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,neurological 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 • Alzheimer’s 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

14. First Major Breakthrough • 1950’s Conventional First Generation Ant psychotics Dopamine Blockage Positive Symptom relief

15. First Generation • Discovered in the 1950’s 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 • 1990’s 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(TCA’s) • 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 O’Neill, 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 levelssignificantly. • Tremor, ataxia, confusion, convulsions. • GI: N&V, 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 client’s life. • Client may choose other forms of treatment

33. Alternative Therapies • Yoga, guided imagery,mindfulness, meditation • Chinese Therapies; acupuncture, acupressure, T’ai 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.