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124 Cards in this Set
- Front
- Back
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The Nervous System:
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All behavior (movement, thought, sleep) comes from cells in the Nervous System.
The two main divisions are: 1) The Central Nervous System (brain, spinal cord) and 2) the Peripheral Nervous System (nerves to & from brain & spinal cord: cranial nerves, spinal nerves. |
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Peripheral Nervous System:
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2 subdivisions: Somatic & Autonomic
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Somatic Nervous System:
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sends & receives sensory messages that control voluntary movement of the skeletal (striated) muscles.
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Autonomic Nervous System:
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controls involuntary bodily functions of smooth muscles & glands including, digestion, heart rate, breathing.
Primary function is to maintain homeostasis. 2 subsys (Symp & Parasymp) Sympathetic Nervous Sys: mobilizing sys. Fight/Flight, activates hormones, ups respiration, heart rate, BP & slows digestion/elimination (Biof targets) Parasympathetic Nervous Sys: is dominant when relaxed, conserves energy, slows heart rate, BP, respiration & increases digestion/elimination |
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The Central Nervous System:
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consists of spinal cord & brain, w/ sensory (afferent) neurons carrying info into CNS and motor (efferent) neurons carrying info away from the CNS to muscles and glands.
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Spinal Cord:
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divided into 4 regions: Cervical C1 – C7, Thoracic T1 – T12, Lumbar L1 – L5, and Sacral S1. When the spinal cord is damaged muscles don’t function (some reflexes still do) Severing b/t C1 – C5 = quadriplegia, severing at C6, C7 or T1 down = paraplegia. partial sever = paresis (weak)
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The Brain:
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control center for all voluntary & most involuntary behavior
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Cerebrum:
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outer layer = cerebral cortex, inside layer = subcortical areas.
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Cerebral Cortex:
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outer surface of brain, not dev at birth. (hemis & lobes)
Left Hemisphere: is dominant in 97% of people. It controls language for most people, & rational, logical, analytical & abstract thought. Right Hemisphere: involved in visuospatial, perceptual, artistic, musical, intuitive activities & also associated w/ emotion. |
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Frontal Lobes:
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critical to personality, emotionality, inhibition, planning, initiative, abstract thinking, judgment & higher cognitive functions (cognitive flexibility) contains the Motor Control Area, which are located in back of the frontal lobes. Broca’s Area is in the left frontal lobe (controls muscles that produce speech)
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Parietal Lobes:
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just behind frontal lobes. Contain primary sensory areas that process somatosensory info (light touch, pain, heat, proprioception) Gerstmann’s syndrome: lesions (agraphia, acalculia, right-left disorientation, finger agnosia)
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Occipital Lobes:
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houses the Primary Visual Cortex.
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Temporal Lobes:
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contain the Primary Auditory Cortex & the Amygdala & Hippocampus, involved in emotional bx & memory. Contains Wernicke’s area (responsible for thinking about and interpreting language).
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Subcortical Brain Areas:
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center of brain surrounded by the cerebral cortex
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Corpus Callosum:
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bundle of fibers that bridges the two hemispheres making communication possible. Split-Brain = no comm = no verbalizing
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Thalamus:
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below the corpus callosum it serves as a sensory relay center, for all senses (except olfaction) integrates & processes info before sending to approp cortical areas. Critical in pain perception (linked to schizo)
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Hypothalamus:
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below the thalamus it helps w/ homeostasis by regulating the endocrine sys. Involved in temp reg, hunger/thirst, sex, aggression & sleep wake cycle. Also sex hormones (men cycle) & gonads (ovary/testes)
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The Pituitary:
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involved in normal & abnormal growth & releases hormones influences other endocrine glands(thyroid, ovaries, testes, pancreas adrenal)
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The Limbic System:
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group of connected structures involved w/emotional bx (aggression) Hypothalamus, Hippocampus, Amygdala, Septum (calms) Thalamus, Front & Temp Lobes. Kluver-Bucy Syndrome (no amygdala = apathy)
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Cerebellum:
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located at base of the brain behind the brain stem. Involved in smooth movement & coordinating motor activity. It also controls the automatic adjustments of posture that result in our maintaining balance.
