Transcript Chapter 003
Chapter 3 Biological Basis for Understanding Psychiatric Disorders and Treatments Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. Function and Activities of the Brain Maintenance of homeostasis Regulation of autonomic nervous system (ANS) and hormones Control of biological drives and behavior Cycle of sleep and wakefulness Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Function of the Brain (Cont.) Circadian rhythms Conscious mental activity Memory Social skills Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Cellular Composition of the Brain Neurons Respond to stimuli Conduct electrical impulses Release chemicals Neurotransmitters Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Cellular Composition of the Brain (cont’d) Presynaptic neuron postsynaptic neuron Transmitter destruction synapse Enzymes Reuptake Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Neuronal Action Neurons can release more than one chemical at the same time Neuropeptides Neurotrophic factors Long-term changes in cells Proteins Gases Effect of steroid hormones Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Organization of the Brain Brainstem Cerebellum Cerebrum Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Function of Brainstem Core – Regulates internal organs and vital functions Hypothalamus – Basic drives and link between thought and emotion and function of internal organs Brainstem – Processing center for sensory information Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Function of Cerebellum Regulates skeletal muscle Coordination and contraction Maintains equilibrium Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Function of Cerebrum Mental activities Conscious sense of being Emotional status Memory Control of skeletal muscles – movement Language and communication Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Visualizing the Brain Structured imaging techniques Computed tomography (CT) Magnetic resonance imaging (MRI) Functional imaging techniques Positron emission tomography (PET) Single photon emission computed tomography (SPECT) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Disturbances of Mental Function Environment Genes Altered neurons Norepinephrine Serotonin Dopamine Glutamate γ-aminobutyric acid (GABA) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 Mechanisms of Action of Psychotropic Drugs Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 Antianxiety and Hypnotic Drugs Benzodiazepines Diazepam (Valium) Clonazepam (Klonopin) Alprazolam (Xanax) Lorazepam (Ativan) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14 Antianxiety and Hypnotic Drugs (Cont.) Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Estazolam (ProSom) Quazepam (Doral) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Antianxiety and Hypnotic Drugs (Cont.) Short-acting sedative-hypnotic sleep agents (“Z-hypnotics”) Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Antianxiety and Hypnotic Drugs (Cont.) Melatonin receptor agonists Ramelteon (Rozerem) Doxepin (Silenor) Buspirone (BuSpar) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 Antidepressant Drugs Tricyclic antidepressants (TCAs) Nortriptyline (Pamelor) Amitriptyline (Elavil) Imipramine (Tofranil) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18 Antidepressant Drugs (Cont.) Selective serotonin reuptake inhibitors (SSRIs) Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Fluvoxamine (Luvox) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19 Antidepressant Drugs (Cont.) Serotonin-norepinephrine reuptake inhibitors (SNRIs) Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20 Antidepressant Drugs (Cont.) Serotonin-norepinephrine disinhibitors (SNDIs) Mirtazapine (Remeron) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 21 Antidepressant Drugs (Cont.) Monoamine oxidase inhibitors (MAOIs) Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (EMSAM) Tranylcypromine (Parnate) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 22 Other Antidepressant Drugs Bupropion (Wellbutrin, Zyban) Vilazodone (Viibryd) Trazodone (Oleptro) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 23 Mood Stabilizers Lithium Anticonvulsant drugs Valproate (Depakote, Depakene) Carbamazepine (Tegretol) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax) Oxcarbazepine (Trileptal) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 24 Antipsychotic Drugs First-generation, conventional, typical of standard antipsychotic drugs Strong antagonists (blocking agents) Bind to D2 receptors Block attachment of dopamine Reduce dopaminergic transmission Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 25 First-Generation (Conventional) Antipsychotic Drugs (Cont.) Antagonists of receptors for Acetylcholine Norepinephrine Histamine Significant side effects Weight gain Sedation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 26 Second-Generation (Atypical) Antipsychotic Drugs (Cont.) Produce fewer extrapyramidal side effects (EPS) Target both the negative and positive symptoms Often chosen as first-line treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 27 Second-Generation (Atypical) Antipsychotic Drugs (Cont.) Dopamine and serotonin blockers Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 28 Second-Generation (Atypical) Antipsychotic Drugs (Cont.) Clozapine (Clozaril) Risperidone (Risperdal) Quetiapine (Seroquel) Olanzapine (Zyprexa, Zyprexa Relprevv) Ziprasidone (Geodon) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 29 Second-Generation (Atypical) Antipsychotic Drugs (Cont.) Paliperidone (Invega) Iloperidone (Fanapt) Lurasidone (Latuda) Asenapine (Saphris) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 30 Third-Generation Antipsychotic Drug Aripiprazole (Abilify) Dopamine stabilizer Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 31 Other Drugs For attention deficit hyperactivity disorder (ADHD) Methylphenidate (Ritalin, also Daytrana, a transdermal system) Dextroamphetamine (Adderall, Vyvanse) Atomoxetine (Strattera) Intuniv (guanfacine) Kapvay (clonidine) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 32 Other Drugs (Cont.) For Alzheimer's disease Tacrine (Cognex) Donepezil (Aricept) Galantamaine (Razadyne) Revastigmine (Exelon) Memantine (Namenda, Namenda XR) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 33 Herbal Medicine Major concerns Potential long-term effects • Nerve damage • Kidney damage • Liver damage Possibility of adverse chemical reactions • With other substances • With conventional medications Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 34 Audience Response Questions 1. If a person has decreased circulating levels of GABA, which health problem would be expected? A. Alzheimer’s disease B. Parkinson’s disease C. Anxiety disorders D. Insomnia Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 35 Audience Response Questions 2. Which neuroimaging technique would reveal problems in the anatomical structure of the brain but not problems in function? A. CT B. PET C. SPECT Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 36