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Biological Therapy and Psychotropic Medications

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Biological Therapy and Psychotropic Medications A Biological Approach to Psychiatric Illness Mary Vercoutere, RN, MSN The Biology of Psychiatric Illness Origin is a ... – PowerPoint PPT presentation

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Title: Biological Therapy and Psychotropic Medications


1
Biological Therapy and Psychotropic Medications
  • A Biological Approach to
  • Psychiatric Illness
  • Mary Vercoutere, RN, MSN

2
The Biology of Psychiatric Illness
  • Origin is a change in cerebral activity
  • Results in behavioral and mental disturbances
  • These are Physiological changes
  • Psychotropic medications are used to treat areas
    of the brain that cause altered mood and thought
    process.

3
The Holistic Approach
  • Whether illness is related to genetics,neurologica
    l factors(changes),drugs, infection, or life
    experience, the resulting changes occur in
  • Memory
  • Mood
  • Thought
  • Sleep cycles,language, basic drives, fluid
    electrolyte balance, others

4
Combined Therapy
  • Pharmacological
  • Psychotherapy

5
Psychiatric Medications
  • Neurons conduct electrical impulses from one end
    of the cell to the other.
  • Presynaptic neurotransmitter release
  • Axon, Dendrite, Synapse
  • Postsynaptic neuron receptors
  • Transmission and reception of electrical activity
    is what influences neuronal response target of
    psychotropics

6
Neurotransmitters and Mental Process
  • Neurotransmitters plays a key role in moving
    information through the brain.
  • Neuron-the nerve cell
  • Synapse-The tiny space between nerve endings of
    neuron on one side and dendrite on the other
  • Neurotransmitter-chemical released by the neuron
    that crosses the synaptic space and has an effect
    on the dendrite.

7
Major Neurotransmitters
  • Dopamine
  • Norepinephrine
  • Serotonin (5HT)
  • Histamine, GABA, others
  • An abnormal neurotransmitter activity,
  • too much or not enough can cause a mental
    disorder.

8
Neurotransmitters
  • Destruction Reuptake
  • Neuropeptides long term effects
  • Inhibition/Stimulation

9
Neurotransmitters
  • Neuronal communication effects growth, shape,
    activity of presynaptic cells in utero.
  • External influences in life.

10
Higher Brain Functions
  • RAS ( reticular activating system
  • Limbic System

11
Brain Imaging
  • Usefulness in psychiatry
  • Schizophrenia
  • Obsessive Compulsive Disorder
  • Alzheimers Disease

12
Psychotropic Drugs
  • Psychotropic Medications reduce many symptoms of
    mental dysfunction. Results are seen in changes
    of emotions and thought process and behaviors.
  • First Generations antipsychotics early
    psychiatric drugs
  • Caused neurologic side-effects as seen in other
    diseases

13
(No Transcript)
14
First Major Breakthrough
  • 1950s Conventional
  • First Generation Ant psychotics
  • Dopamine Blockage
  • Positive Symptom relief

15
First Generation
  • Discovered in the 1950s while researching for
    antihistamines to treat allergies.
  • Reduced psychotic symptoms, especially in
    schizophrenic clients by reducing dopamine.
  • For example they helped correct confusion,
    hallucinations, and delusions positive Symptoms
  • Example phenothiazines, thioxanthenes

16
Antipsychotics
  • Side Effects due to antagonist effect on dopamine
    leads to motor abnormalities
  • Parkinsonian
  • Akinesia
  • Akathisia
  • Dyskinesia
  • Tardive Dyskinesia
  • Neuroleptic Malignant Syndrome (NMS)

17
AIMS
  • Abnormal Involuntary Movement Scale for facial,
    extremity and trunk movement.
  • See page 411 in Varcarolis
  • Extra pyramidal side effects ( EPS)
  • Tardive Dyskinesia (TD)

18
Antipsychotics
  • Alpha-1 agonists orthostatic hypotention
  • Muscarinic blockage
  • Blurred vision
  • Dry mouth
  • Constipation
  • Urination difficulty

19
Atypical Antipsychotics
  • 1990s brought newer drugs target dopamine
    receptors in the limbic system. Results in
    therapeutic effect with less or no motor side
    effects.
  • Additionally works on 5-HT 2 receptors for
    Serotonin.
  • Help both positive and negative symptoms of
    schizophrenia.