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Brain Stem:
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lies below the subcortical regions in front of the cerebellum.
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The Pons & Medulla:
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the Pons is located on the upper part of the brain stem and the Medulla is located on the bottom portion, just above the Spinal Cord. The Pons & Medulla are involved in facial expressions, sleep, (initiation of REM sleep) respiration, movement & cardiovascular activity. Damage can lead to failure of bodily functions or death.
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Reticular Activating System:
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is a diffuse set of cells in the Medulla, Pons, Hypothalamus & Thalamus that serve as a filter for incoming sensory information. Stimulation to this area activates the cortex into a state of alert wakefulness.
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Acetylcholine (Ach):
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the most common NT. Involved in voluntary movement, memory & cog. In Hippocampus, Alzheimer’s = low Ach.
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Catecholamines:
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Dopamine and Norepinephrine.
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Dopamine:
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in Parkinson’s there are low Dopamine levels in the Basal Ganglia b/c of degenerating neurons in the Substantia Nigra.The Dopamine Hypothesis of Schizo: excess Dopamine causes schizo (new antipsychotics disprove)
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Norepinephrine:
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(noradenalin) sig involved in mood, pain perception & sleep. Catecholamine Hypothesis of Affect Disorders (low cats = dep high= mania)
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Serotonin (5-HT):
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sig involved w/ mood disorders & in aggression, sex, sleep onset, pain perception & maybe schizo. Dysregulation of 5-HT linked w/ suicide & assoc impulsivity. Permissive Hypoth of Sero Funct: 5-HT permits mood but Norep up/dn
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The Amino Acids:
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GABA & Glycine inhibit/calm CNS. Low GABA = anx & epileptic seizures (benzo = GABA agonists) Glutamate: fast excitatory synapse transmission (abnorm = schizo) Peptide NT: endorphins: painkillers, reg stress/pain
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The Pituitary:
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“master endocrine gland” b/c it releases hormones that activate other endocrine glands.
Hypopituitarism: kids = dwarfism, pubertal delay. Adults = gonadal failure (infertility) hypothyroidism, diabetes etc… Hyperpituitarism: skeletal overgrowth: acromegaly(post) & gigantism(pre) |
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Thyroid Gland:
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controls metabolism thr secretion of hormone Thyroxin
Hyperthyroidism: weight loss despite inc appetite, heat sensitivity, sweating, diarrhea, tremor, fatigue, agitated depression, insomnia, impaired memory, judgment, hallucinations & delusions Grave’s disease = common Hypothyroidism: weight gain, fatigue, imp. Memory, intellectual funct & sensitivity to cold, myxedematous sx (dry skin, sparse hair, low cardio output) myx madness = personality changes, delusion, hallucination, mania |
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Parathyroid Gland:
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secretes calcitronin (calcium retention)
Hyperparathyroidism: delirium, depression, person changes, psychosis, etc Hypoparathyroidism: neuromuscular sx, personality changes, delirium |
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The Pancreas:
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secretes Insulin. Diabetes Mellitus Type I (juvenile onset or insulin dependent) is more serious than Type II. Tx = dietary control, oral med & Insulin. Kids have control probs. Diabetes Insipidus (med induced).
