Chapter 2 Terms

Question 1

(1) _____________ are the chemical substances manufactured in the neuron that aid in the transmission of information throughout the body. They either excite or stimulate an action in the cells (2) ( _______ ) or inhibit or stop an action (3) ( ________ ). These (1) ___________ fit into specific receptor cells embedded in the membrane of the dendrite, just like a certain key shape fits into a lock. After (1) ( ____________) are released into the synapse and relay the message to the receptor cells, they are either transported back from the synapse to the axon to be stored for later use (4) (_______) or metabolized and inactivated by enzymes, primarily (5) _________________.

Answer 1

(1) Neurotransmitters
(2) excitatory
(3) inhibitory
(4) reuptake
(5) monoamine oxidase (MAO)

Question 2

Name the Neurotransmitter

Excitatory

Controls complex movements, motivation, cognition; regulates emotional response

Answer 2

Dopamine

• Dopamine is implicated in schizophrenia and other psychoses as well as in movement disorders such as Parkinson disease.
• Antipsychotic medications work by blocking dopamine receptors and reducing dopamine activity.

Question 3

Name the Neurotransmitter

Excitatory

Causes changes in attention, learning and memory, sleep and wakefulness, mood

Answer 3

Norepinephrine (noradrenaline)

• Excess norepinephrine has been implicated in several anxiety disorders; deficits may contribute to memory loss, social withdrawal, and depression.
• Some antidepressants block the reuptake of norepinephrine, while others inhibit MAO from metabolizing it.

Question 4

Name the Neurotransmitter

Excitatory

Controls fight or flight response

Answer 4

Epinephrine (adrenaline)

Epinephrine has limited distribution in the brain but controls the fight or flight response in the peripheral nervous system.

Question 5

Name the Neurotransmitter

Inhibitory

Controls food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions

Answer 5

Serotonin

• Serotonin plays an important role in anxiety, mood disorders, and schizophrenia.
• It has been found to contribute to the delusions, hallucinations, and withdrawn behavior seen in schizophrenia.
• Some antidepressants block serotonin reuptake, thus leaving it available longer in the synapse, which results in improved mood.

Question 6

Name the Neurotransmitter

Neuromodulator

Controls alertness, gastric secretions, cardiac stimulation, peripheral allergic responses

Answer 6

Histamine

• The role of histamine in mental illness is under investigation.
• Some psychotropic drugs block histamine, resulting in weight gain, sedation, and hypotension.

Question 7

Name the Neurotransmitter

Excitatory or inhibitory

Controls sleep and wakefulness cycle; signals muscles to become alert

Answer 7

Acetylcholine

Question 8

Name the Neurotransmitter

Neuromodulators

Enhance, prolong, inhibit, or limit the effects of principal neurotransmitters

Answer 8

Neuropeptides

Question 9

Name the Neurotransmitter

Excitatory

Results in neurotoxicity if levels are too high

Answer 9

Glutamate

Question 10

Name the Neurotransmitter

Inhibitory

Modulates other neurotransmitters

Answer 10

γ-Aminobutyric acid (GABA)

Gamma-aminobutyric acid (γ-aminobutyric acid, or GABA), an amino acid, is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep.

Question 11

How can a MRI assist in diagnosing schizophrenia?

Answer 11

cortical thickness

persons with schizophrenia can have as much as 7% reduction in cortical thickness.

Question 12

How can a PET assist in diagnosing schizophrenia?

Answer 12

• Some persons with schizophrenia demonstrate decreased cerebral blood flow.
• A recent breakthrough is the use of the chemical marker FDDNP with PET to identify the amyloid plaques and tangles of Alzheimer disease in living clients; these conditions previously could be diagnosed only through autopsy.

Question 13

The major action of all antipsychotics in the nervous system is to ____________

Answer 13

block receptors for the neurotransmitter dopamine

Question 14

➔ WARNING - Atypical Antipsychotics

Answer 14

Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk for death. Causes of death are varied, but most appear to be either cardiovascular or infectious in nature.

Question 15

The major side effects of antipsychotic drugs

Answer 15

Extrapyramidal side effects

First-generation antipsychotic drugs cause a greater incidence of EPSs than do second-generation antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPSs

Question 16

Extrapyramidal symptoms (EPSs)

Answer 16

acute dystonia, pseudoparkinsonism, and akathisia

Question 17

Acute dystonia

Answer 17

• Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.
• Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as haloperidol and thiothixene.
• Immediate treatment with anticholinergic drugs, such as intramuscular benztropine mesylate (Cogentin) or intramuscular or intravenous diphenhydramine (Benadryl), usually brings rapid relief.

