- Released from the nerve terminal and one of three things can happen ~ Bind to receptors > Interaction is by chance ~ Inactivated by enzymes ~ Reputake into nerve terminal > Released again > Broken down by monoamine oxidase (MAO)

- Mood disorder diminishing person’s ability to function ~ Tied to decreased serotonin and/or norepinephrine activity - Symptoms are measured but serotonin should be measured instead of ~ Very difficult because it can’t cross the BBB

- Excess serotonin levels ~ Happens most often when combing drugs that increase serotonin levels > TCAS, MAOIS, SSRIs, SNRIs. ~ Some OTC drugs, illegal drugs and dietary supplements can also increase levels. ~ Reaction can be severe resulting in death.

Psychiatric Disorders Flashcards by Dessie Alvarado

Neurotransmitters

Released from the nerve terminal and one of three things can happen
~ Bind to receptors
> Interaction is by chance
~ Inactivated by enzymes
~ Reputake into nerve terminal
> Released again
> Broken down by monoamine
oxidase (MAO)

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Major Depression

Mood disorder diminishing person’s ability to function
~ Tied to decreased serotonin and/or
norepinephrine activity
Symptoms are measured but serotonin should be measured instead of
~ Very difficult because it can’t cross the
BBB

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Major Depression: Antidepressant Drugs

Most drugs related to serotonin or norepinephrine.
~ Norepinephrine and serotonin are
related to mood.
> Many parts of the brain
responsible for mood are
stimulated by both serotonin and
norepinephrine.

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Antidepressant Drugs: Tricyclic Antidepressants (TCAs)

Ex: Elavil
Mechanism
~ Block reputake of norepinephrine and
serotonin
> Increases chance of receptor
binding, enhances effects of
neurotransmitter

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Antidepressant Drugs: Tricyclic Antidepressants (TCAs) Adverse Effects

Many adverse effects.
In addition to effect on norepinephrine and serotonin
~ Block alpha-adrenergic receptors
~ Block cholinergic receptors
(Anticholinergics)
Sexual Dysfunction
~ Overactive serotonin
Alpha-adrenergic Block
~ Receptor activation causes
vasoconstriction.
> Block does not allow
vasoconstriction.
• Orthostatic Hypotension
* Body can’t increase BP =
fainting

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Antidepressant Drugs: Tricyclic Antidepressants (TCAs) Anticholinergic Effects

Blurred Vision
Constipation
Decreased Sweating
Dry Mouth
Throat Irritation
Pupil Dilation
Urinary Hesitancy/Retention

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Antidepressant Drugs: Selective Serotonin Reputake Inhibitors (SSRI)

Ex: Prozac, Laxapro, Zoloft
Mechanism
~ Block reputake of serotonin

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Antidepressant Drugs: Selective Serotonin Reputake Inhibitors (SSRI) Adverse Effects

Fewer than TCAs
~ Don’t block alpha-adrenergic
receptors
~ Not Anticholinergic
Sexual Dysfunction
Nausea/Vomiting
Headache
Restlessness
Anxiety
~ Due to increased serotonin in a
specific part of the brain

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Antidepressant Drugs: Monoamine Oxidase Inhibitors (MAOIs)

Ex: Marplan, Nardil, Parnate
Mechanism
~ Inhibit MAO which increases
availability of serotonin and
norepinephrine
Used most often when TCAs or SSRIs do not work.
Not first line because of adverse effects and food/drug interactions associated with MAOIs.

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Antidepressant Drugs: Monoamine Oxidase Inhibitors (MAOIs) Adverse Effects

Sexual Dysfunction
Alpha-adrenergic
~ Orthostatic Hypotension
Anticholinergic Effects
~ Blurred Vision
~ Constipation
~ Decreased Sweating
~ Dry Mouth
~ Throat Irritation
~ Pupil Dilation
~ Urinary Hesitancy/Retention

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Monoamine Oxidase Inhibitors (MAOIs) Adverse Effects: Hypertensive Crisis

Increased BP from excess norepinephrine (due to it not being broken down because MAO was inhibited)
~ Norepinephrine activates alpha-
adrenergic receptors.
Combining MAOls with TCAs.
Combining with sympathomimetic.
Combining with foods high in tyramine
~ Tyramine increases norepinephrine
release.

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Antidepressant Drugs: Serotonin/Norepinephrine Reputake Inhibitors (SNRIs)

Ex: Cymbalta, Effexor
Mechanism
~ Block reputake of serotonin and
norepinephrine
~ Similar to TCAs but don’t block alpha-
adrenergic receptors and are not
Anticholinergic

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Antidepressant Drugs: Serotonin/Norepinephrine Reputake Inhibitors (SNRIs) Adverse Effects

Sexual Dysfunction
Nausea
Constipation
Headache
Weight Loss
Nervousness
Sweating
Insomnia
Hypertension

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Serotonin Syndrome

Excess serotonin levels
~ Happens most often when combing
drugs that increase serotonin levels
> TCAS, MAOIS, SSRIs, SNRIs.
~ Some OTC drugs, illegal drugs and
dietary supplements can also increase
levels.
~ Reaction can be severe resulting in
death.