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Adrenal Cortex:
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secretes corticosteroids involved in using energy resources, inhibition of antibody formation and inflammation. Addision’s disease: undersecretion of cortiosteroids = weakness, depression, stomach probs. Cushing’s disease: Oversecretion = agitated depression, irritability, emotional lability, diff w/ memory & concentration, fattening of face, neck
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Hypoglycemia:
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abnormally low blood sugar (glucose). Sx include hunger, nervousness, fatigue, cold sweats, headache, confusion, rapid heart rate
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Hyperglycemia:
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high blood sugar. Associated w/ diabetes. Sx include increased thirst and urination, dehydration, abdominal pain, nausea, loss of appetite, fatigue and weakness
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Stroke, Trauma, Brain Tumors and other Abnormalities:
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impact depends on specific location (cortical/subcortical & cerebral hemisphere)
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Aphasia:
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language disorder that occurs b/c of lesions in the left hemisphere
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Broca’s Aphasia:
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lesion to the left Frontal Lobe, at the motor strip area which controls the muscles that produce speech. Involves severe probs w/ articulation (dysarthria) making speech slow & effortful (short phrases & long pauses). Comprehension is intact but some probs exist. Probs exist w/ naming objects & repeating phrases. (Expressive or Motor Aphasia)
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Wernicke’s Aphasia:
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lesion to left Temporal Lobe, which causes severe difficulties w/ language comprehension, cannot follow verbal commands or repeat phrases but speak nonsense fluently. They are unaware of the prob & expect others to understand them. (Receptive or Sensory Aphasia)
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Conduction Aphasia:
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lesion b/t expressive & receptive areas. Involves inability to repeat phrases but intact lang comprehension & speech fluency. Like Wernicke’s; speak fluently but makes no sense. They can follow commands & comprehend lang
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One-sided Neglect:
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damage to one side of the brain causes full or partial loss of motor and sensory functioning. (forget to dress one side of body)
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Apraxia:
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inability to enact purposeful motor movements, despite absence of motor/sensory deficits. Caused by left-brain lesion (affects both sides)
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Agraphia:
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impaired writing ability (spelling, word selection, grammar, spatial arrangement) Results from Left hemisphere damage to Frontal lobe, Temporal or Parietal regions and Basal Ganglia.
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Alexia:
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acquired partial or complete inability to read, most commonly b/c stroke to dominant hemisphere. Pure Alexia = visual assoc/temporal damage
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Prosopagnosia:
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inability to recognize familiar faces (retro/anterograde) It is the most common visual agnosia due to damage to visual assoc cortex.
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Anosagnosia:
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lack of awareness of a disability or nature of one’s illness.
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Hydrocephalus:
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excess cerebral spinal fluid (CSF) in brain causing pressure (malabsorb more common) Sx = dementia, urinary probs, unsteady gait
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Dementia:
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Includes impairment in memory, and either (aphasia, apraxia, agnosia, or probs w/ executive functions) Dx made only w/ conclusive medical evidence (2 million in US x3 in 50 yrs, equal w/ men & women)
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Alzheimer’s:
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most common dementia (50%) found more in women. Definitive dx made only w/ autopsy but clinically made w/ consist sx & ruling out all other causes.
Alz has a progressive course: early stage = recent memory probs & irritability, anger. Middle stage = further memory probs & aphasia, agnosia, apraxia & confusion/wandering. Late stage = gait or motor probs, mutism bedridden. Most rapid/relentless course = early onset (Before 65 yo) Considered a cortical dementia (mem, lang, praxis worst) Genetic component (6x) found in hippocampus, amygdala w/ low Ach. |
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Vascular Dementia:
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(10-15%) can coexist w/ Alz. 2x more common in males. Results from numerous CVA (strokes) Onset is younger then Alz w/ abrupt, rapid course, 50% die in 2-3yrs of dx. Primary & 2ndary prvnt, Lifestyle chng/aspirin
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Parkinson’s:
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250,000 in US w/ slightly more men affected. Considered a movement disorder (tremor, rigidity, bradykinesia, shuffling) Also psychosis, dementia & depression.
30-50% have dementia (subcortical, affects processing speed & exec functions) Assoc w/ neuron degeneration in Substantia Nigra (Basal Ganglia: regs voluntary movement). Decrease in dopamine. L-Dopa used in tx for mvmnt. Depress (50-90%) anti-deps used. |
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Huntington’s Disease (Chorea):
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involves Basal Ganglia due to autosomal dominant gene, affects Ach & GABA. Appears (35-45 yo) offspring have 50% chance. Slow progressive dementia w/psy sx, choreiform movements (jerking of the pelvis, trunk, limbs) athetosis (writhing) & facial grimacing
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Pick’s Disease:
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rare dementia (indistinguishable from Alz) 2x women, peaking in 50-60’s. Affects Frontal & Temporal lobes: inapp bx, euphoria temper, disinhibition, poor impulse control & insight. Memory & language probs common but not apraxias/agnosias. Neurons swell “pick bodies”
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AIDS Dementia:
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AIDS not a disease but loss of immunocompetence. IV drug users fastest growing pop. 10-15% of AIDS sufferers dev. dementia. Cog sx: memory probs, atten/con, lang diff. Motor sx: weakness, poor coord. & gait, jerky eye mvmnt. Bx sx: dep sx/ mood swings, person changes
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Dementia due to Head Trauma:
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most reliable complaint of head trauma is impaired memory. Leading cause of brain injury in children/yng adults.
