excretion: 64% in urine, 36% in bile
  • 6. Vingette – George ADMEGeorge is a 75 year old Mexican American came into theclinic with slurred speech and staggering. He recently steppeddown from directing a family run business.George had been treated for difficulty sleeping in the last twoweeks. He reported that the first time he took the medicationhe slept and was “groggy” but felt less anxious.Since that time he reports he was feeling better (no anxiety)but in the last two days he became more and more disorentedand now does not feel safe driving.
  • 7. Neurobiology of Affect Regulation HPA-Axis and ThalamusS Hypothalamus Pituitary Adrenal--axis (HPA- -axis): Is made up of the hypothalamus, pituitary gland, a nd adrenal cortex. Its main task is to mobilize a powerful energetic defense when a person is threatened and to re turn to rest when the threat is gone. The HPA- -axis triggers cortisol secretion.S Thalamus: Is a relay station for the brain. It plays a role in modulating levels of arousal. A damaged thalamus can result in a coma. The thalamus may be the seat of human conscious ness.
  • 8. Neurobiology of Affect Regulation HPA-Axis and ThalamusS Hypothalamus Pituitary Adrenal--axis (HPA- -axis): Is made up of the hypothalamus, pituitary gland, a nd adrenal cortex. Its main task is to mobilize a powerful energetic defense when a person is threatened and to re turn to rest when the threat is gone. The HPA- -axis triggers cortisol secretion.S Thalamus: Is a relay station for the brain. It plays a role in modulating levels of arousal. A damaged thalamus can result in a coma. The thalamus may be the seat of human conscious ness.
  • 9. Thalmus and Hypothalmus
  • 10. HPA AxisHypothalamic pituitaryadrenal axis
  • 11. Neurobiology of Affect Regulation HippocampusS The hippocampus Is found in the medial temporal lobe. S The three major theories used to explain hippocampus functioning are that the hippocampus is involved in: b ehavioral inhibition, declarative memory consolidation, an d sense of place. In those with PTSD hippocampus declines have been noted. S Dissociative Identity Disorder (DID), one study found a 26% decline compared with controls.
  • 12. Neurobiology of Affect Regulation HippocampusS The hippocampus Is found in the medial temporal lobe. S The three major theories used to explain hippocampus functioning are that the hippocampus is involved in: b ehavioral inhibition, declarative memory consolidation, an d sense of place. In those with PTSD hippocampus declines have been noted. S Dissociative Identity Disorder (DID), one study found a 26% decline compared with controls.
  • 13. Hippocampus
  • 14. Neurobiology of Affect Regulation - The InsulaS The insula is a part of the limbic cortex. S The insula has been postulated to be involved in the felt experience of introceptive cues from the body, viscera, app etite, and addiction and plays a role in the integration of bo dy sensation of the primary emotions (such as anger, sadness, happiness, and disgust). S It has connections with the amygdala and the orbital frontal cortex through connections with the thalamus.
  • 15. Insular Cortex
  • 16. Neurobiology of Affect Regulation Cingulate GyrusS The cingulate gyrus is often referred to as the limbic cortex. S At three to nine months of development, the infant grows the ability to modulate social engagement through immobility and w ithdrawing (noradrenalin) and active protection through fight/flight (dopamine), monitors internal and external behavior, attends to mistakes, and modulates behavior for more successful outcomes. S The anterior is discussed here and is related to autonomic homeostasis, reward anticipation; heart rate, decision- making, emotions, and modeling the emotions of others. S It plays a central role in integration of bottom up and top down neural
  • 17. Cingulate Cortex
  • 18. Neurobiology of AffectRegulation: the AmygdalaS The Amygdala is often known as the fear center of the brain.S Although it could be better conceptualized as a smoke detector. It notices changes in the insula, and other limbic structures.S The amygdala is involved in classical conditioning and emotional memory. Likely involved in “flash bulb” memories.
  • 19. Amygdala
  • 20. Neurobiology of Affect Regulation Basal Ganglia… Septal NucleusS Basal Ganglia (BG): Is central to the modulation of movement, emotional set, a nticipation of movement, eye movement, motivation, and reward.S Septal Nucleus: Plays a role in pleasure, relaxation and rest. It has an inhibitory effect of cortisol. In rat pups, a damaged septal nucleus leads to increased aggression and loss of maternal behaviors.
  • 21. Neurobiology of Affect Regulation Basal Ganglia… Septal NucleusS Basal Ganglia (BG): Is central to the modulation of movement, emotional set, a nticipation of movement, eye movement, motivation, and reward.S Septal Nucleus: Plays a role in pleasure, relaxation and rest. It has an inhibitory effect of cortisol. In rat pups, a damaged septal nucleus leads to increased aggression and loss of maternal behaviors.
  • 22. Basal Ganglia
  • 23. Basal Ganglia
  • 24. Neurobiology of Affect Regulation Orbital Frontal CortexS Orbital Frontal Cortex: “emotion and reward” area of the prefrontal cortex. S This is likely the most abstract area of emotional processin g. S It is also the last to mature. S It reaches full maturity in the early twenties. S It is involved in decision making and expectation.
  • 25. Neurobiology of Affect Regulation Orbital Frontal CortexS Orbital Frontal Cortex: “emotion and reward” area of the prefrontal cortex. S This is likely the most abstract area of emotional processin g. S It is also the last to mature. S It reaches full maturity in the early twenties. S It is involved in decision making and expectation.
  • 26. Frontal Cortex
  • 27. Emotion Regulation
  • 28. Brain Structures and Mental HealthS Group Activity.S Devide up into groups.S Look at the brain structures and their functions.S Identify as a group possible menal health conditions that maybe associated with the brain areas and why.
  • 29. Autonomic Nervious System
  • 30. Autonomic Responses
  • 31. Stress Reactions
  • 32. Tracking the Stress Response
  • 33. Receptor Actions
  • 34. Major Areas to AssessS Axis – IIS Substance Abuse/Drug SeekingS Medical ConditionsS Primary and secondary gain.
  • 35. Medical Illnesses ChecklistS Sudden onset “out of the blue”S Older then 55 yrsS PT Taking multiple medicationsS No family hx of similar MH dx.S Hallucinations or illusions (visual)S Looks ill, poor vitals, fever or weekness
  • 36. Role PlaysS Form groups of two.S One person is the clinician, one the client.S You have a 10 min session.S 5 minuet debriefing
  • 37. Closing Questions