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Serotonin Syndrome Symptoms

Hyperthermia
Agitation
Seizures
Tremor
Confusion
Sweating
Tachycardia
Hypertension
Anxiety

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Schizophrenia

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Chronic disturbances of perception, mood and cognitive function

Schizophrenia Cause

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Multiple factors but brain chemistry may be one
Dopamine: Excitatory
~ Efficient Movement
~ Pleasure/Reward
~ Memory
~ Focus
~ Cognition
Serotonin
~ Mood

Schizophrenia: Positive Symptoms

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Exaggeration of normal function
Hallucinations: Experiencing something not present.
~ Sight
~ Sound
~ Taste
~ Smell
Delusions: Strong belief despite evidence to the contrary.
Paranoia: Belief that others are hostile without supporting evidence.
Psychomotor Agitation/Hyperactivity

Schizophrenia: Negative Symptoms

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Diminished normal function
Social/Emotional Withdrawal
Apathy
Loss of Drive
Psychomotor Depression

Schizophrenia: Antipsychotic Drugs - Typical/First Generation

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Ex: Ex. Thorazine, Haldol
Block receptors for dopamine

Schizophrenia: Antipsychotic Drugs - Atypical/Second Generation

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Ex: Abilify
Generally less blocking of dopamine (helps w/ + symptoms)
May increase glutamate levels (helps w/ - symptoms)
~ Glutamate is excitatory to neurons of
the brain
Fewer adverse effects

Schizophrenia: Antipsychotic Drugs Adverse Effects

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Movement Disorders
~ Dystonia
~ Pseudo Parkinsonism
~ Tardive Dyskinesia
Orthostatic Hypotension
~ Alpha-adrenergic receptors are
blocked
Anticholinergic Effects
~ Blurred Vision
~ Constipation
~ Decreased Sweating
~ Dry Mouth
~ Throat Irritation
~ Pupil Dilation
~ Urinary Hesitancy/Retention

Bipolar Disorder

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Mood disorder alternating between periods of major depression and mania
~ Mania
> Elevated Mood
> Unrealistic Optimism
> Hyperactivity
> Decreased Need for Sleep
> Poor Attention
> Poor Judgement
> Hallucinations/Delusions
Antipsychotic drugs are used along w/mood stabilizers to treat mania

Mood Stabilizers: Lithium

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~ Initially used for gout
~ Mechanism (not well understood)
> Appears to decrease the function of
dopamine and glutamate receptors
both at which are excitatory to
neurons

Mood Stabilizers: Lithium Adverse Effects

- Can cause toxicity even at therapeutic levels ~ May result in seizure, coma, or death - Early S&S ~ Nausea ~ Diarrhea ~ Confusion ~ Muscle Weakness ~ Headache ~ Polyuria ~ Polydipsia ~ Fine Hand Tremor

Mood Stabilizers: Valproic Acid

- Initially used for epilepsy. - Just as effective as lithium with fewer adverse effects. - Mechanism (Not well understood) ~ Appears to increase Gamma- Aminobutyric Acid (GABA) levels > GABA is inhibitory to neurons

Mood Stabilizers: Valproic Acid Adverse Effects

- Nausea/Vomiting - Diarrhea - Indigestion - Tremor - Sedation

Mood Stabilizers: Carbamezpine

- Initially used for epilepsy - Mechanism ~ Inhibits neurons > Decreases influx of Na • helps neurons to depolarize = less activity > Inhibits glutamate release

Mood Stabilizers: Carbamezpine Adverse Effects

- Nausea/Vomiting - Diarrhea - Sedation - Confusion - Headache - Blurred Vision - Slurred Speech

Anxiety Disorders

Stressful situation that creates a sense of uncertainty making one fearful or apprehensive.

Anxiety Disorders: Generalized Anxiety Disorder

Excessive and uncontrollable worry about several events or activities.

Anxiety Disorders: Panic Disorder

Sudden onset of fear with racing heart, sweating, dyspnea, chest pain, nausea.

Anxiety Disorders: Social Anxiety Disorder

Fear of social or performance situations.

Drugs for Anxiety Disorders: Benzodiazepine

- Ex: Xanax, Librium, Valium - Mechanism ~ Enhances the action of GABA > Binds to a portion of the GABA receptor and that binding causes changes to the GABA receptor • Makes receptors more sensitive to GABA

Drugs for Anxiety Disorders: Benzodiazepine Adverse Effects

- Physical dependence - Sedation - Amnesia

Drugs for Anxiety Disorders: Buspirone

- Slower acting than benzodiazepine, but fewer adverse effects. ~ Does not cause dependence. - Ex: BuSpar - Mechanism (Not well understood) ~ High serotonin levels in some areas of the brain increase feelings of fear/ anxiety > Appears to block serotonin receptors in these areas

Drugs for Anxiety Disorders: Buspirone Adverse Effects

- Headache - Dizziness

Psychiatric Disorders Flashcards

(37 cards)