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Closed Head Injury:
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skull not pierced/crack but short-term loss of consciousness.
Concussions: most common, causes neural dysfunction but not contusion (bruising) retro/anterograde amnesia, Post Concussion Syndrome: irritable, fatigue, headache, dizziness. Contusions: more serious, coup/countercoup injury. May lose conscious for 1 min to 1 hr. If con may be agitated, violent. Discrete Impairment: at site of injury (frontal/ temporal lobe syndromes) = loss insight, planning, irritable, hostile. Diffuse Impairment: general loss of functioning (mental speed, concentration) |
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Delirium:
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(acute confusional state) results from disturbed brain functioning
Ach = prime neurotransmitter . Sx: disturbed consciousness, poor focus & ability to shift/sustain attention & change in cognition or perceptual disturb. Differ from dementia by acute onset, fluctuating course, clouded sensorium Neuro patterns & sleep affected. Causes incl infection, metabolic/endocrine disorders, post-op, sub intox & withdrawl. Tx = Ativan & anti-psychotics |
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Amnestic Disorders:
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2 most common causes are head trauma & Etoh abuse
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Korsakoff’s:
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amnestic syndrome caused by Thiamin (B1) deficiency, most sig prob is anterograde amnesia (bad at paired-assoc lists) some retrograde amnesia & remote memory probs for adult life. confabulation, poor insight, limited spontan. conversation but normal IQ, attention/alertness/ motivation
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Effects of ECT:
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bilateral ECT effects are cumulative but are reversible in 6mo. Retrograde amnesia is the biggest prob in some studies but antero in others. Unilateral thought to affect memory less but inconclusive.
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Pain:
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Melzak & Wall’s Gate Control theory states that pain is caused by open neural gates in the spinal cord but pressure can close gates. Pain management is best done w/ time-contingent rather than pain-contingent tx
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Sleep:
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2 major phases of sleep non-REM (stages 1-4) & REM (rapid eye)
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Stage 1:
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transition b/t wakefulness & sleep, mostly Theta Waves (4-8 hz)
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Stage 2:
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most of sleep spent here. spindle/rhythmical responses (12-16 hz)
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Stages 3 & 4:
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slow Delta Waves (1-2 hz) Sleeper hard to awaken here
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REM sleep:
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after Stage 4, EEG pattern of Stage 1 reappear w/ REM
Sleep stages alternate throughout the night but vary by age & person (newborns 50% REM, 5yo 20-25%, old age 18%) deeper stages b/c less freq in 2nd half of the night as REM dominates. Non-REM = slow heart rate & respiration, & continued muscle tone. REM = high heart rate/respiration but relaxed muscles. NREM is physically restorative, REM psy restores |
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Seizures:
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2 types generalized & partial
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Generalized seizures:
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occur b/c of electrical abnormalities in the brain.
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Tonic Clonic seizures:
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Tonic stage (continuous tension/contraction) Clonic stage (rapid involuntary, alternating muscle contraction & relaxation) Tonic Clonic seizures occur during Grand-Mal Seizures which incl. convulsions & loss of consciousness. After there is headache confusion fatigue amnesia
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Petit Mal seizures:
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or absence seizures occur most in kids & begin before age 5. Last from 1-30 sec; begin w/ brief level of conscious change, then blinking, blank stare, slight mouth twitching. Posture is retained.
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Partial seizures:
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Simple Partial seizures: electrical abnormalities in a focal area of the brain only. Can be small or large (half body) & person usually conscious.