Question 18

Torticollis

Answer 18

Spasms or stiffness in muscle groups can produce torticollis (twisted head and neck)

Question 19

opisthotonus

Answer 19

opisthotonus (tightness in the entire body with the head back and an arched neck)

Question 20

oculogyric crisis

Answer 20

oculogyric crisis (eyes rolled back in a locked position)

Question 21

Drug-induced parkinsonism (pseudoparkinsonism)

Answer 21

• Symptoms resemble those of Parkinson disease and include a stiff, stooped posture; masklike facies; decreased arm swing; a shuffling, festinating gait (with small steps); cogwheel rigidity (ratchet-like movements of joints); drooling; tremor; bradycardia; and coarse pill-rolling movements of the thumb and fingers while at rest.
• Parkinsonism is treated by changing to an antipsychotic medication that has a lower incidence of EPS or by adding an oral anticholinergic agent or amantadine, which is a dopamine agonist that increases transmission of dopamine blocked by the antipsychotic drug.

Question 22

Akathisia

Answer 22

• Akathisia is reported by the client as an intense need to move about. The client appears restless or anxious and agitated, often with a rigid posture or gait and a lack of spontaneous gestures. This feeling of internal restlessnessand the inability to sit still or rest often leads clients to discontinue their antipsychotic medication.
• Akathisia can be treated by a change in antipsychotic medication or by the addition of an oral agent such as a beta-blocker, anticholinergic, or benzodiazepine.

Question 23

Neuroleptic malignant syndrome (NMS)

Answer 23

• Neuroleptic malignant syndrome (NMS) is a potentially fatal idiosyncratic reaction to an antipsychotic (or neuroleptic) drug.
• The major symptoms of NMS are rigidity; high fever; autonomic instability such as unstable blood pressure, diaphoresis, and pallor; delirium; and elevated levels of enzymes, particularly creatine phosphokinase. Clients with NMS are usually confused and often mute; they may fluctuate from agitation to stupor.
• Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS. Treatment includes immediate discontinuance of all antipsychotic medications and the institution of supportive medical care to treat dehydration and hyperthermia until the client’s physical condition stabilizes. After NMS, the decision to treat the client with other antipsychotic drugs requires full discussion between the client and the physician to weigh the relative risks against the potential benefits of therapy.

Question 24

Tardive dyskinesia (TD)

Answer 24

• Tardive dyskinesia (TD), a syndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs
• The symptoms of TD include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. After it has developed, TD is irreversible, although decreasing or discontinuing antipsychotic medications can arrest its progression. Unfortunately, antipsychotic medications can mask the beginning symptoms of TD; that is, increased dosages of the antipsychotic medication cause the initial symptoms to disappear temporarily. As the symptoms of TD worsen, however, they “break through” the effect of the antipsychotic drug.
• Preventing TD is the primary goal when administering antipsychotics. This can be done by keeping maintenance dosages as low as possible, changing medications, and monitoring the client periodically for initial signs of TD using a standardized assessment tool such as the Abnormal Involuntary Movement Scale

Question 25

Anticholinergic Side Effects

Answer 25

Anticholinergic side effects often occur with the use of antipsychotics and include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, and decreased memory. These side effects usually decrease within 3 to 4 weeks but do not entirely remit. The client taking anticholinergic agents for EPSs may have increased problems with anticholinergic side effects. Using calorie-free beverages or hard candy may alleviate dry mouth, and stool softeners, adequate fluid intake, and the inclusion of grains and fruit in the diet may prevent constipation.

Question 26

Although the mechanism of action of is not completely understood, antidepressants somehow interact with the two neurotransmitters, _____________ , that regulate mood, arousal, attention, sensory processing, and appetite

Answer 26

norepinephrine and serotonin

Question 27

Antidepressants are divided into four groups:

Answer 27

1. Tricyclic and the related cyclic antidepressants 2. Selective serotonin reuptake inhibitors (SSRIs) 3. MAO inhibitors (MAOIs) 4. Other antidepressants such as desvenlafaxine (Pristiq), venlafaxine (Effexor), bupropion (Wellbutrin), duloxetine (Cymbalta), trazodone (Desyrel), and nefazodone (Serzone)

Question 28

Although the MAOIs have a low incidence of sedation and anticholinergic effects, they must be used with extreme caution for several reasons:

Answer 28

* A life-threatening side effect, hypertensive crisis, may occur if the client ingests foods containing tyramine (an amino acid) while taking MAOIs. * Because of the risk of potentially fatal drug interactions, MAOIs cannot be given in combination with other MAOIs, tricyclic antidepressants, meperidine (Demerol), CNS depressants, many antihypertensives, or general anesthetics. * MAOIs are potentially lethal in overdose and pose a potential risk in clients with depression who may be considering suicide