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Neurobiologic Theories
Great strides are being made in understanding the brain and mental illness, but much is still unknown; nurses need to keep abreast of developments to provide effective teaching
Limbic system
Spinal cord Nerves that control voluntary acts
Cerebrum
Divided into two hemispheres with four lobes each:
Cerebellum
Receives and integrates information from all body areas to coordinate movement and posture
Brain Stem
Midbrain Pons Medulla oblongata Locus ceruleus Cranial nerve nuclei 3 through 12
Limbic System
Above the brain stem and includes: Thalamus Hypothalamus Amygdala
Neurotransmitters
Chemical substances manufactured in the neuron to aid in transmission of information
Either inhibitory or excitatory
Neurotransmitters include:
Dopamine (control of complex movements, motivation, cognition, regulation of emotional responses) Norepinephrine (attention, learning, memory, sleep, wakefulness, mood regulation) Epinephrine (flight-or-fight response) Serotonin (food intake, sleep, wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions)
Neurotransmitters include:
(contd)
Histamine (alertness, control of gastric secretions, cardiac stimulation, peripheral allergic responses) Acetylcholine (sleep and wakefulness cycle, signals muscles to become alert) Glutamate (an excitatory amino acid) GABA (modulates other neurotransmitters)
Psychopharmacology
Psychopharmacology and medication management are important in the treatment of many mental illnesses. Principles that guide the use of medications include:
Antipsychotic Drugs
Uses:
Schizophrenia, acute mania, psychotic depression, drug-induced psychosis, other psychotic symptoms Action:
Treat psychotic symptoms, such as delusions and hallucinations, by blocking dopamine receptors
Adhering to medication regimen Reducing sugar and caloric intake Clozaril Weekly WBC monitoring
Agranulocytosis (Clozaril)
Nausea
Antidepressant Drugs
SSRIs; TCAs; MAOIs
Uses: Major depression, panic disorder and other anxiety disorders, bipolar depression, psychotic depression
Action:
Interact with the monoamine neurotransmitter systems in the brain, particularly the neurotransmitters norepinephrine and serotonin
fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro) Patient Teaching Take in the morning Take with food
Akathisia
Nausea Insomnia
imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), doxepin (Sinequan), clomipramine (Anafranil) Side Effects Patient Teaching Anticholinergic (blurred vision, urinary retention, dry mouth, constipation) Orthostatic hypotension Sedation Weight gain Tachycardia Sexual dysfunction Taking in the evening Using caution when driving
phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) Patient Teaching Following tyramine-free diet (avoid aged cheeses, aged meats, beer and wine, sauerkraut, soy) Avoiding sympathomimetic drugs Using caution when driving
Weight gain
Dry mouth Orthostatic hypotension
Sexual dysfunction
Hypertensive crisis with excessive tyramine or sympathomimetic drugs
lithium; anticonvulsant medications (carbamazepine (Tegretol), valproic acid (Depakote), lamotrigine (Lamictal), gabapentin (Neurontin)
Uses:
Bipolar disorder Action: Act on the neurotransmitters of the brain
Mood-Stabilizing Drugs
Side Effects (Lithium) Nausea Diarrhea Anorexia Fine hand tremor Polydipsia Polyuria Fatigue Weight gain Patient Teaching (Lithium) Taking with food Having monthly blood levels drawn 12 hours after last dose (maintain therapeutic levels between 0.51.5 mEq/L)
Acne
Antianxiety Drugs
Uses:
Anxiety disorders, insomnia, OCD, depression, PTSD, alcohol withdrawal
Action:
Moderate the actions of GABA
Antianxiety Drugs
Side Effects
Tolerance and dependence Drowsiness Sedation Poor concentration Impaired memory Clouded sensorium Patient Teaching Using caution during driving due to slower reflexes and response time
ADHD, residual ADD in adults, and narcolepsy Action: Cause release of neurotransmitters
Stimulant Drugs
Side Effects Anorexia Weight loss Patient Teaching Avoiding caffeine, sugar, and chocolate Taking after meals Long-term use can cause dependency
Nausea
Irritability
Disulfiram
Antabuse
Uses:
Disulfiram
Side Effects Fatigue Drowsiness Patient Teaching Avoiding alcohol (including products such as shaving cream, aftershave, cologne, many OTC medications) Family should never administer without the person's knowledge
Halitosis
Tremor Impotence
Cultural Considerations
Ethnic backgrounds influence responses to some
psychotropic medications:
African Americans respond more rapidly to antipsychotic and tricyclic antidepressant medications than do whites and have a greater risk of side effects Asians metabolize antipsychotic and tricyclic antidepressants more slowly, requiring lower doses to produce the same effects Hispanics require lower doses of antidepressants than whites to achieve desired effects Asians and African Americans require lower doses of lithium than whites to produce desired effects
Self-Awareness Issues