Jacksonian seizures: initial local motor seizure then spreads in brain “marching up a limb” Complex Partial seizures: proceeded by an aura & purposeless bx. Consciousness freq impaired, but full recovery. |
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Tests of Brain Function & Structure:
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PET scan MRI & CAT scan
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PET Scan (Positron Emission Tomography):
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the PET scan is used for demonstrating brain activity or functioning, and shows the functional capacity of a particular region of the brain.
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MRI (Magnetic Resonance Imaging):
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the MRI is used for visualization of brain structure. The MRI is a technique that utilizes radio waves rather than x-rays to see structures within the brain.
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CAT scan (Computerized Axial Tomography:
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the CAT scan is also used for viewing brain structure. The CAT scan results in x-ray like pictures of internal organs that are clearer and more accurate than normal x-rays.
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Typical or Traditional Antipsychotics (Neuroleptics/Major Tranquilizers):
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Chlorpromazine (thorazine)
Haldol (haloperidol) Stelazine (trifluoperazine) Navane (thiothixene) Mellaril (thioridazine) Orap (pimozide) Prolixin (fluphenazine) Loxitane (loxapine) Moban (molindone) Serentil (mesoridazine) Trilafon (perphanazine) |
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Atypical or Novel Antipsychotics:
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Clozaril (clozapine)
Risperdal (risperidone) Zyprexa (olanzapine) Seroquel (quetiapine) Geodon (ziprasidone) Abilify (ariprazole) |
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Antipyschotics: Description & Functions:
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Older antipsychotics are equally effective in tx positive sx but aren’t good w/ negative sx. High potency antipsy require a lower dosage & are less sedating & usually tried first.
Clozaril, Risperidal & Zyprexa are atypicals tried initially are effective w/ both pos & neg sx. Depots neuroleptics are given intramuscularly & last for 2-4 wks (called Haldol decanoate |
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Presumed Mechanism of Action:
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all antipsy are Dopamine antagonists but atypicals are antisertonergic, antiadrenergic, anticholinergic & antihistaminergic
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Disorders Tx w/ Antipsy:
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Disorders Tx w/ Antipsy: Schizo; best outcome w/ late, acute onset, good premorbid funct, no emot blunting, focused delusions, married status, no family hx of schizo. Haldol used to mange Delirium, Brief Psychotic Disorder, Tourette’s, Autism/PDD, Delusional Disorder.
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Side Effects:
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for lower potency antipsy: sedation, anticholinergic sx, orthostatic hypertension, low seizure threshold. For high potency: extrapyramidal sx. Typ = Tardive Dyskinesia. weight gain, sexual.
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Anticholinergic effects:
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dry mouth, constipation, urinary hesitancy, blurred vision, dry eyes, photophobia, nasal congestion, confusion & poor memory.
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Orthostatic Hypertension:
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dizziness or lightheadedness on standing up.
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Extrapyramidal effects:
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movement-related sx which are the most damaging of all the antipsy:
Dystonia: acute, painful muscle spasms of the neck, back, tongue, eyes or larynx (pass in 2 wks) Parkinsonism: also pseudo, involves mask-like face, shuffling gait, drooling, resting tremor, rigidity. Persist throughout tx & afflict 12-45% of all clients. Akathisia: most prevalent side-effect & common cause for stopping antipsy. Causes dysphoria, internal agitation, “jitters” rocking & may persist throughout tx (beta-blockers, benzos, anticholinergics lessen) |
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Tardive Dyskinesia:
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abnormal movements of lips, jaw, tongue & limbs & trunk (occurs 6mo after tx, plateaus 3-6 yrs; 50% recover)
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Aganularcytosis:
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occurs w/i hours to 12 wks w/Clozaril, can be fatal; sudden drop in granulocyte count, sore throat/fever.
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Depend/Toler/Wthdwl:
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Antipsy do not cause depend/tol/ addiction. Wthdwl only if high dose stopped suddenly. OD lethal only w/30-60 day dose taken at 1 time.
