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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 change in cerebral activity Results in behavioral and mental disturbances These are Physiological changes

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Biological Therapy and Psychotropic Medications

A Biological Approach to

Psychiatric Illness

Mary Vercoutere, RN, MSN


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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.


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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


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Combined Therapy

  • Pharmacological

  • Psychotherapy


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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


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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.


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Major Neurotransmitters

  • Dopamine

  • Norepinephrine

  • Serotonin (5HT)

  • Histamine, GABA, others

  • An abnormal neurotransmitter activity,

    too much or not enough can cause a mental disorder.


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Neurotransmitters

  • Destruction & Reuptake

  • Neuropeptides : long term effects

  • Inhibition/Stimulation


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Neurotransmitters

  • Neuronal communication effects growth, shape, activity of presynaptic cells in utero.

  • External influences in life.


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Higher Brain Functions

  • RAS ( reticular activating system

  • Limbic System


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Brain Imaging

  • Usefulness in psychiatry

  • Schizophrenia

  • Obsessive Compulsive Disorder

  • Alzheimer’s Disease


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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


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First Major Breakthrough

  • 1950’s Conventional

    First Generation Ant psychotics

    Dopamine Blockage

    Positive Symptom relief


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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


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Antipsychotics

  • Side Effects due to antagonist effect on dopamine leads to motor abnormalities:

  • Parkinsonian

    Akinesia

    Akathisia

    Dyskinesia

    Tardive Dyskinesia

    Neuroleptic Malignant Syndrome (NMS)


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AIMS

  • Abnormal Involuntary Movement Scale for facial, extremity and trunk movement.

    See page 411 in Varcarolis

  • Extra pyramidal side effects ( EPS)

  • Tardive Dyskinesia (TD)


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Antipsychotics

  • Alpha-1 agonists: orthostatic hypotention

  • Muscarinic blockage

  • Blurred vision

  • Dry mouth

  • Constipation

  • Urination difficulty


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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.


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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.


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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.


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Other Atypicals

  • Seroquel

  • Zyprexa

  • Geodone

  • Abilify


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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


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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


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Antidepressants

  • Selective serotonin reuptake inhibitors (SSRI)

  • Prozac

  • Zoloft

  • Paxil

  • Celexa

  • Lexapro

  • Fewer side effects


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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


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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


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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.


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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


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Antiepileptics

  • Membrane stabilizing to reduce mood swings

  • Carbamazepine (Tegretol)-antidepressant and neurologic analgesic

  • Valproic acid (Depakote)-anticonvulsant

  • Lamotrigine (Lamictal)

  • Neurontin, gabapentin, others.


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Anti-manic Medication

  • Valproic Acid (Depakote): treats mania and is preventative against episodes.

  • Need for psychoeducation

  • Supportive environment


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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


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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


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  • 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


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  • 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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