Functions of the Brain Monitor Regulate Initiate and Maintain basic drives Mediate Store/Retrieve Think Language Process
Brain 101 Review• Neurons ▫ Neurotransmitters: Dopamine: fine muscle movement, integration of emotion & thoughts, decision making Norepinephrine: affects mood, fight/ flight response Serotonin: sleep regulation, pain perception, sexual behavior & agression Gamma-aminobutyric acid (GABA): plays role in inhibition, muscle relaxing properties Acetylcholine: role in learning, memory, regulates mood, sexual drive
Anatomy of the brain• Major areas ▫ Brainstem ▫ Cerebellum ▫ Cerebrum ▫ Limbic System: This is the area that is located right above the brainstem which is responsible for controlling emotions
Cheat sheet• Serotonin: Depression or anxiety related• Norepinephrine: Bipolar (deals with flight or fight response), mania, anxiety• Dopamine: Schizophrenic disorders and ADHD• Acetylcholine: Alzheimers related• GABA: Anxiety disorders, Schizophrenia
Psychotropic Drugs• Basic Side Effects for Consideration: ▫ Changes in basic drives ▫ Sleep patterns ▫ Body movement ▫ Autonomic functions The ideal drug would relieve mental disturbance without inducing untoward mental or physical side effects!
On your own:• You may want to review the Brain Imaging Techniques (PET/ MRI/ CT) that are normally used for diagnostics.• Similarly your book describes the visual images that you can expect from the disorders we will be discussing.
Anti-AnxietyBenzodiazepine: binds GABAGABA: Primary inhibitory neurotransmitter in the brain that suppresses the ability of the neurons to fire. This results in CNS depression and reduction in anxiety, skeletal muscle spasms, alcohol withdrawal symptoms and seizures. -KLONOPIN -TRANXENE -VALIUM (diazepam) -ATIVAN (lorazepam) -XANAX (alprazolam)* NOT TO BE TAKEN WITH ALCOHOL & OTHER CNS DEPRESSANTSSide effects: sedation, drowsiness, dizziness, coordination problems BUSPAR (not a CNS depressant) ; has less sedative properties, much better tolerated than most benzos, no addictive potential
Bipolar DisorderManic Phase Drugs:Lithium-action is not fully understood but alters multiple neurotransmitters to normalize transmission of norepinephrine, dopamine, serotonin, acetylcholine*Lithium monitor for toxicity >2.5 can lead to death.ANTIEPILEPTIC DRUGS: Depakote (Divalproex)-alters GABA mediated neurotransmission Tegretol-anticonvulsant
Bipolar (con’t)Other Agents Valproate (Depakene)-antiepileptic Lamictal- antiepileptic Neurontin -antiepileptic Topamax- antiepileptic Klonopin (Clonazepam): a benzodiazepine used for anxiety, strong sedating properties; calms rapidly, used w/ Lithium ..however, clients can develop a tolerance and dependence
Typical Antipsychotic Drugs• Blocks attachment of Dopamine (typical)• Typical: phenothiazines becoming obsolete because of side effects and they only target Positive symptoms of Schizophrenia• Thorazine (most sedative)/ Haldol (least sedative)• Two Main Concerns: • The blockage of Dopamine can lead to extrapyramidal side effects such as; parkinsonism, dyskinesia, akathisia, muscle stiffness. • These agents cause severe anticholinergic effects
Atypical Antipsychotics• Binds to Dopamine receptors in the limbic system• Decrease motor side effects• Target positive and negative symptoms of Schizophrenia• Less side effects!!!- Clozapine (can cause agranulocytosis)- Risperidone- Olanzapine and Geodon
Antidepressant Drugs• Typical antidepressants:-Tricyclic (TCA’s)- Elavil- NortriptylineWork by blocking reuptake of norepinephrine and serotoninSide Effects: Anticholinergic in nature, this really affects compliance
Antidepressant Drugs• Selective Serotonin • Monoamine Oxidase Reuptake Inhibitors Inhibitors (MAOIs) (SSRIs) • -Marplan• -Prozac • -Nardil• -Zoloft • -Parnate• -Paxil* Effective yet: How this works: Monoamine*Less anticholinergic effects neurotransmitters are destroyed than TCA’s by the enzyme Monoamine oxidase; MAOI drugs inhibit the* Less sedative than TCA’s enzyme, so that the transmitters can get where they need to be.
Heterocyclic (Novel) Antidepressants• These differ structurally from the TCA’s, SSRI’s, and MAOI’s ▫ Wellbutrin (also used for smoking cessation by inhibiting the nicotinic acetylcholine receptors which cause the addiction) ▫ Effexor ▫ Cymbalta The novel antidepressants act differently because each acts on a different neurotransmitter or group of neurotransmitters