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Antidepressants: Tricyclics (TCA’s):
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Tertiary Amines:
Elavil (amitryptyline) Anafranil (clomipramine) Tofranil (imipramine) Sinequan (doxepin) Surmontil (trimipramine) Secondary Amines: Vivactil (protriptyline) Asendin (Amoxapine) tetracyclic Pamelor/Aventyl (nortriptyline) Norpramin (desipramine) |
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Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRI’s)
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Prozac (fluoxetine)
Lexapro (escitalopam) Luvox (fluvoxamine) Zoloft (sertraline) Paxil (paroxetine) Celexa (citalopram) |
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Antidepressants: Monoamine-Oxidase Inhibitors (MAOI’s)
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Nardil (phenelzine)
Parnate (tranylcypromine) |
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Other Antidepressants:
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Wellbutrin (bupropion)
Effexor (venlafaxine) Serzone (nefazodone) Remeron (mirtazipine) Ludiomil (maprotiline) Desyrel (trazadone) |
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Presumed Mechanism of Action:
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block reuptake of Norepinephrine and/or Serotonin. MAOI’s inhibit monoamine oxidase, which purges Norep/Sero by reuptake.
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Disorders Tx:
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Major Depression: all classes of antidep appear equally effective in tx “typical depressions.”
SSRI’s have fewer side-effects & now used 1st. Psychotic Deps: tx w/ TCA’s & antipsy. Inpatient, Melancholic, Geriatric Deps: tx w/ TCA’s. Atypical Deps: incr appetite, hypersomnia, rejection sensitivity & profound lack of energy, tx-resistant Dep & Dep w/ Panic Disorder may best tx w/ MAOI’s but SSRI’s might be equally effective. Mild to Moderate Deps: placebo & psychotherapy are equally effective so psy tried 1st. Bipolar Disorder, Dep type: careful tx b/c Tricyclics induce mania 10-15% & SSRI’s do also at much lower rate. Dep w/ Sleep Probs: tx w/ Desyrel (trazadone) or Sinequan (doxepin) b/c hypno effects. Panic Disorder: tx w/Xanax (alprazolam) & Klonopin(clonazepam) & Tofranil (imipramine) or Paxil (paroxetine) or Prozac (fluoxetine) |
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Disorders Tx cont:
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Obsessive-Compulsive Disorder: tx w/ Anafranil (clomipramine) or any SSRI, esp. Prozac.
Chronic Pain Disorders: tx w/ TCS’s: Elavil (amitryptiline), Norpamin (desipramine) & Sinequan (doxepin), unclear if SSRI’s help. Bulimia: antideps most typical tx including: Norpamin (desipramine) & Tofranil (imipramine). SSRI’s are common now esp. Prozac. Premature Ejaculation: tx w/ Anafranil (clomipramine) & Paxil (paroxetine). Other Uses: antideps used for severe bereavement, anorexia nervosa, premenstrual phase dysphoric syndrome, enuresis, childhood sleepwalking or Night Terrors, Dysthymia & BPD. |
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Side Effects:
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Tricyclics: can trigger manic eps & severe anticholinergic sx (confusion, memory probs, dry mouth), sedation, orthostatic hypoten, wgt gain, nausea, sexual dys.
SSRI’s: no antichol. or severe sedation like TCA’s but cause headaches, nervousness, restlessness, insom, sedation, GI distress & sexual dys. New Antideps: naus, head, insom, restless, psychosis, seizure |
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Monoamine Oxidase Inhibitors Side Effects:
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freq cause orthostatic hypotension, weight gain, edema, sexual dysfunction & insom.
Tyramine-Induced Hypertensive Crisis: clients who take MAOI’s must not take foods high in Tyramine b/c they can induce a hypertensive emergency that needs immediate medical attention. Sx include: severe headache, stiff neck, palpitations, sweating, nausea, and vomiting. Tyramine-rich foods include Etoh, fava beans, aged cheese, liver, orange pulp, pickled or smoked fish or meats, packaged soup, yeast, vitamin supplements, meat extracts & dry sausage. Foods moderately taken include: soy sauce, sour cream, bananas, avocados, eggplant, plums raisins, spinach, tomatoes, yogurt. |
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Depend/Tol/Wthdwl:
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Antideps don’t cause depend/tol/addiction. Abruptly stopping can cause non-lethal withdrawal sx.
