Chapter 3

Biological Basis for Understanding Psychiatric Disorders and Treatments

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Maintenance of homeostasis Regulation of autonomic nervous system (ANS)

and hormones Control of biological drives and behavior Cycle of sleep and wakefulness

Function and Activities of the Brain

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Circadian rhythms Conscious mental activity Memory Social skills

Function of the Brain (Cont.)

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Neurons Respond to stimuli Conduct electrical impulses Release chemicals

Neurotransmitters

Cellular Composition of the Brain

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Presynaptic neuron synapse

postsynaptic neuron Transmitter destruction

Enzymes Reuptake

Cellular Composition of the Brain (cont’d)

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Neurons can release more than one chemical at the same time

Neuropeptides Long-term changes in cells

Neurotrophic factors Proteins Gases

Effect of steroid hormones

Neuronal Action

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Brainstem Cerebellum Cerebrum

Organization of the Brain

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Core – Regulates internal organs and vital functions

Hypothalamus – Basic drives and link between thought and emotion and function of internal organs

Brainstem – Processing center for sensory information

Function of Brainstem

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Regulates skeletal muscle Coordination and contraction Maintains equilibrium

Function of Cerebellum

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Mental activities Conscious sense of being Emotional status Memory Control of skeletal muscles – movement Language and communication

Function of Cerebrum

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Structured imaging techniques Computed tomography (CT) Magnetic resonance imaging (MRI)

Functional imaging techniques Positron emission tomography (PET) Single photon emission computed tomography

(SPECT)

Visualizing the Brain

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Environment Genes Altered neurons

Norepinephrine Serotonin Dopamine Glutamate γ-aminobutyric acid (GABA)

Disturbances of Mental Function

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Mechanisms of Action of Psychotropic Drugs

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Benzodiazepines Diazepam (Valium) Clonazepam (Klonopin) Alprazolam (Xanax) Lorazepam (Ativan)

Antianxiety and Hypnotic Drugs

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Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Estazolam (ProSom) Quazepam (Doral)

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Antianxiety and Hypnotic Drugs (Cont.)

Short-acting sedative-hypnotic sleep agents (“Z-hypnotics”) Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta)

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Antianxiety and Hypnotic Drugs (Cont.)

Melatonin receptor agonists Ramelteon (Rozerem) Doxepin (Silenor) Buspirone (BuSpar)

Antianxiety and Hypnotic Drugs (Cont.)

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Tricyclic antidepressants (TCAs) Nortriptyline (Pamelor) Amitriptyline (Elavil) Imipramine (Tofranil)

Antidepressant Drugs

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Selective serotonin reuptake inhibitors (SSRIs) Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Fluvoxamine (Luvox)

Antidepressant Drugs (Cont.)

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Serotonin-norepinephrine reuptake inhibitors (SNRIs) Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta)

Antidepressant Drugs (Cont.)

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Serotonin-norepinephrine disinhibitors (SNDIs) Mirtazapine (Remeron)

Antidepressant Drugs (Cont.)

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Monoamine oxidase inhibitors (MAOIs) Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (EMSAM) Tranylcypromine (Parnate)

Antidepressant Drugs (Cont.)

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Bupropion (Wellbutrin, Zyban) Vilazodone (Viibryd) Trazodone (Oleptro)

Other Antidepressant Drugs

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Lithium Anticonvulsant drugs

Valproate (Depakote, Depakene) Carbamazepine (Tegretol) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax) Oxcarbazepine (Trileptal)

Mood Stabilizers

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First-generation, conventional, typical of standard antipsychotic drugs

Strong antagonists (blocking agents) Bind to D2 receptors

Block attachment of dopamine Reduce dopaminergic transmission

Antipsychotic Drugs

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Antagonists of receptors for Acetylcholine Norepinephrine Histamine

Significant side effects Weight gain Sedation

First-Generation (Conventional) Antipsychotic Drugs (Cont.)

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Produce fewer extrapyramidal side effects (EPS) Target both the negative and positive symptoms Often chosen as first-line treatment

Second-Generation (Atypical) Antipsychotic Drugs (Cont.)

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Dopamine and serotonin blockers

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Second-Generation (Atypical) Antipsychotic Drugs (Cont.)

Clozapine (Clozaril) Risperidone (Risperdal) Quetiapine (Seroquel) Olanzapine (Zyprexa, Zyprexa Relprevv) Ziprasidone (Geodon)

Second-Generation (Atypical) Antipsychotic Drugs (Cont.)

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Paliperidone (Invega) Iloperidone (Fanapt) Lurasidone (Latuda) Asenapine (Saphris)

Second-Generation (Atypical) Antipsychotic Drugs (Cont.)

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Aripiprazole (Abilify) Dopamine stabilizer

Third-GenerationAntipsychotic Drug

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For attention deficit hyperactivity disorder (ADHD) Methylphenidate (Ritalin, also Daytrana, a

transdermal system) Dextroamphetamine (Adderall, Vyvanse) Atomoxetine (Strattera) Intuniv (guanfacine) Kapvay (clonidine)

Other Drugs

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For Alzheimer's disease Tacrine (Cognex) Donepezil (Aricept) Galantamaine (Razadyne) Revastigmine (Exelon) Memantine (Namenda, Namenda XR)

Other Drugs (Cont.)

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Major concerns Potential long-term effects

• Nerve damage• Kidney damage• Liver damage

Possibility of adverse chemical reactions• With other substances• With conventional medications

Herbal Medicine

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1. If a person has decreased circulating levels of GABA, which health problem would be expected?

A. Alzheimer’s disease

B. Parkinson’s disease

C. Anxiety disorders

D. Insomnia

Audience Response Questions

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2. Which neuroimaging technique would reveal problems in the anatomical structure of the brain but not problems in function?

A. CT

B. PET

C. SPECT

Audience Response Questions

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