20
Clozapine (clozaril)
  • First atypical antipsychotic
  • Major Side effect can cause agranulocytosis
  • by suppressing the bone marrow in 1 of the
    clients.
  • Weekly WBC count necessary for those taking
    Clozapine.

21
Risperidone (Risperdal)
  • Similar to Clozapine in treatment of psychotic
    (positive)symptoms i.e..delusions,hallucinations
  • Agranulocytosis not a SE.
  • High doses can cause motor effects.
  • Hypotension ( not safe for the elderly due to
    fall risk)
  • Sedation.

22
Other Atypicals
  • Seroquel
  • Zyprexa
  • Geodone
  • Abilify

23
Antipsychotics
  • Treating the elderly nursing implications in
    assessment for movement, sedation and
    hypotensive side effects.
  • Basic goals for this population the effects of
    aging.
  • Assess for toxic effects

24
Mood Disorders
  • Depression
  • Antidepressants Typical Tricyclics(TCAs)
  • Elavil,Tofranil, Pamelor.
  • SE blurred vision, dry mouth, tachycardia, and
    constipation
  • Sedation, drowsiness
  • Considerations for the elderly

25
Antidepressants
  • Selective serotonin reuptake inhibitors (SSRI)
  • Prozac
  • Zoloft
  • Paxil
  • Celexa
  • Lexapro
  • Fewer side effects

26
Antidepressants
  • Monoamine oxidase inhibitors (MAOI)
  • Monoamines
  • MAOIs drugs prevent the breakdown of monoamines
    by inhibition of monoamine oxidase
  • Marplan, Nardil
  • Strict dietary restrictions to prevent
    hypertensive crises

27
Mood Disorders
  • Bipolar I disorder
  • Client experiences chronic episodes of mania,
    hypomania, depressive episodes, mixed episodes.
  • Mania includes experience of elevated mood,
    flight of ideas, increased psychomotor
  • activity.
  • Well- known writers Virginia Woolf, Sylvia
    Plath,
  • Eugene ONeill, Ernest Hemingway

28
Lithium
  • Used to treat both the depression and mania.
  • Other names Carbolith, Eskalith, Lithonate.
  • Dangerous SE can occur as toxic level close to
    therapeutic level.
  • Major problem clients take themselves off due to
    unpleasant SE or due to cognitive, behavior
    effects of mania.

29
Side Effects to Lithium
  • Lithium works at the cell membrane level to
    stabilize electrical activity. Changes in fluid
    /electrolytes change blood levels significantly.
  • Tremor, ataxia, confusion, convulsions.
  • GI NV, diarrhea
  • Arrhythmias
  • Polyuria, polydipsia, edema
  • Other

30
Antiepileptics
  • Membrane stabilizing to reduce mood swings
  • Carbamazepine (Tegretol)-antidepressant and
    neurologic analgesic
  • Valproic acid (Depakote)-anticonvulsant
  • Lamotrigine (Lamictal)
  • Neurontin, gabapentin, others.

31
Anti-manic Medication
  • Valproic Acid (Depakote) treats mania and is
    preventative against episodes.
  • Need for psychoeducation
  • Supportive environment

32
Caution in use of Psychotropic Meds
  • Important to evaluate the benefit against the SE
    of all medications. Psychotropics are especial
    dangerous as work in the brain and have CNS
    effects.
  • Can trigger many unwanted sensations, organ
    dysfunctions (heart, liver, etc.), and other
    effect a clients life.
  • Client may choose other forms of treatment

33
Alternative Therapies
  • Yoga, guided imagery,mindfulness, meditation
  • Chinese Therapies acupuncture, acupressure, Tai
    Chi
  • Herbal remedies
  • Support groups, CBT
  • Dietary changes
  • Holistic life-style changes

34
?????????Question?????????
  • Med compliance can be challenging for some
    elderly due to (choose all that apply)
  • a.Cognitive decline is reversible for some
    elderly and meds are not needed.
  • b. Aging changes cause rapid language loss.
  • c. moderate to severe cognitive deficits.
  • d. misreading the label due to poor eyesight

35
????????????Question???????????
  • Common and potentially hazardous side effects of
    the conventional Antipsychotics is
  • a. a blockage of dopamine.
  • b. Arrhythmias and a cardiac event.
  • c. a narrow therapeutic range with frequent
    toxicity.
  • d. Extrapyramidal symptoms and tardive
    dyskinesia.
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