Both TCA’s & MAOI’s are highly lethal w/ suicidal overdose (esp w/ Etoh). TCA’s aren’t used w/ clients w/ heart conditions, high blood pressure or seizures. |
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Anxiolytics (anxiety reduction):
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Xanax (alprazolam)
Klonopin (clonazepam) Valium (diazepam) Ativan (lorazepam) Librium (chlordiazepoxide) Tanxene (clorazepate) Serax (oxazepam) Paxipam (halazepam) |
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Sedative/Hypnotics (induce sedation/improve sleep):
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Restoril (temazepam)
Prosam (estazolam) Halcion (triazolam) Dalmane (flurazepam) Ambien (zolpidem) Doral (quazepam) Sonata (zaleplon) |
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Presumed Mechanism of Action:
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Benzos enhance GABA’s ability to bind to its receptor site, thus increasing its effects. It is a major inhibitory NT & results in reduced anx, incr sedation, muscle relaxation & seizure reduction.
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Disorders tx:
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Anxiety disorders: Benzos use w/ tx anx is limited b/c of abuse potential & dependence (usually rx’d short-term). Should consider other causes of anx (hyperthyroidism, stroke, myocardial infarct, asthma, peptic ulcer) drugs (CNS stims: coke, meth, pseudoephedrine) wthdrwls (benzo, Etoh, opiates, barbiturates) & meds (SSRI, Tricyclics, Antipsys).
Adjustment Disorder: approp when anx is for particular stressor (wedding) use should be limited to 1-2 wks. Panic Disorder w/ or w/o Agoraphobia: Xanax (alprazolam) or Klonopin (clonazepam) except mini-wthdrwl w/ Xanax (antideps 1st choice for LT tx). GAD: Benzos used as needed for acute anx & while other psy approaches initiated (high failure to respond 25-30%) & tolerance & dependence an issue. Buspar often used instead. |
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Disorders tx cont:
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Sleep Probs: Benzos best used for short-term sleep probs (insomnia less than 7 days) & is caused by acute stress or jet lag. Rebound insomnia occurs when d/c & causes prolonged use. Benzos suppress REM & causes REM rebound (vivid disturbing dreams).
Other Disorders: tx w/ Depression & Klonopin (clonazepam) for acute Mania. Benzos tx akathisia & Etoh withdrawal, s/t used as Anticonvulsants (Klonopin), muscle relaxer & adjuncts in anesthesia |
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Side Effects:
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most common is sedation & drowsiness. Mild cog impairment & some amnesia. Ataxia & Depression can occur when dosages are high. When taken w/ Etoh can cause sever drowsiness, paradoxical inhibition & respiratory probs & be fatal.
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Depend/Tol\/Wthdrwl:
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Benzos can cause psy & physio dependence. Diff in how quickly they take effect & half-life (most addictive = rapid onset/short half life, PRN) X-tolerant w/Etoh, Wthdrwl can be fatal (1. tremors, sweat, agitation, 2. hallucinations/panic 3. grand mal seizures) Chronic/acute OD
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Buspar:
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non-benzo anxiolytic. Adv are no sedation, cog impair or wthdrwl. Low potential for abuse/dependence. Buspar effects take 2-4 weeks & no PRN (used w/ GAD, not Panic) Side effects: headaches, nausea, & dizzy.
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Beta Blockers:
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Inderal (propranolol) rx’d for somatic sx of anx, especially social & performance. Also used for drug-induced akathisia, Lithium-induced tremor & Etoh withdrawl. Typically for heart & BP. Well tolerated except sexual dysfnct in 10% males, dizzy, drowsy, short breath, angina, cold hands/feet diff sleep/nightmares. Less common is depression, anx & thought disturbances (non-addictive/no wthdrwl, but OD probs)
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Antihistamines:
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used w/ mild insomnia & EPS sx. Side effects include: sedation, dizzy, low BP. Atarax, Vistaril & Benadryl.
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Barbiturates:
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Strong sedating effects & are much more likely than Benzos to cause addiction & lethal OD.
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Mood Stabilizers: Lithium:
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Eskalith, Eskalith CR Lithane(lithium carbonate)
Cibalith-S Lithobid (lithium citrate) |
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Mood Stabilizers: Anticonvulsants:
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Tegretol (carbamazepine)
Depakene (valproic acid) Neurontin (gabapentin) Lamictal (lamotrigine) Depakote (divalproex) |
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Other Mood Stabilizers:
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Zyprexa (olanipine) for maintenance tx of bipolar disorder
Klonopin (clonazepam) for acute mania Risperidal (resperidone) for acute mania |
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Presumed Mechanism of Action:
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It is theorized that Mood Stabilizers are cell membrane stabilizers & affect a variety of NT’s (action is speculative)
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Disorders tx:
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Bipolar Disorder: Lithium is drug of choice for Bipolar & takes a long time to take effect (1-3 wks for mania; 6-8 wks for dep) so it is usually combined w/ an antipsy (mania) & an antidep. After several months it has a prophylactic effect (half number of mood eps & less severity) used w/ Schizoaffective, Bipolar type. (blood checked every wk, then 3-4x/yr)
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Other Disorders:
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Lithium s/t used w/ antideps in tx-resistant depression & in combo w/ anitpsy for Schizo. Also used w/ Impulse Control disorders (Intermittent Explosive) & part of tx for Cyclothymia & Borderline PD.
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Side effects/Overdose:
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fine hand tremor, gastric distress, wgt gain, polyuria & polydipsia, fatigue & mild cog impair. Neg effects on kidneys, thyroid, heart & skin. Lithium Toxicity: can be fatal; mimics flu sx, incl vomiting, abdom pain, diarrhea, also, severe tremor, ataxia, coma, seizures confusion.
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Depend/Tol/Wthdrwl:
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Lithium doesn’t cause tolerance, addiction, depend or withdrawal & b/c of side effects & Bipolar sx non-compliance is a major issue. It is contraindicated for pre-existing heart disease, thyroid disease, renal damage & pregnancy. Because of its effects on multiple body systems & numerous negative drug interactions clients on Lithium always require close medical supervision.
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Anticonvulsants:
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are typically used when Bipolar disorder doesn’t respond to Lithium or it is otherwise contraindicated. Tegretol (carbamazepine) may be more effective w/ rapid cycling or dysphoric manic episodes. Anticonvulsants are also used to tx Impulse Control disorders (Intermittent Explosive), used occasionally to tx depression. Tegretol (carbamazepine) is the drug of choice for certain neurological chronic pain disorders (Trigeminal neuralgia)
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Side effects:
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carbamazepine mimics Etoh intox; Valporic Acid incl GI distress, sedation tremor. No withdrawal w/ Anticonvulsants
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Stimulants:
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Dexedrine/Spansule (dextroamphetamine)
Ritalin (methylphenidate) Cylert (pemoline) Adderal (amphetamine) Plegine/Prelu-2 (phendimetrazine) Provigil (modafinil) for narcolepsy |
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Mechanism of Action:
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work in several ways to increase the levels & effects of the catecholamines
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Disorders tx:
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used primarily for ADHD in children. Response occurs within 2 days of administration. Stimulants are sometimes used to tx adult ADHD, treatment-resistant depression, treatment-resistant obesity, narcolepsy & chronically medically debilitating conditions (e.g. AIDS, cancer)
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Side effects:
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Stimulants may cause loss of appetite, insomnia, headaches, GI distress (stomach aches, nausea). They may temporarily suppress growth in children & drug holidays are recommended (no drug for weekends or summer vacations).
Other side effects include anxiety, irritability, insomnia & dysphoria, as well as increases in heart rate & BP. Movement disorders s/t occur. Decreased appetite, fatigue & stomach fullness may be signs of liver damage if within several mo of beginning tx. |
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Depend/Tol/Wthdrwl:
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can casue psychological dependence & drug abuse. They have street value as uppers (except Cylert) Also can cause physio dependence & tolerance (esp w/ Narcolepsy) addiction & physical withdrawal.
Withdrawal sx incl. incr appetite, wgt gain, inc sleep, decr energy & rarely paranoia. OD is rarely lethal b/c discrepancy b/t therapeutic dosage & lethal dosage. Most OD’s from illegal drugs, sx incl. agitation, suicidal id, chest pain, hallucin., confusion, dysphoria, delusions |
